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 Senate Letter Seeks Delay in Requirements of Participation Regulations

A second letter has been delivered to the heads of the Dept. of Health and Human Services (HHS) and Centers for Medicare & Medicaid Services (CMS) seeking a one-year delay in the implementation of the updated Requirements of Participation (ROP) for skilled nursing facilities (SNFs), according to sources at the American Health Care Association (AHCA).

On Oct. 26, the Hoeven letter – named for main sponsor Sen. John Hoeven (R-N.D.) – was sent to Acting HHS Secretary Eric Hargan and CMS Administrator Seema Verma with the names of 24 signatories. This effort joins a previous push in the House when a similar letter to delay the ROP regulations garnered 122 signatories.

Clif Porter, senior vice president, government relations for AHCA, says congressional support reflects members’ concerns about how the new regulations will affect SNF care. In the letters, lawmakers ask HHS to enact a delay ahead of the implementation of phase two of the ROP set to take place on Nov. 28 so that revisions can be made.

“The letters also reflect rural concerns regarding practicality of implementation,” he said. 

In the Hoeven letter, the senators note, “there is nothing more important than ensuring the safety of nursing home residents, and the goal of improving care in SNFs is one we all share.”

However, the letter continued, “we believe that improving care and reducing administrative burdens on SNFs are not mutually exclusive issues. That is why we request that you take into consideration the concerns of SNFs and long term care providers, and consider delaying for one year the overly burdensome parts of the ROP rule.”

The House letter, spearheaded by Rep. Jim Renacci (R-Ohio), urged the same action by HHS and CMS.

The Hoeven and Renacci letters and efforts by AHCA stem from a final rule issued by CMS on Oct. 4, 2016, that updated regulations for SNFs and nursing facilities. Even though the SNF industry and its congressional backers said many of the provisions included in the rule mean well, all told they represent a burden to providers who are caring for some of the country’s most vulnerable individuals.

These issues include 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. Across the nation this would total $831 million in the first year and on-going annual costs of $736 million.

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 Hoeven letter also said a delay in the implementation of the revised ROP would allow CMS to work with long term and post-acute care providers and patient advocacy groups to weigh possible revisions to the regulation.​

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