As many of you know, CMS released the Proposed FY 2018 payment rule (https://www.gpo.gov/fdsys/pkg/FR-2017-05-04/pdf/2017-08521.pdf). Within this proposed rule, the agency opened the door for comments related to the three bulleted items below, as well as other provisions of the revised Requirements of Participation (RoPs) that are problematic in terms of the burden they impose on providers. CMS would like to hear not only issues and burdens you may have in these areas, but also specific solutions you may offer. Comments are due to CMS on June 26. You may either submit your comments directly to CMS (https://www.regulations.gov/document?D=CMS-2017-0060-0002), or you may send them to LeadingAge (jhilliard@leadingage.org) by June 19th for incorporation into our letter.

 

When preparing your comments it is helpful to begin with one or two sentences that describe your community and where you are located. Even if you don’t want to prepare a formal letter, you can send us bullet points of your comments. You may take the language below, or you may expand on it or other related issues that impact your nursing home setting.

 

The list below reflects LeadingAge’s position regarding the three areas outlined by CMS for possible elimination or revision to reduce the regulatory burden imposed on LTC facilities by the RoPs, as well as other provisions of the RoPs which may also be burdensome for providers. Above all, LeadingAge is seeking members’ practical perspective in these areas, including examples as to how these provisions affect them negatively.

• Grievance Process – LeadingAge takes the position that maintaining evidence related to grievances for three years and strict timelines for resolving grievances are overly prescriptive and costly. Also, the designation of a grievance official with extensive duties that are similar to a compliance officer does not afford facilities the flexibility to deal with grievances as their need (and state law) dictates.
• QAPI – LeadingAge supports the overall concept and goals of QAPI as a valuable tool to promote quality care; however the mandated process is rigid, inflexible and far too detailed. Accordingly, LeadingAge supports revisions to this portion of the RoPs that would allow facilities the freedom to design a program that best suits their individual needs consistent with an overarching regulatory framework.
• Discharge Notices – LeadingAge maintains that requiring providers to report every non-resident-initiated transfer or discharge of residents to the state LTC Ombudsman is unnecessary and accomplishes nothing more than to burden both the facility and the LTC Ombudsman with paperwork. Rather, LeadingAge supports notification of the Ombudsman only in cases of involuntary transfers or discharges.

Additional Talking Points – The following are additional areas of the RoPs for which LeadingAge is soliciting input from the membership:

• Training Requirements – LeadingAge is concerned that the training requirements are overly broad and take too much staff time away from resident care.
• Facility Assessment – Changing acuity, resident needs and demographics will require almost constant review and updating of the facility assessment. This will require substantial staff time, both for day-to-day operations and emergencies.
• Infection Preventionist – Facilities will be required to hire new staff with specialized training in infection prevention and control simply to comply with this requirement.
• Other – LeadingAge is interested in hearing from members about other provisions of the RoPs that are problematic and present a significant economic or practical burden on their ability to provide resident-centered care.