cms final rule
Post on 13-Apr-2017
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Released October 4th, 2016
Reinforces patient centered care approach
Key detrimental elements were removed from the final rule
Phased in over 3 years
Greatest changes in regulations affecting SNF’s since OBRA ’87
Average cost per facility year 1 to implement changes= $62,900
Average cost per facility per year thereafter to implement changes= $55,000
Adds new requirements to the conditions of participation
The final rule is a large, detailed document
© Arete Rehab 2016
PHAS
E 1 PHASE 3
PHASE 2
§ 483.1 Basis and scope§ 483.5 Definitions§ 483.10 Resident Rights § 483.12 Freedom from abuse, neglect, & exploitation§ 483.15 Admission, transfer, & discharge rights§ 483.20 Resident Assessment§ 483.21 Comprehensive person centered care plan§ 483.24 Quality of life§ 483.25 Quality of care§ 483.30 Physician services§ 483.35 Nursing services§ 483.40 Behavioral health services§ 483.45 Pharmacy Services§ 485.50 Laboratory, radiological, other diagnostics § 483.55 Dental services§ 483.60 Food and nutrition services§ 483.65 Specialized rehab services§ 483.70 Administration§ 483.75 Quality assurance§483.80 Infection control§ 483.85 Compliance§483.90 Physical environment
§ 483.10 Resident Rights (g)(4)(ii-v)§ 483.12 Freedom from abuse, neglect, & exploitation (b)(5)§ 483.15 Admission, transfer, & discharge rights (c)(2)§ 483.21 Comprehensive person centered care planning (a)§ 483.35 Nursing services facility assessment§ 483.40 Behavioral health services (a)(1) § 483.45 Pharmacy Services (c)(2), (e), § 483.55 Dental services (a)(3), (a)(5), (b)(3), (b)(4),§ 483.60 Food and nutrition services (a)(2)(I)§ 483.70 Administration (e)§ 483.75 Quality assurance (a)(2)§ 483.80 Infection control (a), (a)(3)§483.90 Physical environment (h)(5)
§ 483.10 Resident Rights (g)(4)(ii-v)§ 483.12 Freedom from abuse, neglect, & exploitation (b)(4)§ 483.21 Comprehensive person centered care planning(b)(3)(iii)§ 483.25 Quality of care (m)§ 483.60 Food and nutrition services (a)(1)(iv) § 483.70 Administration (d)(3)§ 483.75 Quality assurance (g)(1)§483.80 Infection control (b), (c)§483.90 Physical environment (f)(1)
© Arete Rehab 2016
• Resident Rights Updates language only
• Freedom from Abuse, Neglect, and Exploitation Requires facility to investigate and report all allegations of abusive conduct Prohibits employing individuals with disciplinary action against their professional license for
abuse, neglect, mistreatment, and/or misappropriation of property• Admission, Transfer, and Discharge
Requires facility to document all transfers/discharges in the medical record Requires facility to provide specific information to be exchanged with receiving provider/facility
upon transfer• Resident Assessments
Clarifies coordination of resident assessment with PASARR • Comprehensive Person Centered Care Planning
Requires facility to develop and implement a baseline care plan within 48 hours of admission that includes instructions to provide effective patient care that meets professional standards of quality care
Requires facility to include nursing assistant & food/nutrition staff in care plan development Requires facility to develop & implement discharge planning process that focuses on patients
discharge goals Requires facility to include patients as active partners in discharge care and effective transitions
to reduce preventable re-admissions.
The Details
© Arete Rehab 2016
• Quality of care Requires facility to provide the necessary care and services to attain or maintain highest
practicable level of physical, mental, and psychosocial well-being consistent with care plan• Quality of life
Requires facility to ensure resident care & treatment is in accordance with professional standards, care plan and resident choices.
• Physician services Allows facility physician to delegate order writing to clinically qualified professionals, i.e. dietary,
rehab• Nursing services
Requires facility to add a competency requirement for determining the sufficiency of nursing staff• Behavioral Health services
Requires facility to provide necessary behavioral health care Allows facility to add gerontology to the list of possible human service fields for minimum
educational requirement of a social worker. • Pharmacy Services
Requires facility pharmacist to review medical record during monthly drug regime review Requries “antipsychotic” drugs to refer to “psychotropic” drugs Requires several provisions to reduce, eliminate the need for psychotropic drugs to safeguard a
resident’s health, if not clinically contraindicated.
More Details
© Arete Rehab 2016
• Laboratory, Radiological, & Other Diagnostic services Clarifies that a facility PA, NP or clinical nurse specialist may order lab, imaging, and other
diagnostic services within their scope of practice• Dental
Prohibits facility from charging Medicare recipient for the loss or damage to dentures determined to be facility responsibility
Requires policy identifying when denture loss is facility responsibility Requires facility to assist residents to apply for dental service reimbursement under Medicaid. Clarifies “promptly” to mean a referral made in 3 days.
• Food and Nutrition Requires facility to offer a nourishing, palatable well-balanced diet that meets the residents daily
nutritional and special dietary needs. Requires facility to consider resident preferences Requires facility to provide sufficient staff, including designation of a director of food and nutrition
service.• Specialized Rehabilitation Services
Adds respiratory services as specialized rehab services
Even More Details
© Arete Rehab 2016
• Administration Requires facilities to conduct, document, and annually review a facility wide assessment to
determine needed resources to competently care for its residents, during day to day and during emergency operations
Prohibits pre-dispute binding arbitration agreements• Quality Assurance and Performance Improvement
Requires facility to develop, implement, and maintain data driven QAPI program that focuses on systems, outcomes and quality of life
• Infection control Requires facility to develop infection prevention and control program with antibiotic stewardship
program with at least one identified Infection Preventionist• Compliance and Ethics Program
Requires facility to have a compliance and ethics program with written compliance and ethics standards, policy and price
• Physical environment Requires constructed, re-constructed, or newly certified facility to accommodate no more than 2
patients to a room with a bathroom with at least a commode and sink in each room • Training
Requires facility to develop, implement, and maintain an effective training program for all new staff and existing staff, individuals under contractual relationships, and volunteers consistent with role.
Finally, the end of the details
© Arete Rehab 2016
Effective Date
3 Years1 Year
EFFECTIVE DATE:60 Days from Publication
PHASE ONE 90%DATA
PERCENTAGE
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look like when placed in this area.
AVG.EVALUATION
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look like when placed in this area.
Phase 1 Phase 3
Phase In Time Line
EFFECTIVE DATE: 1 Year From Phase 1
PHASE TWO
EFFECTIVE DATE: 3 Years from Phase
1
PHASE THREE
Phase 2
© Arete Rehab 2016
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