This week’s Ftag of the Week on the CMSCG Blog is one of two related Ftags in the Administration regulatory group, F845 Facility Closure – Administrator. The second F-tag, F845 Facility Closure, will be reviewed in an upcoming post in our CMSCG Blog series. The American Healthcare Association/National Center for Assisted living (ACHA/NCAL) conducted a survey recently which found that more than fifty percent (54%) of nursing homes surveyed are operating at a loss and almost fifty percent (49%) survey stated that they have had to make cuts due to increased expenses/ lost revenue in 2021. These financial hardships imply that some nursing homes may unfortunately need to make the decision to close, so this regulation is one that some Administrators may need to become more familiar with. We also need to keep in mind that if you track the Special Focus Facility (SFF) data that is routinely released, it is common to see one or two facilities noted as closing.
F845 – Background
Back in April of 2013, the Centers for Medicare & Medicaid Services (CMS) issued a final rule related to long-term care facilities providing notice of closure, with much of the burden falling on the Administrator to ensure appropriate planning and notice of closure is provided when a facility is closing. F845 addresses the responsibilities of the Administrator, whether the closure is voluntary or if the facility is being terminated from the Medicare and/or Medicare programs.
A closure plan must be developed when a facility plans to close or is being involuntarily terminated and will have to close when its provider agreement was terminated. The plan must be submitted to the State Survey Agency for review and approval. The closure plan needs to include:
- The steps that will be taken for a safe and orderly facility closure
- The steps and associated information on how the residents will be safely transferred, discharged, or relocated.
- Who is responsible for ensuring that the closure plan and associated procedures will be successfully carried out.
Facility staff should assist residents and/or their representatives with obtaining information that can help them make an informed decision about which facility to relocate to, whether it is a similar or lower level of care or if possible, return to the community. Just because the facility will be ceasing to operate does not mean that the job for facility staff is over. Staff need to ensure that there is a plan in place for every resident to be transferred or discharged.
Just because the facility will be ceasing to operate does not mean that the job for facility staff is over.
The facility should have a process in place to ensure that the closure is safe and orderly, and diminishes the chance of a negative outcome for a resident by ensuring that the receiving facility/location is provided with sufficient information about the resident, including the resident’s care routines, needs and preferences for continuity of care.
Facility staff must also assist residents and/or their representatives with obtaining information that can help them make an informed decision about which facility to relocate the residents to and what their options are.
The Interpretive Guidance (IG) notes that the Administrator or the Administrator’s designee should provide notice, prior to an impending facility closure to:
- The facility’s Medical Director
- Residents’ primary physician
- CMS Regional Office
- State Medicaid Agency
The IG states that the facility’s notifications should be developed with input from the Medical Director and other management staff. Regardless, written notification of an impending facility closure must be provided to multiple parties, including:
- The State Survey Agency
- State Long-Term Care Ombudsman
- Facility residents
- Residents’ legal representatives/other responsible parties
This notice must be provided in a language and manner that the recipients understand. CMS further notes that providing notice to other entities as soon as possible is encouraged, although not required. Included in the list of potential entities to notify includes vendors, community partners, employees, union representatives, etc.
Timeframes for Providing Written Notice
- If the closure is voluntary, written notice must be provided at least 60 days prior to the closure.
- If the facility is being terminated involuntarily, then written notice will need to be provided no later than the date that CMS or the State Medicaid Agency specifies. If the facility plans to remain open despite being involuntarily terminated, written notice must still be provided.
When Written Notification is Not Required:
These requirements for providing written notice do not apply to temporary facility closures that are the result of an emergency situation, such as a fire or other situation where the building becomes unusable. It is still important to ensure thorough communication with residents and their representatives and other required parties when there is an emergency, but this regulation does not cover emergency-related requirements.
Written Notice Content Requirements
The written notice needs to include the facility’s closure plan as part of its content. Additionally, the notice needs to include contact information for several key people and agencies, as relevant. These include:
- Contact information for the primary facility contact/contacts who are responsible for the daily operations and management of the facility during the closure process.
- Name, address and telephone number of the State Long-Term Care Ombudsman
- Mailing address and telephone number of the agency responsible for protection and advocacy of individuals with developmental disabilities
- Mailing address and telephone number of the agency responsible for protection and advocacy of individuals with mental illness
Is Written Notification Enough?
The intent of the regulations related to facility closure is to ensure that the potential for transfer trauma is minimized for all residents by ensuring there are no “surprises” that the facility is closing its doors without letting involved parties know. As such, the IG states that facility staff should discuss the information that is provided in the written notification, which includes the closure plan, with the facility’s residents, their representatives and family members to assist them with understanding closure and what rights they have.
The intent of the regulations related to facility closure is to ensure that the potential for transfer trauma is minimized for all residents by ensuring there are no “surprises” that the facility is closing its doors without letting involved parties know.
Once notice of closure has been submitted, from that day forward, the facility is no longer permitted to accept new residents. The facility is expected to be focused on helping the current residents to relocate to a new facility or other care site.
Administrator Obligations Regardless of Direct Control over Closure
CMS recognizes that there are several circumstances where the Administrator may not have direct control over a facility closure, or implementing the facility’s written notice, closure plan and procedures, such as when an Administrator is hired to assist with closing the facility and was not present during the closure decisions. This Administrator is still responsible for implementing and developing the closure plans, procedures and providing notifications to all relevant parties as required by regulations. The Administrator, regardless of tenure or involvement in the decision-making process, is expected to work with the State Survey Agency and the CMS Regional Office throughout the closure to ensure that the appropriate procedures are implemented.
In our next post in the CMSCG “Ftag of the Week” Blog Series, we will review F846 Facility Closure, the closely associated regulation for both voluntary and involuntary nursing home closures. As you are aware, facilities need to have policies & procedures in place at all times in the event the facility needs to close, and next week’s post will address these requirements.
About CMS Compliance Group, Inc.
CMS Compliance Group, Inc. is a regulatory compliance and quality improvement consulting firm with extensive experience servicing post-acute and long term care facilities and agencies. With the idea of continuous quality improvement in mind, CMS Compliance Group’s interdisciplinary team provides a unique approach to client service, ensuring that all departments can achieve and maintain compliance while improving quality of care. Our consultants provide proactive and reactionary compliance consulting services to clients across the country and have an established reputation for rapidly addressing and successfully resolving the most serious issues that occur in nursing homes, assisted living facilities, home health agencies and other providers.
To learn more about CMSCG’s nursing home consulting services, including assistance with facility closure, please click here or call us at 631.692.4422.