CMS Proposed Changes to RoPs (Part 2)

As promised, CMS Compliance Group is diving into the proposed rule, “Medicare & Medicaid Programs; Requirements for Long-Term Care Facilities; Regulatory Provisions to Promote Efficiency and Transparency” published in the Federal Register on July 18, 2019. We’ll look at proposed changes related to Behavioral Health, Pharmacy Services, Food and Nutrition Services and the Physical Environment in this post.

Behavioral Health

The Behavioral Health requirements have been some of the most concerning for providers since the line between providing skilled nursing services and mental health services seemed to be a bit blurred. To address this, CMS has stated that it believes it is important to focus on the care and treatment of residents who have mental disorders or psychosocial adjustment difficulties, so it is not proposing to remove the requirements, but has identified regulatory duplications that can be removed from the section. These include:

  • Removing the duplicative requirement under the Behavioral Health regulatory group (F741 Sufficient/ Competent Staff-Behavioral Health Needs) that facilities have sufficient direct care staff who have the appropriate competencies and skill sets to provide nursing and related services in accordance with the facility assessment since this requirement is part of the Nursing Services regulatory group (F725 Sufficient Staff). The intent of this revision, per the proposed rule, is to ensure facilities are responsible for providing sufficient staff who possess basic competencies and skillsets to meet the residents’ behavioral health needs per their care plans.
  • Removing the duplicative requirement currently listed under F744 Treatment/Service for Dementia that includes the requirement to provide specialized rehab services (F825 Provide/Obtain Specialized Rehab Services). 

Pharmacy Services

14-day limits on PRN orders for psychotropic meds (F758 Free From Unnecessary Psychotropic Meds/PRN Use) was one of the big changes when the RoPs were updated. What was specifically set out is that PRN orders for antipsychotics were limited to 14 day and could not be renewed unless a physician/prescribing practitioner evaluated the resident for continued need. CMS has proposed that the specific requirement for PRN antipsychotics be removed, allowing the physician/prescribing practitioner to extend the order so long as he/she documents the rationale in the resident’s medical record and indicates the duration for the PRN order.

Food and Nutrition Services

The proposed rule revises the initial RoP requirements for the director of food and nutrition services. The requirements included extensive education and training requirements for that role if the facility did not have a dietitian employed full-time by the facility. CMS is proposing a revision to the standards required (F801 Qualified Dietary Staff) to indicate that, at a minimum, a person who is designated as the director of food and nutrition services has two or more years of experience in that role or has completed at least a course in food safety that covers key dietary operations management topics. That person will still be required to receive frequently scheduled consultations from a qualified dietitian or other clinically qualified nutrition professional.

Physical Environment

  • Life Safety Code – CMS proposes to allow existing LTC facilities that were certified prior to July 5, 2016 to use the Fire Safety Equivalency System (FSES) to determine equivalent fire protection levels and to continue to use the 2001 FSES mandatory values for determining containment, extinguishment and people movement. The table of proposed mandatory values is included in the rule.
  • Resident Rooms and Bathrooms – CMS has proposed to revise the regulation regarding the number of residents per room (F911 Bedroom Number of Residents) and the requirement regarding bathroom facilities (F918 Bedrooms Equipped/Near Lavatory/Toilet) to only apply to newly constructed facilities and newly certified facilities that were never used as a LTC facility before.

If you missed Part 1 of our blog series on the proposed rule, “Medicare and Medicaid Programs: Requirements for Long-Term Care Facilities: Regulatory Provisions to Promote Efficiency, and Transparency,” you can view it here. Part 3 will be posted shortly.

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