CMS Releases Final Conditions of Participation Rule for Long-Term Care Facilities

This week the Centers for Medicare & Medicaid Services (CMS) issued a final rule to make major changes to improve the care and safety of the nearly 1.5 million residents in the more than 15,000 long-term care facilities that participate in the Medicare and Medicaid programs. The policies in this final rule are targeted at reducing unnecessary hospital readmissions and infections, improving the quality of care, and strengthening safety measures for residents in long-term care facilities. These revisions mark first major rewrite of the conditions of participation for long-term care facilities since 1991.

This rule will bring best practices for resident care to all facilities that participate in Medicare or Medicaid, implement a number of important safeguards that have been identified by resident advocates and other stakeholders, and include additional protections required by the Affordable Care Act. CMS received nearly 10,000 public comments, which were considered in finalizing this rule.

Some of the changes finalized in this rule include:

• 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.

CMS set out to revise the long-term care facility standards and originally issued the proposal in conjunction with the White House Conference on Aging in 2015, which marked the 50th anniversary of Medicare and Medicaid and was attended by the Society’s Immediate Past-President Naushira Pandya, MD, FACP, CMD.

The final rule is available on the Federal Register here.

The Society submitted extensive comments on the proposed rule last year and will thoroughly review the final rule and provide guidance and education on the new requirements for our members.