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 Congressional Effort to Delay Requirements of Participation Regs Gains Steam

Bipartisan congressional support for delaying implementation of the updated Requirements of Participation (ROP) for skill nursing facilities (SNFs) has gained significant ground, as the number of signatories to a letter circulated in the House garnered the support of 122 members, according to the American Health Care Association (AHCA).

The House letter, spearheaded by Rep. Jim Renacci (R-Ohio), urges the Department of Health and Human Services and the Centers for Medicare & Medicaid Services (CMS) to work with providers and patient advocacy groups to consider revisions to the ROP rule and delay by one year the implementation of phase two of the revised ROP. If left as is, the implementation of phase two would start next month on Nov. 28.

The aim of the long term and post-acute care (LT/PAC) profession is to alleviate regulatory and financial burdens on long term care facilities while ensuring patient safety and a high quality of care, according to Clif Porter, senior vice president, government relations, for AHCA.

He said that the Renacci letter importantly gained the support of a variety of lawmakers, with signatories coming from both the Republican and Democratic parties, from ultra conservatives to members of the Congressional Black Caucus, to members of House leadership.

“This speaks to the fact this is very much a nonpartisan, nonideological issue for members of Congress. Regardless of party and position, they feel strongly about delaying implementation of the ROP and the alleviation of new regulations and financial burdens on the long term care community,” Porter said.

The Renacci letter and overall ROP discussion stems from a final rule issued by CMS on Oct. 4, 2016, that updated regulations for SNFs and nursing facilities.

“While many of the provisions included in the rule mean well, taken together they represent a burden to providers caring for some of the country’s most vulnerable individuals,” the Renacci letter said. “The unfunded mandate includes changes to update standards of practice, consideration for types of residents in nursing centers, and changes that CMS believes will improve care for residents.”

CMS estimates that the cost of compliance during the first year of the updated ROP could be as much as $62,900 per facility and $55,000 in subsequent years. In total across the nation this would total $831 million in the first year and on-going annual costs of $736 million.

Renacci’s letter said that coming “on top of the already thin margins that SNFs operate on, this burden is even harsher for SNFs that care for patients who use Medicaid to pay for their care, as Medicaid only reimburses 89 cents for every dollar of care.”

In addition to the challenge presented by higher costs, some of the updated requirements appear to be duplicative since in many cases providers have already developed effective procedures and guidelines to protect patients and ensure the provision of quality care, the letter said.

A delay in the implementation of the revised ROP would allow CMS to work with LT/PAC providers and patient advocacy groups to weigh possible revisions to the regulation.

“We encourage you to re-evaluate the nursing home requirements of participation to allow for thoughtful revisions to be made and to give providers time to comply with the changes,” the Renacci letter said.

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