In October 2016, the Centers for Medicare and Medicaid Services (CMS) published a final rule revising for Medicare and Medicaid requirements of participation (RoP) for nursing facilities. In the July 18, 2019 Federal Register, CMS proposed the rule that will reform some of the requirements that have been identified as “obsolete and burdensome regulations that could be eliminated and reformed to improve effectiveness or reduce unnecessary reporting requirements and other costs, with a particular focus on freeing up resources that health care providers, health plans and states could use to improve and enhance resident health and safety”. They proposed to delay implementation of some phase 3 requirements, which has a deadline of November 28, 2019. However, facilities are still waiting on CMS guidance.  

Let’s review the three major provisions in phase 3:

  1. Quality assurance and performance improvement (QAPI) implementation;
  2. Infection control;
  3. Compliance and Ethics Program.

Quality Assurance and Performance Improvement:

CMS is requiring all LTC facilities to develop, implement, and maintain an effective comprehensive, data driven QAPI program that focuses on systems of care, outcomes of care and quality of life. Section 483.70 requires statement of responsibility for the program to be included in the obligations of the governing body. The rule also requires that facilities include abuse, neglect, and exploitation into the QAPI program.

In the proposed rule, CMS removed the prescriptive requirements of a QAPI program’s design and scope. This will allow facilities flexibility to determine how to best develop their QAPI program tailored to meet their individual needs and ensure the promotion of quality of care. The policies and procedures related to program effectiveness, data systems, and monitoring is still required however, CMS proposed to eliminate the specific details of what should be contained in the policies and procedures. Facilities are also still required to act for quality improvement, measuring success, and performance tracking however, CMS proposed to eliminate the prescriptive details of what the policies and procedure requirements should include.

Infection Control:

CMS is requiring facilities to develop an Infection Prevention and Control Program (IPCP) that includes an Antibiotic Stewardship Program and designate at least one Infection Preventionist (IP).

In the proposed rule, CMS removes the need to hire the infection preventionist, which will allow facilities to contract with an individual or another way to meet the requirement of the IPCP, “must have sufficient time at the facility to meet the objectives set forth in the facility’s IPCP.” Facilities must still meet the IPCP requirement but can still meet the requirements without adding additional personnel.

Compliance and Ethics Program:

This is a new section.  CMS is requiring the operating organization for each facility to have in effect a compliance and ethics program that has established written compliance and ethics standards, policies and procedures that are capable of reducing the prospect of criminal, civil, and administrative violations in accordance with section 1128I(b) of the Act.

In the proposed rule, CMS removed the need for a compliance officer, compliance liaisons, and reviewing of the facilities compliance program every year but rather review “periodically”.

With limited guidance from CMS, facilities are left to implement changes per their discretion.

Gina Tomcsik, Director of Compliance and Regulatory Strategy