Wednesday, July 17, 2019

CMS Releases Proposed Rule for Requirements of Participation and Final Arbitration Rule

Yesterday, the Centers for Medicare and Medicaid Services (CMS) issued the proposed rule that is intended to ease some of the pressures of the Requirements of Participation (RoPs) and delays implementation of Phase 3 by a year: Medicare and Medicaid Programs: Requirements for Long-Term Care Facilities: Regulatory Provisions to Promote Efficiency, and Transparency.

Many of the changes that AHCA advocated for are included in this proposed rule.

The proposed rule includes changes to the current long term care (LTC) requirements of participation and survey process designed to reduce excessively burdensome and overly prescriptive regulations while allowing centers to focusing on providing high-quality care. Some of the significant proposed changes include:
  • Reducing paperwork burden by only requiring facilities to send discharge notices to the State LTC Ombudsman for "facility-initiated involuntary transfers and discharges."
  • Revising the requirements for new staffing positions that were created by the final rule released in October 2016, including removing requirements for a compliance officer and compliance liaisons, removing specific duties required of the grievance official, and revising certain training requirements for the director or food and nutrition services.
  • Removing overly prescriptive details in the Quality Assurance and Performance Improvement (QAPI) requirements.
  • Updating portions of the enforcement regulations, including those related to the informal dispute resolution and independent informal dispute resolution processes.
As mentioned, CMS has delayed implementation of some Phase 3 requirements for one year. The total estimated cost savings over each of the first five years is approximately $644 million. AHCA's press statement on the proposed rule can be found here.

CMS also issued yesterday the final rule that reverses the Obama-era ban on the use of arbitration agreements. This rule makes it very clear that we have the ability to use pre-dispute agreements, while at the same time adding provisions intended to make sure that residents and/or their representatives understand the agreements into which they are entering. Additionally, the rule prevents a facility from making the signing of an agreement a precondition of admission. AHCA's press statement on the final rule can be found here.

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