On Oct. 4, CMS published the biggest overhaul to federal long-term care regulations since 1991.

The lengthy Final Rule reforms the requirements for long-term care facilities participating in Medicare and Medicaid. CMS will implement the new and revised regulations in three phases, with Phase 1 regulations having an implementation date as early as Nov. 28 and Phase 3 three years later on Nov. 28, 2019.

Executive Summary of Final Rule

The Final Rule outlines new and/or revised provisions that govern the following key areas, among others:

• Arbitration, prohibiting a facility from entering into an arbitration agreement prior to a dispute arising;

• Compliance Plan, requiring the implementation of a compliance and ethics program;

• Training, setting forth requirements of a training program for facility staff, contractors, and volunteers;

• Abuse, imposing required investigations and reports, and prohibiting certain hiring practices;

• Administration, requiring an annual self-assessment of facility resources, resident population, and a facility-based and community-based risk assessment;

• Quality Assurance and Performance Improvement (QAPI), addressing the development and maintenance of a QAPI program for systems of care, outcomes of care, and quality of life;

• Resident Assessment, clarifying what is appropriate coordination of resident assessments with the PASARR program under Medicaid;

• Care Planning, imposing requirements on the development of care plans and discharge planning;

• Nursing Service, adding a competency requirement for determining the sufficiency of nursing staff;

• Pharmacy Service, requiring pharmacists' monthly review of medical charts and implementing measures to reduce or eliminate the use of psychotropic drugs; and,

• Infection Control, requiring the development of an Antibiotic Stewardship Program.

Acknowledging that the last time requirements for participation were reviewed and updated was 25 years ago, CMS passed the Final Rule for a variety of reasons, including:

• The substantial changes in the delivery of long-term care over the years;

• The emergence of significant innovations in resident care and quality assessment practices;

• The increase in a more diverse and clinically complex population; and,

• Enhanced research and knowledge of resident safety, health outcomes, individual choice, and quality assurance and performance improvement.

CMS' stated goal of the new regulations is to improve the quality of life, care, and services in long-term care facilities, optimize resident safety, reflect current professional standards, and improve the logical flow of the regulations.