DOH Discusses New Nursing Home Requirements

LeadingAge NY staff met with Department of Health (DOH) representatives to discuss various survey-related issues, including the new Federal Rules of Participation (ROPs), which took effect on Nov. 28, 2016. The new Interpretive Guidance has not been issued, and DOH anticipates that a draft copy will be available in May 2017. DOH has set up a mailbox for providers to send in questions that will, in turn, be forwarded to the Centers for Medicare and Medicaid Services (CMS) for interpretation. The mailbox is nhrop@health.ny.gov.

Among some of the issues clarified were the following:

One feature of the new requirements is the ability of the physician to delegate to the dietician and the therapist the ability to write orders in their particular area, if allowed by state law. This is currently not allowed under NYS law, although there is some exploration into this, and there may be some changes that will ultimately be considered.

Under the new requirements, all discharges from the facility, for whatever reason, must have a copy of the discharge notice forwarded to the State Ombudsman. DOH is meeting with the State Ombudsman within the next few weeks to discuss the requirement and to see, based on the resources currently in the Ombudsman office, how this can be met. DOH interprets this to mean that all discharges are subject to this new requirement.

The new regulations require the reporting of allegations of abuse within two hours. Obviously, the timeframes to report and the increased volume that would result are of significant concern. DOH is actively seeking clarification from CMS and has advised that providers follow the current Nursing Home Incident Reporting Manual guidelines. LeadingAge NY has also asked that DOH reach out to their regional offices to advise them that the current Manual instructions are guiding facilities until CMS further clarifies the requirement.

All facilities are now surveyed under the 2012 Life Safety Code (LSC). As part of the LSC, DOH is asking facilities to fill in a worksheet reflecting the existence (not the number) of electrical equipment within the facility. Additionally, any new piece of electrical equipment brought in by a resident (e.g., a television) should be inspected for safety and condition, and this review must be documented.

Later in 2017, in conjunction with the issuance of revised F-Tags, a new survey process will be put into place. 70% of sampled residents will be chosen from the MDS, and high-risk residents, individuals observed that the surveyor has concerns about, complaints by residents/families, and new admissions within the past 30 days will comprise the remaining 30%. There will be some flexibility to add more onsite residents, and that may change the ratio. The survey will be data-driven (similar to the thresholds used in the QIS) and will provide more flexible interview questions/process than is currently the case.

Contacts: Elliott Frost, efrost@leadingageny.org, 518-867-8832 and Michelle Synakowski, msynakowski@leadingageny.org, 518-867-8850