On July 16, 2015, CMS published a proposed rule that would overhaul the Medicare and Medicaid participation requirements for long-term care facilities at 42 C.F.R. Part 483.  As CMS points out, an overhaul is necessary because the participation requirements have not been significantly updated since 1991, yet (i) the number of individuals in long-term care facilities has increased; (ii) the health conditions of such individuals have become more complex and of a higher acuity level; and (iii) a significant percentage of the population requires behavioral health services.  Comments on the proposed rule are due by September 14, 2015. 

Among the many proposed changes, key provisions in the proposed participation requirements include the following:

  • Adding a new section to focus on facility responsibilities that also revises visitation requirements and moves some existing requirements to the conditions of participation for quality of life and resident’s rights;
  • Adding a new section requiring facilities to train new and existing staff and volunteers in accordance with their respective roles and mandating training requirements regarding quality assurance, performance improvement, and infection prevention and control; resident rights; and abuse, neglect and exploitation;
  • Adding a new section regarding comprehensive person-centered care planning that, among other requirements, requires facilities to (i) develop a baseline care plan within 48 hours of each resident’s admission; (ii) document in each comprehensive care plan the resident’s goals for admission and discharge planning, as appropriate; (iii) implement the discharge planning requirements in The Improving Medicare Post-Acute Care Transformation Act of 2014; and (iv) reconcile all discharge medications with the resident’s pre-admission medications in the discharge summary;
  • Adding a new section regarding laboratory, radiology, and other diagnostic services;
  • Adding a new section requiring the provision of behavioral health care in accordance with residents’ plans of care and comprehensive assessments;
  • Revising the pharmacy services provision to require that a pharmacist: (i) review all residents’ charts every six months; (ii) perform an individual chart review when a resident is new, returns or is transferred from another facility or hospital; (iii) perform a monthly chart review during the monthly drug regimen review when the resident takes or has been prescribed an antibiotic, psychotropic drug or a drug that the Quality Assessment and Assurance Committee requests be included in the monthly review; and (iv) document all irregularities (including unnecessary drugs) and notify the facility’s medical director and the resident’s attending physician regarding such irregularities;
  • Revising the pharmacy services provision to include controls on residents’ use of psychotropic drugs;
  • Revising the nursing services provision to include a competency requirement for the facility’s assessment of whether it has sufficient staffing;
  • Expanding several definitions, including adding definitions for “abuse” and “neglect”;
  • Restructuring the resident rights provisions; and
  • Revising the quality of care and quality of life provisions.

A copy of the proposed rule is accessible here