The Centers for Medicare & Medicaid Services (“CMS”) released a final rule (“Final Rule”) recently, updating the Medicare Conditions of Participation (“CoPs”) for long-term care (“LTC”) facilities. Over fifteen years, it is the first time that substantial LTC CoP revisions have been issued.
Long-Term Care facilities impacted by the Final Rule involve skilled nursing facilities for Medicare and nursing facilities for Medicaid, or those facilities that are properly certified. The Final Rule goes into effect on the day of November 28, 2016, although a phased implementation has been planned by CMS. The 3 implementation phases must be completed by the Long-term Care providers by the day of November 28 in the years 2016, 2017 and 2018, respectively. CMS has assumed that the costs of agreement or compliance will be $62,900 in the 1st phase of implementation, and $55,000 each year for phases two and three.
The Final Rule is targeted at, “decreasing unessential hospital readmissions and infections, improving the quality of care, and strengthening safety measures for residents in these facilities”, CMS explained.
For your review, the Final Rule is extensive and is available here. Few of the problems addressed in the Final Rule are summarized below.
Admission, Transfer & Discharge Rights
The Final Rule requires that a transfer or discharge be documented in the medical record and that particular data be exchanged with the receiving provider or facility when a resident is transferred.
Freedoms from Abuse, Neglect and Exploitation
The Final Rule requires Long-Term Care facilities to examine and report entire allegations of abusive conduct. The Final Rule also illustrates that facilities can’t hire people who have had a disciplinary step taken against their professional license by a state licensure body as an outcome of a finding of abuse, neglect, residents’ mistreatment or misappropriation of a resident's property.
The Final Rule needs that a pharmacist reviews a medical chart of resident during each monthly drug regimen review. Existing requirements is also being revised by the CMS regarding “antipsychotic” drugs to refer to “psychotropic” drugs. Furthermore, several provisions are being required by CMS intended to decrease or eradicate the requirement for psychotropic drugs, if not clinically contraindicated, to protect the health of residents.
Quality of Life
The Final Rule needs that deployed on the comprehensive assessment of a resident, Long-Term Care facilities make sure that residents get treatment and care in accordance with professional standards of practice, the comprehensive person-centered care plan, and the choices of residents.
Comprehensive Person-Centered Care Planning
The Final Rule needs facilities to establish and execute a baseline care plan for each resident within forty-eight hours of their admission, which involves the instructions required to give effective and person-centered care that meets expert standards of quality care.
The Final Rule needs Long-Term Care facilities to establish an Infection Prevention and Control Program that involves an Antibiotic Stewardship Program and designate at least 1 Infection Preventionist.
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