LeadingAge NY Advocacy on Proposed Nursing Home Regulations

 

Late last week, LeadingAge New York submitted extensive written comments on the Centers for Medicare and Medicaid Services (CMS) proposed regulation, Medicare and Medicaid Requirements for Long-Term Care Facilities. While offering general support for updating the nursing home requirements for participation, we expressed serious concerns about some provisions and the added costs that providers would incur to comply with the new standards. 

We expressed major concerns in the following areas:

·         Transitions of care: facility must exchange detailed resident information/data elements with the receiving provider, without any financial support for interoperable health IT;

·         Baseline Interim Care Plan: facility is given a 48-hour timeframe to develop a baseline care plan for each newly-admitted resident; the specifics of the content are unclear;

·         Interdisciplinary Team: require nurse aides and others to attend interdisciplinary team meetings;

·         Pharmacy: required reviews of antibiotics and antipsychotics; increased reviews of residents’ medical charts; and drug reconciliations at admission and discharge;

·         In-Person Evaluation: require in-person consultation by physician or extender of resident prior to hospitalization;

·         Behavioral Health Services: require determination of direct care staff needs, ensure “appropriate competencies and skills” and offer training to provide behavioral health care;

·         QAPI: provide surveyors with access to facility QAPI documentation, which could be used to identify or support findings of non-compliance;

·         Infection Control: require facilities to have an Infection Prevention and Control Officer at unknown cost to the facility, with concern about access to expertise in rural areas;

·         Compliance and Ethics: establish a compliance and ethics program containing a series of specific areas within a one-year period;

·         Physical Environment: any facility construction or reconstruction plan would require that each resident room have its own bathroom equipped with a shower; and

·         Implementation and Compliance Costs: massive changes will require extended timeframe for implementation; Medicare/Medicaid should fund compliance costs.

CMS indicated that the first-year cost of the proposed rule would be $46,491 per facility. In contrast, LeadingAge NY has estimated that a median size nursing home in New York State (i.e., 160 beds) would incur an estimated first-year compliance cost of $160,817 from these requirements, nearly four times greater than the estimates provided in the proposed rule.  

We greatly appreciate the input we received from members on the proposed rule, the assistance of the Nursing Facility Cabinet in reviewing our comments, and those members that individually submitted comments to CMS. At press time, over 8,000 sets of written comments had been submitted on the rule. Any additional written comments may be filed by 5:00 pm on Oct. 14, 2015 by navigating to http://www.regulations.gov/; entering “CMS-2015-0083” in the search box; hitting “Search”; and hitting the “Comment Now!” button.

Contact: Dan Heim, dheim@leadingageny.org, 518-867-8866