Proposed LTC Regs: The Overview

So far, it’s been pretty quiet in terms of explanations of the newly released CMS document that seeks to modernize long term care regulations. That’s because the 403 pages are chock full of changes, rearranging of existing statutes, and lots of evidence on why these changes should be made. The document, published in the July 16, 2015 Federal Register, contains updates to the regulations governing the LTC industry that have been proposed to enhance quality of life and quality of care. At CMS Compliance Group, our tagline is “Defining Quality in Healthcare,” so when we saw that this document is aimed at driving quality, we were thrilled to see that the proposed regulations were written with person-centered care in mind. Let’s take a look at the basics of what is being proposed.

Proposed Layout of New LTC Regulations

Facility Responsibilities New section encompassing the responsibilities of the facility, including residents’ rights provisions
Freedom from abuse, neglect, and exploitation Revisions to “Resident behavior and family practices” section that will update clinical practices to enhance resident safety
Transitions of Care This section, formerly, “Admission, transfer and discharge rights,” will include all requirements for when a resident is discharged to any other setting, including new requirements for discharge information
Resident Assessments Updates to clarification of PASARR screening, preadmission screening requirements for individuals with mental illness/intellectual disabilities, and new requirements for resident evaluations for change in condition
Comprehensive Person-Centered Care Planning New section that would require extensive focus on care-planning, including development of a baseline care plan within 48 hours of admission, enhancements to the IDT, and new discharge planning requirements
Quality of Care and Quality of Life The theme of this section will be about ensuring that residents are delivered high quality care, and includes proposed changes to ADL regs, staff qualifications, updates to clinical practices and special need issues requirements
Physician Services There is an increasing focus on the role of the physician, but also allows for delegation of orders to help physicians distribute their workload to qualified team members
Nursing Services Staffing has been a key theme throughout this year with Nursing Home Compare 3.0, so CMS discusses sufficient staffing and the way it proposes facilities to calculate their required staffing
Behavioral Health Services New section that includes proposed regulations for staffing, competency of staff, and updates to the social worker qualification
Pharmacy Services A number of requirements have been proposed for pharmacy services, including pharmacist reviews, attending physician documentation, psychotropic drug administration, and the existing regulations about unnecessary medications, med errors and immunizations
Laboratory, Radiology, and Other Diagnostic Services New section that proposes to expand the staff that can order services, and changes to notification of abnormal lab values
Dental Services This section includes information about facility responsibility for dental services, referrals, and replacement for dentures
Food and Nutrition Services A significant number of changes have been proposed for this area, including sufficient staff who are properly trained to work in dietary service, changes to menus and nutritional adequacy based on resident preferences, and flexibility of meal service
Specialized Rehabilitative Services Adding respiratory services to this section has been proposed, along with clarification of rehabilitative service offerings for residents with mental illness/intellectual disability
Administration Many pieces of the section as facilities would recognize it have been moved to other sections where they are more relevant under the proposed changes. The biggest change here is the Facility Assessment, which will be the basis for compliance with many of the new proposed regulations.
Quality Assurance and Performance Improvement (QAPI) This new section includes the requirements for QAPI, which will finally be implemented in nursing homes
Infection Control New requirements, including enhanced systems for IC and a staff member with new designation and responsibilities has been proposed for this section
Compliance and Ethics Program New section that would require facilities to have a comprehensive compliance and ethics program in place
Physical Environment Changes to resident rooms, bathroom facilities and smoking are among the proposed regulatory updates in this section
Training Requirement New section that would require facilities to implement a training program for staff that would encompass many topics including communication, resident rights and facility responsibilities, abuse, neglect and exploitation, QAPI & infection control, compliance and ethics, in-service training for nurse aids, and behavioral health training


Keep checking the CMSCG Blog for details on these proposed long term care regulations and follow #LTCRegs for our updates. Need compliance assistance for your nursing facility? Contact CMS Compliance Group today.

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