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CMS Proposes Changes to RoPs, Delay of Some Phase 3 Requirements (Part 1)

The Centers for Medicare & Medicaid Services (CMS) announced a proposed rule, “Medicare & Medicaid Programs; Requirements for Long-Term Care Facilities; Regulatory Provisions to Promote Efficiency and Transparency” on July 17, 2019. The proposed rule would make some changes to the already implemented Requirements of Participation (RoPs) as well as change and delay some of the Phase 3 components which are scheduled to be effective this November. In the next few CMSCG Blog posts, we’ll provide a recap of the proposed changes for each part of the proposed rule. In this post, we will review the proposed changes to Resident Rights, Admission Transfer and Discharges, Bed Rails and Nursing Services.

Residents Rights

Two changes were proposed under the Resident Rights regulatory group:

  • Choice of Attending Physician (F555 Right to Choose/Be Informed of Attending Physician)Proposed to remove language stating that a facility must ensure residents “remain informed” about their attending physician. The revision would require that residents only need to be informed of their primary care physician’s information at admission, when the information changes or the resident requests it.
  • Grievances (F585 Grievances) –
    • Proposed to clarify the difference between “resident feedback” and a grievance to allow a facility to differentiate between general feedback and what is a grievance that would generally require an investigation into an allegation related to quality of care. CMS would still expect the facility to include information in its grievance policy regarding how it determined whether something was a grievance or feedback.
    • Proposed a revision requiring a facility to ensure that any written grievance decisions include “pertinent information” that includes a summary of the findings/conclusions and any corrective actions taken.
    • Proposed to reduce the retention period for grievances from 3 years to 18 months.
    • Additionally, CMS is proposing to remove the specific duties required of a designated grievance official. This would provide facilities with flexibility related to who the grievance official’s responsibilities would be delegated to, including making multiple persons responsible for the grievance process.

Admission, Transfer and Discharge Rights

CMS has proposed that facilities will send a copy of a transfer or discharge notice to the LTC Ombudsman Office only when there is a facility-initiated involuntary transfer or discharge. Currently, all transfer and discharge notices are supposed to be sent to the Ombudsman (F623 Notice Requirements Before Transfer/Discharge).

Quality of Care

CMS has proposed a revision around the installation or use of bed/side rails. The revision would remove references to the “installation” of bed/side rails and only refer to the “use” of bed/side rails (F700 Bedrails).

Nursing Services

The proposed rule includes changes to the requirement for daily posted nurse staffing information (F732 Posted Nurse Staffing Information) to reduce the data retention period from 18 months to 15 months. CMS feels that while the Payroll-Based Journal data captures a retrospective report of staffing, the daily actual posted staffing data provide information to residents/representatives about who is working and the amount of staff on a shift by shift basis.

Stay tuned for Parts 2 and 3 of our look at the proposed rule that could change the Requirements of Participation.

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