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CMS Announces New Conditions of Participation for Long-Term Care Facilities

Recently, the Centers for Medicare & Medicaid Services (“CMS”) issued a final rule (“Final Rule”) updating the Medicare Conditions of Participation (“CoPs”) for long-term care (“LTC”) facilities. It is the first time in over 15 years that substantial LTC CoP revisions have been released.

LTC facilities affected by the Final Rule include skilled nursing facilities for Medicare and nursing facilities for Medicaid, or those facilities that are duly certified. The Final Rule took effect on November 28, 2016, however CMS has planned for a phased implementation. LTC providers must complete the three implementation phases by November 28 in the years 2016, 2017 and 2018, respectively. CMS has estimated that the costs of compliance will be $62,900 in the first phase of implementation, and $55,000 per year for phases two and three.

CMS explained that the Final Rule is aimed at, “reducing unnecessary hospital readmissions and infections, improving the quality of care, and strengthening safety measures for residents in these facilities.”

The Final Rule is extensive and is available here for your review.  Some of the issues addressed in the Final Rule are summarized below.

Freedoms from Abuse, Neglect and Exploitation

The Final Rule requires LTC facilities to investigate and report all allegations of abusive conduct. The Final Rule also specifies that facilities cannot employ individuals who have had a disciplinary action taken against their professional license by a state licensure body as a result of a finding of abuse, neglect, mistreatment of residents or misappropriation of a resident's property.

Admission, Transfer and Discharge Rights

The Final Rule requires that a transfer or discharge be documented in the medical record and that specific information be exchanged with the receiving provider or facility when a resident is transferred.

Comprehensive Person-Centered Care Planning

The Final Rule requires facilities to develop and implement a baseline care plan for each resident within 48 hours of their admission, which includes the instructions needed to provide effective and person-centered care that meets professional standards of quality care.

Quality of Life

The Final Rule requires that, based on the comprehensive assessment of a resident, LTC facilities ensure that residents receive treatment and care in accordance with professional standards of practice, the comprehensive person-centered care plan, and the residents' choices.

Pharmacy Services

The Final Rule requires that a pharmacist review a resident's medical chart during each monthly drug regimen review. CMS is also revising existing requirements regarding “antipsychotic” drugs to refer to “psychotropic” drugs and define “psychotropic drug” as any drug that affects brain activities associated with mental processes and behavior. In addition, CMS is requiring several provisions intended to reduce or eliminate the need for psychotropic drugs, if not clinically contraindicated, to safeguard the resident's health.

Infection Control

The Final Rule requires LTC facilities to develop an Infection Prevention and Control Program that includes an Antibiotic Stewardship Program and designate at least one Infection Preventionist.

We encourage LTC facilities to carefully review and familiarize themselves with the Final Rule in order to ensure compliance. Foster Swift’s Health Care attorneys are available to help clients understand and implement the Final Rule’s many requirements. If you have questions, or need assistance with implementing the Final Rule, please contact Jennifer B. Van Regenmorter or Julie Hamlet.

Categories: Compliance, Long Term Care, Medicare/Medicaid, News & Events, Pharmacy, Providers

 has particular expertise in health law and she represents providers with emphasis in the areas of physicians, hospice, home care and long term care, including one of the country’s largest long-term care organizations. She has a vast array of experience in teaming with providers in the areas of regulatory compliance and contracts. 

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