On July 16, 2015, for the first time in almost 25 years, the Centers for Medicare and Medicaid (CMS) released a proposed rule regarding long-term care facilities’ eligibility to participate in the Medicare and Medicaid programs. According to CMS, the proposed rule is aimed at “aligning requirements with current clinical practice standards to improve resident safety along with the quality and effectiveness of care and services delivered to residents.”

The proposed rule includes the following major provisions:

Resident Rights (§ 483.10)

  • Residents will be afforded the ability to more freely choose their roommate and special considerations will be made for same sex couples, “if the marriage was valid in the jurisdiction in which it was celebrated” per the recent Supreme Court ruling.

Transition of Care (§ 483.15)

  • Facilities will be required to disclose a resident’s medical information when/if such resident is transferred to a new facility or provider.

Resident Assessments (§ 483.20)

  • Facilities will be required to notify the proper state and federal authorities in the case a resident’s mental or physical health is decidedly changed.

Comprehensive Person-Centered Care Planning (§ 483.21)

  • Facilities will be required to, “develop a baseline care plan for each resident, within 48 hours of their admission,” including input of a nurse aide, a member of the food and nutrition services staff, and a social worker, who shall be part of the interdisciplinary team that develops the comprehensive care plan. Facilities will be required to take into consideration residents with post-traumatic stress disorder and develop specific plans for care.

Behavior Health Services (§ 483.40)

  • Facility staff assisting in the care of residents with specific mental and psychological illnesses will be required to be educated in the appropriate care of those residents.

Pharmacy Services (§ 483.45)

  • Resident medication will be reviewed every six months and irregularities documented and reviewed by the resident’s physician.

Food and Nutrition Services (§ 483.60)

  • Facilities will be required to manage the dietary needs of residents by employing individuals with the proper credentials to ensure residents receive the nutrition outlined in their care plan, staffing a Director of Food Services with at least the minimum educational requirements needed for determining care plan nutrition needs, allowing for specialty diets requested by residents with specific religious or ethnic concerns and, take into consideration resident allergies, intolerances, and preferences and ensure adequate hydration.

Administration (§ 483.70)

  • Facilities will be required to, at least, annually administer a facility-wide evaluation to analyze facility needs.
  • Binding arbitration agreements, if implemented, must clearly state they serve to nullify a resident’s right to legal remedy for any activity outlined in the agreement and that the document must be a stand-alone agreement and not contained within any other facility agreements. Facility staff must explain the agreement to the resident and obtain acknowledgement of same before admission. Further, they cannot be used as a condition of residence in the facility. Finally, the agreement must not contain any language that prohibits communicating with federal, state, or local officials.

Infection Control (§ 483.80)

  • Facilities will be required to document a plan for, “preventing, identifying, reporting, investigating, and controlling infections and communicable diseases…”

Training Requirements (§ 483.95)

  • Facility staff is required to participate in educational courses focused on resident rights and on activities that constitute abuse, neglect, exploitation, and misappropriation of resident property.

For more information on CMS’ proposed rule, follow this link. To submit a comment to the Department of Health and Human Services regarding this Proposed Rule, please follow the instructions outlined on page two of the Proposed Rule by September 14, 2015.