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Future Changes to the Requirements of Participation for Medicare/Medicaid Certified Skilled Nursing Facilities

Future Changes to the Requirements of Participation for Medicare/Medicaid Certified Skilled Nursing Facilities


Health Care Law Note
(January 11, 2017)

In our first, second, and third Law Notes in this multi-part series, we covered provisions in the new Participation Requirements for Medicare/Medicaid Certified Skilled Nursing Facilities ("SNFs") that were to be implemented by November 28, 2016, as part of the "Phase 1" requirements.  While recognizing that SNFs have plenty on their plate ensuring that policies, procedures, training, and operations are compliant with Phase 1 requirements, we want to highlight some additional items that need to be addressed as part of Phases 2 and 3.  Many of the Phase 2 and Phase 3 requirements build on Phase 1 requirements.

Noteworthy Phase 2 requirements to implement by November 28, 2017

  • Ensure residents receive necessary behavioral health care and services to attain the highest practicable physical, mental, and psychosocial well-being (Behavioral health services, 42 C.F.R. §483.40 *New Section*)1
  • Prepare a new quality assurance and improvement ("QAPI") plan that can be presented to state agency surveyors by November 28, 2017 (Quality assurance and performance improvement, 42 C.F.R. §483.75)
  • Create policies identifying when loss or damage of dentures is SNF's responsibility (Dental services, 42 C.F.R. §483.55)
  • Add an antibiotic stewardship program to the existing infection prevention and control program (Infection control, 42 C.F.R. §483.80)2
  • Establish or update smoking policies in accordance with applicable laws (Physical environment, 42 C.F.R. §483.90)

Noteworthy Phase 3 requirements to implement by November 28, 2019

  • Establish and maintain data-driven QAPI program that focuses on systems of care, outcomes of care, and quality of life (Quality assurance and performance improvement, 42 C.F.R. §483.75)
  • Designate an infection preventionist to serve on the quality assessment and assurance committee (Infection Control, 42 C.F.R. §483.75)
  • Create or update written compliance and ethics policies and procedures that will help implement the previously prepared QAPI plan and will reduce the prospect of criminal, civil, and administrative violations and promote quality of care (Compliance and ethics, 42 C.F.R. §483.85 *New Section*)
  • Install resident call system at each resident's bedside or update existing system as needed (Physical environment, 42 C.F.R. §483.90)
  • Establish and maintain training programs for staff, contracted service providers, and volunteers (Training requirements, 42 C.F.R. §483.95 *New Section*)3  

We will provide additional guidance regarding the specifics of these Phase 2 and Phase 3 requirements in the coming months.  We hope these highlights will help SNFs update internal policies and procedures and set budgets going forward. The Centers for Medicare & Medicaid Services ("CMS") has estimated the average costs of compliance per facility to be $62,900 in the first year and $55,000 per year for subsequent years. SNFs may be able to minimize some of those anticipated costs by proactively adopting at an early date changes that must be implemented as part of Phase 2 and Phase 3.

1 To review the Phase 1 changes that are part of this new section, click here.

2 To learn more about additional changes and effective dates in this section, click here.

3 To learn more about additional changes and effective dates in this new section, click here.

Authors
Susan McNear Fradenburg
T (336) 378-5482
F (336) 378-5400
Katye M. Jobe
T (919) 755-8753
F (919) 838-3128
Associated Attorneys
Associated Industries
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