 New CMS regulations to impact residents’ rights,
quality of care
The
Centers for Medicare and Medicaid Services published a Reform of Requirements
for Long-Term Care Facilities last week with
revisions it states reflect “substantial advances… in the theory and practice
of service delivery and safety.” While the regulations are prescribed to roll
out in three phases over the next three years, Phase 1 changes must be
implemented by Nov. 28, 2016.
Below is a portion of a release jointly developed by Consumer Voice, the Center for Medicare Advocacy and Justice in Aging
that discusses some of the ways the revisions will impact residents’ rights
and quality of care:
Residents’
Rights
Prohibiting Pre-Dispute Arbitration: Currently, many nursing facility
admission agreements include provisions obligating a resident to have disputes
adjudicated through private arbitration. Such “pre-dispute” arbitration agreements
now will be prohibited. Arbitration agreements will be allowed only when
the events at issue occurred before the arbitration agreement was signed.
Improvements to Involuntary Transfer-Discharge Procedures: The new
regulations specify that transfer-discharge for non-payment is inappropriate
when a resident has submitted necessary paperwork to a third-party payor (such
as Medicaid), and that payor is now evaluating the claim for payment. Also,
facilities now will be obligated to send a copy of each transfer-discharge
notice to the state’s long-term care ombudsman program, which is available to
advise the resident.
Limiting Facility’s Ability to “Dump” Resident at Hospital: In an effort
to evade transfer-discharge requirements, some facilities “dump” residents by
refusing to readmit them from hospitalizations. To address the problem,
the new regulations explicitly require a facility to follow the
transfer-discharge procedures when the facility claims that a hospitalized
resident cannot return to the facility.
Modifying Residents’ Rights to Have Visitors: The new regulations
continue current law providing each resident with a right to receive visitors
at any time. In an unwelcome change, however, if a visitor is not a family
member, the right to receive a visit now is “subject to reasonable clinical and
safety restrictions,” as set forth in facility policy.
Grievances: Far too often, complaints from residents and families have
been dismissed or not taken seriously. The regulations will now call for
facilities to have a grievance policy and a grievance official to oversee the
grievance process. Complainants will receive a written grievance decision that
includes the steps taken to investigate, a summary of the finding or
conclusions, a statement as to whether the grievance was confirmed or not
confirmed and the action taken or to be taken by the facility.
Quality of Care
Staffing: Although inadequate staffing is the greatest problem in nursing
facilities today, the new regulations do not include a minimum staffing
standard or a requirement for a 24-hour registered nurse. Instead, the new
regulations continue current policy: requiring “sufficient” staffing levels and
registered nurse presence for eight hours daily. Staff must have
“appropriate competencies and skills sets,” and staffing levels must take into
consideration the number, acuity and diagnoses of the resident population based
on a newly mandated facility assessment.
Person-Centered Care: The previous regulations required that care be
individualized, and based on a care plan, but the new regulations add emphasis.
The new regulations define person-centered care and require that facilities
learn more about who the resident is as a person, provide greater support for
resident preferences and give residents increased control and choice.
Care Planning: Under the new regulations, facilities must develop
and implement a baseline care plan for a new resident within 48 hours of
admission. The care planning process itself calls for greater resident involvement
and participation. In addition, the certified nursing assistant
responsible for the resident and a member of the food and nutrition services
staff must participate in the care planning process.
Abuse, Neglect and Exploitation: Provisions related to abuse,
neglect and exploitation are now included in a separate section, which brings
more attention and focus to these issues. New protections include
prohibiting licensed individuals with a disciplinary action from being hired
and requiring that suspicion of a crime be reported to law enforcement and the
state survey and certification agency.
Antipsychotic Drugs: Many residents with dementia are
inappropriately given harmful antipsychotic drugs, despite strong current
federal rules. The new regulations water down existing protections by folding
antipsychotic drugs into a broader category of psychotropic drugs and moving
them from quality of care regulations to pharmacy services.
Training: Training requirements have been expanded to apply to all
staff, contractual employees and volunteers. Mandatory topics include communication,
residents’ rights and abuse, neglect and exploitation. Certified nursing
assistants will be required to receive training on dementia management and
resident abuse prevention.
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