The Centers for Medicare and Medicaid Services finalized a major new rule approximately one month ago to make significant changes to improve patient care and safety. The new rule’s compliance obligations, which will be implemented in three phases that begin this year and extend through 2019, represent the largest update the industry has seen since 1991. The “megarule" as some in the industry are calling it sets high standards for care and targets infections, hospital readmissions, staffing practices and resident safety among other areas.

In its official rule announcement, CMS outlines the finalized objectives as:

• “Strengthening the rights of long-term care facility residents, including prohibiting the use of pre-dispute binding arbitration agreements.
• Ensuring that long-term care facility staff members are properly trained on caring for residents with dementia and in preventing elder abuse.
• Ensuring that long-term care facilities take into consideration the health of residents when making decisions on the kinds and levels of staffing a facility needs to properly take care of its residents.
• Ensuring that staff members have the right skill sets and competencies to provide person-centered care to residents. The care plans developed for residents will take into consideration their goals of care and preferences.
• Improving care planning, including discharge planning for all residents with involvement of the facility’s interdisciplinary team and consideration of the caregiver’s capacity, giving residents information they need for follow-up after discharge, and ensuring that instructions are transmitted to any receiving facilities or services.
• Allowing dietitians and therapy providers the authority to write orders in their areas of expertise when a physician delegates the responsibility and state licensing laws allow.
• Updating the long-term care facility’s infection prevention and control program, including requiring an infection prevention and control officer and an antibiotic stewardship program that includes antibiotic use protocols and a system to monitor antibiotic use.”

The regulations included in Phase One must be implemented by the effective date of the final rule which is November 28, 2016. The regulations in Phase 2 include brand new requirements and those provisions that required more complex revisions and must be implemented by November 28, 2017. In this phase, one of the most important aspects will be the implementation of a new survey process. The third Phase includes all the remaining requirements that were not implemented in Phases 1 and 2 and must be implemented by November 28, 2019. CMS expects that this final Phase will allow for the complete set of revised requirements to be incorporated into the practices of LTC facilities and sufficiently enforced through the updated survey process.

Some of the biggest changes in Phase 1 concern:

• Elimination of the use of pre-dispute arbitration
• Expanded resident rights
• Expanded drug regimen review process
• New discharge plan requirements
• Person-centered care plans
• Behavioral health services

Providers can access the new surveyor training for LTC facilities from CMS as well as more information on the timeline for implementation here.
By Kindred Rehabilitation Services