LeadingAge New York Seeks Input on Proposed Federal Nursing Home Regulations
Earlier this month CMS published a proposed rule, that if adopted will make significant changes to the current nursing home regulations. The proposed rule, the first substantive changes to the requirements since 1991 will have a profound impact on how care will be provided in the nursing home. The public comment period ends on Sept. 14th and LeadingAge NY is soliciting member comments to share with CMS over sections of the proposed regulations that members either support or have concerns about.
The document is over 400 pages. As a means of helping members digest the information contained in the proposed rule, we have scheduled a call for Monday, Aug. 17th from 1:00-2:00. The call-in information will be sent to members the week of Aug. 3rd.
Some sections of the proposed regulations simply reorganize the current requirements. Some sections of the proposed regulations are already requirements in New York (i.e. presence of a staff person to administer CPR, establishment of a grievance procedure, and required training on abuse). However, there are a number of newly added sections and we ask members to pay particular attention to the language in these sections as we will be focusing on many of these newer sections on the call on Aug. 17th.
One provision of the proposed rule, under Administration is the requirement to conduct and document a facility-wide assessment to determine what resources are necessary to care for its residents competently during both day-to-day operations and emergencies. The facility must review and update that assessment, as necessary, and at least annually. The assessment must address the facility’s resident population (that is, number of residents, overall types of care and staff competencies required by the residents, and cultural aspects), resources (for example, equipment and overall personnel), and a facility-based and community-based risk assessment.
Another provision, under Physician Services, would require an in-person evaluation by a physician, a physician assistant (PA), nurse practitioner (NP, or clinical nurse specialist (CNS) before an unscheduled transfer to a hospital. A change under physician services would allow physicians to delegate dietary orders to dietitians and therapy orders to therapists.
In the area of Comprehensive Person-Centered Care Plans the changes would include adding a nurse aide, food and nutrition services, and a social worker to the Interdiscuplinary Team (IDT) that develops the comprehensive care plan and would require written explanation in the medical record if participation of the resident and their resident representative is determined not practicable. It would also require development of a baseline care plan for each resident within 48 hours of admission, including instructions needed to provide effective and person-centered care meeting professional standards.
A new section on Behavioral Health Service would require staff to have appropriate competencies to provide behavioral health care and services, including care of residents with mental and psychosocial illnesses and implementing non-pharmacological interventions.
A new section on Quality Assurance and Performance Improvement (QAPI) would require all LTC facilities to develop, implement, and maintain an effective comprehensive, ongoing, data-driven QAPI programs that focus on systems of care, outcomes of care and quality of life
Compliance and Ethics Program, another new section, would require the operating organization for each facility to have in operation a compliance and ethics program with established written compliance and ethics standards, policies and procedures capable of reducing the prospect of criminal, civil, and administrative violations.
Facility Responsibilities, another added section, includes requirements related to visitation, abuse and neglect, the prohibition of employment of individuals with disciplinary actions realted to abuse, neglect, mistreatment or misappropriation of resident property; and requires implementation of policies prohibiting abuse, neglect, mistreatment and misappropriation. This section adds a new term "exploitation", that is added to address circumstances that may not rise to the level of abuse or neglect, but would nonetheless be prohibited (the term has not as yet been defined).
Another new section, Laboratory, Radiology and other Diagnostic Services, would clarify that a PA, NP, or CNS may order laboratory, radiology, and other diagnostic services in accordance with state and scope of practice laws and would clarify that the ordering practitioner be notified of abnormal laboratory results when they fall outside of clinical reference ranges, in accordance with facility notification policies and procedures.
Training Requirements sets forth all requirements of an effective training program for new and existing staff, contract staff, and volunteers. The proposed topics include effective communication; resident rights and facility responsibilities; abuse, neglect, and exploitation; QAPI and infection control; compliance and ethics. Dementia management and resident abuse prevention training as part of the 12 hours per year in-service training for nurse aides would be required. Facilities would also be required to provide behavioral health training to all staff, based on the facility assessment.
Please review as much of the document as possible and join the call on Aug. 17th, from 1:00-2:00 p.m.
Contact: Elliott Frost, efrost@leadingageny.org, 518-867-8832