CMS REVISED RULES OF PARTICIPATION

Transcription

1 CMS REVISED RULES OF PARTICIPATION Webinar #3 December 1, 2016 Rebecca J. Bartle, RN, MSN, HFA Hoosier Owners and Providers for the Elderly Ref: S&C NH (11/9/16) Centers for Medicare and Medicaid Services (CMS) Survey and Certification Letter: Advance Copy - Revisions to State Operations Manual (SOM), Appendix PP - Revised Regulations and Tags Certification/SurveyCertificationGenInfo/Downloads/Surve y-and-cert-letter pdf 1

2 CONTENTS of 821 Page Document Pages 1-3 S&C NH November 9, 2016 Pages Draft Appendix PP (New Regulatory Text inserted into current Appendix PP) Pages New Regulatory Text (as distributed in training) Pages F- Tag Job List F-Tags Added as of 11/28/16- Revised Rules of Participation F523- Facility Closure- Administrator F524- Facility Closure F525- Binding Arbitration Agreements F526- Hospice Services F527- Mandatory Submission of Staffing Information Based on Payroll Data in a Uniform Format 2

3 Available Resources. Leading Age E-News Briefs 11/28/16 Mega-Rule Nursing Facility New Resources and Update In an effort to keep members up to date regarding the implementation of the new CMS nursing home megarule, here are a variety of resources to assist members to prepare: On-demand CMS training: CMS has on-demand, online training related to the Phase 1 requirements available for providers as described in a recent Survey & Certification letter. When the training materials are complete, CMS will post them here. The training will be available until July CMS will not track provider utilization of the training, and there is no completion test or certificate provided. CMS Webinar Slides: This link provides access to the slides from the October 27, 2016, CMS webinar presentation, Long-Term Care Facilities: Reform of Requirements. CMS Mega-Rule -- Phase I (NEW): This Leading Age document highlights the rule's requirements, effective November 28, High Level Summary of the Final Rule: This LeadingAge document provides a high-level overview of the final rule. Comprehensive Summary of the Final Rule(UPDATED): An 80-page summary of each section of the rule; key insights and points; a timeline for completion/effective dates; a comparison between key sections of the new rule and the current rule; suggested next steps for providers; and additional resources as available. 3

4 Mega Rule -- Side-by-Side Summary(NEW): This lengthy document compares the current nursing home requirements to the new/changed provisions contained in the mega-rule (our thanks to LeadingAge Minnesota). Annotated Table of Contents Complete Text of the Final Rule Questions from Webinar #2 In reference to the baseline care plan and adding aide involvement, in the first session on page 32 it says phase 1 for new care plan section; however, in the implementation checklist on page 4 it says phase 2. When is the adding of aide actually set to begin? 4

5 Questions from Webinar #2 Would it be possible to be provided the implementation timeline in WORD form so we can add our dated notes as we progress through the process? Questions from Webinar #2 Residents rights- Have the residents rights been updated to reflect changes with the ROP? 5

6 Questions from Webinar #2 Abuse allegation Is it the responsibility of the facility to notify APS upon making an allegation of abuse incident report to ISDH, or will ISDH do so? Questions from Webinar #2 Volunteers/contractors - Does the new rule requiring check for under employment prohibition mean we need to perform criminal background check or just OIG check? 6

7 Questions from Webinar #2 Post-acute providers- QM data? Questions from Webinar #2 14 day limit psychotropic meds- implementation is in Phase 1 or 2? 7

8 Questions from Webinar #2 Does a facility have to designate and have in place an Infection Preventionist in phase 1 or phase 3? Questions from Webinar #2 Was there any guidance on consultant pharmacist participation? Under pharmacy services, where it states Medical chart review for phase 2. Consultant pharmacists now review charts from home as all info is in the electronic chart. I have heard that this will cause the pharmacist to be at the facility. Does the wording actually state that, or as long as the pharmacist has access to all charts and info it can still be done away from facility? This is especially important as we plan our antibiotic stewardship, and want to look at residents newly started on antibiotics. We cannot physically go to facilities every day. 8

9 Questions from Webinar #2 Artificial supplements - we do not charge for supplements that are supplied by the dietary department, such as resource, magic cup, mighty shakes, Carnation instant breakfast etc. However, we are charging for supplements such as Ensure, Two-Cal, Glucerna, etc. Are we not supposed to charge for these according to the new rule? Does this apply to the residents with feeding tubes also? Questions from Webinar #2 Does all staff in AL and Residential need to be CPR and First Aid certified? My staff is only CPR certified but I believe that they need a separate certification for the First aid certification. 9

10 Questions from Webinar #2 This regulation "The resident has the right to have reasonable access to the use of a telephone, including TTY and TDD services" - do we have to have a special phone set up in the facility with the TTY and TDD service capabilities? Questions from Webinar #2 While updating my CPR policy and adding the wording about staff continuing CPR until EMS arrives, I noticed that our facility policy still has the wording about livor mortis and when not to perform CPR. I know that we have had several discussion about CPR in the last couple of quarterly sessions, so I just need some guidance in whether to take this part out and always do CPR on full code residents or keep it this way? What do you suggest? I tried to check interpretative guidelines and found in there that we don't have to initiate CPR if obvious signs of clinical death are present? 10

11 Questions from Webinar #2 I am wanting more clarification on what facilities had to do in Phase 1. Do the policies and procedures need to be done in Phase 1? A DEEPER DIVE. Please refer to Implementation Timeline 11

