Centers for Medicare & Medicaid Services Revised Requirements for Long-Term Care Facilities
March 2017
Effective 11/28/2016, Centers for Medicare &Medicaid Services (CMS) revised the requirements that Long Term Care Facilities (LTC’s) must meet to participate in the Medicare and Medicaid programs. According to CMS, the original regulations were published on February 2, 1989 and although they have been revised since then, they have not been comprehensively reviewed and updated since 1991. Given the “significant innovations in resident care and quality assessment practices” in addition to the changing population of LTC facilities, CMS felt the need to conduct a comprehensive review and revision of the LTC requirements for participation in Medicare and Medicaid programs.
The new revisions can be found in the Federal Register/Vol. 81, No. 192/Tuesday, October 4, 2016 at https://www.gpo.gov/fdsys/pkg/FR-2016-10-04/pdf/2016-23503.pdf. Below are summaries of those revisions that may impact upon the duties, requirements, and potential liability of the various members of the Emerson Employee Safety Committee:
- Freedom from Abuse, Neglect, and Exploitation (42 CFR 483.12): Revised to specify that facilities cannot employ individuals who have had a disciplinary action taken against their professional license by a state licensure body as a result of a finding of abuse, neglect, mistreatment of residents or misappropriation of their property.
- Admission,Transfer, and Discharge (42 CFR 483.15):Revised to specify that a transfer or discharge must be documented in the medical record and that specific information must be exchanged with the receiving provider/facility upon transfer.
- Comprehensive Person-Centered Care Planning (42 CFR 483.21): A new section added that requires facilities to develop and implement a baseline care plan for each resident within 48 hours of admission. The revised regulations now require that a nurse aide and a member of the dietary staff be on the interdisciplinary team that develops the comprehensive care plan. Also added is a requirement that facilities develop and implement a discharge planning process that focuses on the resident’s discharge goals and prepares residents to participate in post-discharge planning and care.
- Physician Services (42 CFR 483.30): Revised to specify that attending physicians may delegate dietary orders to qualified dietitians or other clinically qualified nutrition professionals and therapy orders to therapists.
- Nursing Services (42 CFR 483.35): Revised to include a competency requirement for determining the sufficiency of nursing staff, based on a facility assessment that includes number of residents,resident acuity, range of diagnoses and the content of individual care plans.
- Behavioral Health Services (42 CFR 438.40):Revised to include “gerontology” to the list of possible human services fields from which a bachelor degree could provide the minimum educational requirement for a social worker.
- Pharmacy Services (42 CFR 483.45): Revised to require that a pharmacist review a resident’s medical chart during each monthly drug regimen review.
- Laboratory, Radiology, and Other Diagnostic Services (42 CFR 483.50): A new section added that clarifies that a physician assistant, nurse practitioner or clinical nurse specialist may order laboratory, radiology, and other diagnostic services for a resident in accordance with state law, including scope-of-practice laws.
- Dental Services (42 CFR 483.55): Revised to specifically prohibit facilities from charging a Medicare resident for the loss or damage of dentures deemed to be the facility’s responsibility. Also requires facilities to have a policy identifying those instances when the loss or damage of dentures is the facility’s responsibility. Also requires facilities to assist residents who are eligible to apply for reimbursement of dental services under the Medicaid state plan and any referral for lost or damaged dentures must be made within 3 business days absent documented proof of extenuating circumstances.
- Food and Nutrition Services (42 CFR 483.60): Revised to require facilities to employ sufficient staff, including the designation of a director of food and nutrition service, with the appropriate competencies and skills sets to carry out the functions of dietary services while taking into consideration resident assessments and individual plans of care, including diagnoses and acuity, as well as the facility’s resident census when providing each resident with a nourishing, well-balanced diet that meets the resident’s special dietary needs and takes into account the resident’s dietary preferences.
- Specialized Rehabilitative Services (42 CFR 483.65): Revised to include respiratory services.
- Physical Environment (42 CFR 483.90): Any facility that is constructed, re-constructed, or newly certified after 11/28/16 must not accommodate more than two (2) residents per bedroom and must have a bathroom equipped with at least one commode and sink in each room.
- Training Requirements (42 CFR 483.95): A new section added that sets forth all the requirements of an effective training program that facilities must develop, implement and maintain for all new and existing staff, contractors, and volunteers based on individual roles.
