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CMS Final Rule: Newly Reformed Requirements of Participation for Long-Term Care Facilities

The CMS final rule on Requirements of Participation will be published in the Federal Register on October 4, 2016. These regulations are effective on November 28, 2016. The regulations included in Phase 1 must be implemented by November 28, 2016. The regulations included in Phase 2 must be implemented by November 28, 2017. The regulations included in Phase 3 must be implemented by November 28, 2019. A detailed discussion regarding the different phases of the implementation timeline can be found in Section B. II "Implementation Date." The following is a statement from Mark Parkinson, President and Chief Executive Officer at the American Health Care Association (AHCA) regarding the Centers for Medicare and Medicaid Services (CMS) final rule on Requirements of Participation:

The CMS rule represents the first updates and requirements for skilled nursing centers to participate in Medicare since 1991. A lot has changed in the profession in those decades, and we were pleased to offer constructive comments to improve the services we provide for the millions we serve today.

While the agency took some steps forward in helping individuals in our centers, there were several provisions that harm our efforts to continue the tremendous strides we've made in quality and care delivery. Further, even CMS admits this new wave of regulations will bring with it hundreds of millions in additional costs without any new funding streams. We will spend the coming days and weeks determining what overall impact those mandates will have on our members.

With respect to the arbitration ruling, AHCA is extremely disappointed that CMS included in the final rule a provision banning all pre-dispute arbitration agreements. That provision clearly exceeds CMS's statutory authority and is wholly unnecessary to protect residents' health and safety.

There are some positives in the final rule compared to the proposed rule that we have already identified:

  1. Certain provisions of the rule are phased in over a three-year period. It is important to note that all regulations are effective 60 days following the date of public inspection of the final rule, Nov. 28, 2016, but the rule provides additional time for facilities to implement key areas. The process CMS has used for the phase-in is a bit complicated, and we will work through it and provide the details to members in an easy-to-understand format.
  2. There is no required staffing ratio in the final rule.
  3. There is no requirement for a physician or physician extender to conduct an in-person evaluation of a patient prior to an unscheduled transfer to a hospital.

OHCA and AHCA will continue to review the ROPs and will provide further review and educations for providers. Providers may be interested in attending the Comprehensive Survey Forum seminar scheduled for October 10, 2016 at the Holiday Inn Independence, and October 11, 2016 at Quest Conference Center, Columbus, Ohio. This program will we will identify all of the policies and procedures that will be needed and or updated. Details and online registration are available below under "Education" and at