12 1) Updated definitions These need to be incorporated into your policies and procedures. 2) Resident Rights All this language should be incorporated into your policy and procedure manuals. Subsections (g)(4)(ii)-(v) relating to a resident s receipt of certain notices for the facility, are not effective until November 28, 2017 (Phase 2). 12

13 3) Freedom from Abuse, Neglect and Exploitation All Phase 1, with two exceptions written policies specific to the reporting of crimes in accordance with the Elder Justice Act (Phase 2); and written policies that establish coordination with the QAPI program (Phase 3). Most of these providers are already doing but you need to make sure your policy and procedure language is consistent with these new requirements. 4) Admission, Transfer, and Discharge Rights All Phase 1, with the exception of (c)(2) Transfer /Discharge Documentation (Phase 2). This is a lot of new terminology that must be consistent in your written policies addressing resident representative, admission policy, admission agreement, transfer and discharge policies, LOA policy, and communications plans. There is also some specific new language for bed hold requirements and other resident rights issues related to transfers and discharges. Make sure these changes are reflected in your written policies. 13

14 This is also the section that bans pre-dispute arbitration, and bans waivers for loss of property; your policies must reflect the same. The LeadingAge Provider Summary has a lengthy table that compares the prior requirements, subsection by subsection, with the new requirements. It is worthwhile to read it item by item as there are likely significant edits and changes you will need to complete to your written policies. 5) Resident Assessment All Phase 1. This includes new language changes and moves the language on care plans and discharge planning to Resident assessment must also include the resident s strengths, goals, life history and preferences not just their needs. There are specific pre-admission screening and resident review (PASRR) requirements for mental health referrals that should be noted. 14

15 6) Comprehensive Resident Centered Care Plans This is a new section and is all included in Phase 1, with the exceptions of the base line care plan requirement (Phase 2) and the inclusion of traumainformed care (Phase 3). Phase 1 includes the requirement to include specialized services based on the PASRR recommendations; the expansion of the inter-disciplinary team (IDT), and expanded documentation for discharge planning. 7) Quality of Care and Quality of Life Is also Phase 1, except for the requirements that pertain to trauma-informed care. You must insure you have appropriate personnel to provide basic life support/cpr (you cannot be a no-cpr facility). There may need to be updated policies and procedures related to pain, tube feedings, restraints, bedrails, ADL assistance, and mobility/range of motion (ROM). 15

16 8) Physician Services The entire section is phase 1. It allows attending physicians to delegate to a qualified dietitian writing dietary orders and to a qualified therapist writing therapy orders to the extent permitted under state law. 9) Nursing Services This is all Phase 1, except for that which is linked to the facility assessment to determine sufficient number and competencies for staff (Phase 2). This does include new requirements for documentation of training. 16

17 10) Behavioral Health Services Most of this is Phase 2. However, the requirement that the facility must provide comprehensive assessment and medically related social services is Phase 1 11) Pharmacy Services The entire section is Phase 1, except the medical chart review (Phase 2) and the expansion of psychotropic drugs and the limit of PRN orders to 14 days (Phase 2). The Phase 1 requirements include the requirement to notify any irregularities to the medical director. 17

18 12) Laboratory, Radiology and Other Diagnostic Services This section is all Phase 1. Make sure your community has standards for service and timeliness, a process for overseeing and tracking quality and policies and procedures that describe abnormal ranges and notification timing policies. 13) Dental Services This is all Phase 1, except for the loss and replacement of dentures policy and referral for dental services which are both Phase 2. You must update policies and procedures related to loss of denture and facility responsibility. You must provide for transportation and you must document that the resident can eat and drink while awaiting referral. 18

19 14) Food and Nutrition Phase 1 requirements: Education requirements for newly hired director of food and nutrition services or newly hired dieticians, Participation of food services person in IDT, Policy requiring menus that reflect cultural and ethnic needs of residents, Allowance of physicians to delegate to a registered or licensed dietician the task of prescribing a resident s diet, as allow by state law, and Must have a policy regarding use and storage of food brought by families to secure safe and sanitary storage, handling and consumption. 15) Specialized Rehab Services Phase 1 Update written policies to include respiratory therapy to the list of specialized rehabilitation services and include the policy for obtaining these services when the need is identified. 19

20 16) Administration Phase 1 requirements include updating policies and procedures to define that the administrator reports to/ is to be accountable to the governing body, and that the governing body is responsible and accountable for quality assurance/performance improvement (QAPI); and there shall be no pre-dispute arbitrations. The portion of this section related to facility assessments is Phase 2, and QAPI implementation is Phase 3. 17) QAPI The only immediate action in Phase 1 is the make up the quality assessment and assurance (QAA) committee. Written policies should be updated to reflect new team member requirements. Most of this section is due in Phase 3. 20

21 18) Infection Control Phase 1 requires updated policies and procedures: - regarding infection control and prevention, - policies regarding when and how infection control procedures will be used, - policies related to employees with communicable diseases or infections, and - policies regarding hand washing and storage and processing of linens. Update policies regarding immunizations. 19) Physical Environment Phase 1 requirements include policies and procedures related to new requirement for substantial reconstruction, regular inspection of bedframes, mattresses and bedrails. 21

22 20) Training requirements Update written policies for training of staff and volunteer training. Must provide and document training in dementia and abuse to all volunteers, must have training for feeding assistants, and must have staff training at least annually on abuse and dementia care. Where do I go from here? Participate in the available CMS Provider Trainings Continue to revise policies and procedures; date revisions Maintain a record of facility efforts toward compliance, to ease identification of revisions made to comply with new rules When asked, you will be able to denote what you revised and when 22

23 Submit Questions Quarterly Compliance- Thursday, February 2,