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Proposed updates on regulations governing long-term healthcare facilities

The Centers for Medicare & Medicaid (CMS) recently issued a 403-page Proposed Rule in the Federal Register to update regulations that long-term care facilities must meet in order to qualify for Medicare and Medicaid payments. The revision is the first of its kind since the rules were first published in 1989.

While the Proposed Rule is still under consideration and available for public comment until September 14, the sweeping changes do not require Congressional approval in order to become effective. The Proposed Rule is aimed at meeting the needs of more diverse and clinically complex residents, and is part of a “commitment to transform our health system to deliver better quality care and spend our health care dollars in a smarter way,” said HHS Secretary Sylvia M. Burwell in a statement accompanying the Proposed Rule.

Nursing homes will have to adapt

Medicare and Medicaid payments cover approximately 125 million Americans. Long-term care facilities in particular rely on Medicare and Medicaid payments in order to remain operational. The failure to remain compliant with Medicare and Medicaid payments is simply not an option for most nursing homes.

The Proposed Rule addresses a variety of issues, from mealtimes to medication. Among its significant proposals, feds will require long-term care facilities to:

  • Conduct a facility-wide assessment to determine what additional resources the facility needs to care for residents
  • Have in place a “competency” requirement for the minimum staffing needs of the facility
  • Have a pharmacist review a resident’s use of any psychotropic drug or antibiotic monthly
  • Revisit the facility’s food and nutrition services, including taking into consideration particular residents’ needs, such as eating at non-traditional mealtimes

This list is by no means exhaustive. The full impact of what the updated regulations may mean for any one long-term care facility will require a thorough analysis.

Help with regulatory compliance and civil defense

Long-term care facilities do not yet have a date at which to become compliant or risk a withholding of Medicare and Medicaid funding. However, generally the CMS requires changes within one year of issuing the final rule, although it may relax that timeframe due to the complexity and scope of the current proposed rule.

Clearly, however, long-term care facilities should familiarize themselves with the Proposed Rule and begin discussing the practical implications of the new law as soon as is feasible.

If your facility has questions regarding compliance with the proposed rule or is subject to an investigation or lawsuit, contact Rivas Goldstein, LLP to discuss your situation and legal options.