The Centers for Medicare & Medicaid Services (CMS) has proposed simplifying and streamlining long-term care (LTC) facility rules and survey processes to “increase provider flexibility and reduce excessively burdensome regulations, while also allowing facilities to focus on providing high-quality healthcare to their residents.”  In addition to numerous other provisions, CMS proposes the following changes that the agency anticipates would significantly reduce costs to LTC facilities:

  • Revising grievance policy requirements, including clarifying the difference between resident feedback and a grievance; removing the specific duties required of the grievance official who is responsible for overseeing the grievance process; paring the specific requirements for the content of written grievance decisions; and shortening the required document retention period related to results of grievances.
  • Limiting the conditions under which a facility must send a copy of a transfer or discharge notice to the State LTC Ombudsman to facility-initiated involuntary transfers or discharges.
  • Providing more flexibility in the required qualifications for a director of food and nutrition services.
  • Streamlining facility assessment requirements, including clarifying that data collected under the facility assessment requirement can be used to inform policies and procedures for other LTC requirements, removing duplicative requirements, and revising the requirement for the review of the facility assessment from annually to biennially.
  • Providing facilities with more flexibility in tailoring their Quality Assurance and Performance Improvement program to the specific needs of the facility.
  • Streamlining the regulatory requirements for compliance and ethics programs, including removing requirements for a compliance officer and compliance liaisons and reducing the frequency of mandatory program reviews.
  • Allowing LTC facilities that were Medicare or Medicaid certified before July 5, 2016, and that previously used the 2001 Fire Safety Equivalency System (FSES) to determine fire protection levels to continue to use the 2001 FSES scoring values when determining compliance with certain fire safety standards.
  • Limiting to newly-constructed facilities and newly-certified facilities that have never previously been a nursing home the current physical environment requirements that LTC facilities accommodate no more than two residents in a bedroom and equip each resident room with its own bathroom containing a commode and sink.
  • Revising the hearing process, including replacing the requirement for a facility to file a written waiver with a constructive waiver process that would operate by default when CMS has not received a timely request for a hearing.

CMS also proposes to delay implementation of certain “Phase 3” LTC requirements for participation that are scheduled to go into effect November 28, 2019; instead, they would be implemented one year following the effective date of the final rule.

CMS will accept comments on the proposed rule until September 18, 2019.