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 CMS Proposes Wide-Reaching Rules For Nation’s Long Term, Post-Acute Care Centers

Washington—The Obama administration on Monday unveiled a new set of proposed regulations that would require the nation’s 15,000 long term and post-acute care centers to focus on what regulators are calling a “competence-based” approach to elder and rehabilitative care.

In an as-yet unpublished rulemaking notice, the Centers for Medicare & Medicaid Services (CMS) are asking for comment on rules that would require caregivers to asses their centers’ capabilities and their residents’ needs.

“Using the information from that assessment, facilities would be required to provide sufficient staff with the necessary competencies and skills to meet each resident’s needs based on acuity, diagnosis, and the resident’s person-centered comprehensive care plan,” the rulemaking notice states.

Most centers are already doing that kind of work, “at least informally,” but CMS officials say they want to “ensure” that the practice “is consistently performed and documented” in the nation’s care centers.

The proposed regulations also include a long-awaited proposed rule on compliance and ethics programs and requirements for each nursing center’s Quality Assurance and Performance Improvement program.

Monday’s notice had long been expected, but the administration began circulating copies of it just hours before the annual White House Conference on Aging began. The “competence-based” requirements would cover “every service” offered by a care center “and apply to all members of the staff, including the interdisciplinary team.”

“For example,” the notice says, “a facility that provides dementia care would need to ensure it has sufficient numbers of staff and that the staff has the necessary training, education, and/or experience to care for individuals with dementia. These staff may be nursing service staff, behavioral health staff, or other appropriate care providers. Similarly, adding a competence-based requirement would ensure that a facility serving residents requiring post-acute rehabilitation care had sufficient staff with the required training, education and/or experience to care for individuals requiring those services. We propose that the focus be on the competencies and skill sets of the individuals delivering care and services rather than just on the overall number of caregivers available. This competence-based approach is compatible with existing state requirements and business practices and promotes both efficiency and effectiveness in care delivery. In addition to a competence-based approach, this proposed rule is intended to meet the spirit of current [Health and Human Services] quality initiatives that cut across various providers.”

The 403-page rulemaking notice also would require care centers to follow minimum standards for person-centered care, including:

  • A “baseline care plan” for each resident, “which includes the instructions needed to provide effective and person-centered care that meets professional standards of quality care,” to be written within 48 hours of admission;

  • The inclusion in residents’ care plans of “any specialized services or specialized rehabilitation services” required by the results of pre-admission screenings and resident reviews; if a center disagrees with the pre-screening and review, officials there will have to lay out their medical rationale in the residents’ care plans;

  • Adding a nurse’s assistant, a member of the food and nutrition staff, and a social worker to the interdisciplinary team that develops a resident’s comprehensive care plan;

  • A written explanation from care centers when residents or their representatives aren’t part of the care planning team;

  • Taking into account “quality, resource use, and [residents’] treatment preferences and goals of care” in discharge plans;

  • Writing a resident’s goals, potential for future discharge, and discharge planning into comprehensive care plans;

  • Reconciling discharge medications with resident’s pre-admission medications in the discharge summary; and

  • Summaries for follow-up care once a resident leaves a care center.

Officials at the American Health Care Association/National Center for Assisted Living, the nation’s largest provider advocacy group, said Monday they were reviewing the mammoth rulemaking notice and will likely offer their thoughts within the public comment period.

The rulemaking will be published in the Federal Register Thursday; afterwards, the public will have 60 days to comment on the proposed rules.

Bill Myers is Provider’s senior editor. Email him at Follow him on Twitter, @ProviderMyers.

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