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Second Phase of Changes to Federal Requirements of Participation for Nursing Homes Now in Effect

In mid-November, we blogged on the changes to the Federal Requirements of Participation for Nursing Homes, the already established set of criteria put in place by the Centers for Medicare and Medicaid Services (CMS), the federal entity responsible for overseeing nursing homes. CMS is also the single largest payer for healthcare in this country, including for the care of those who reside in nursing homes.

On November 28th, phase 2 of the 3 part improvement plan went into effect. As a concession for nursing homes arguing that instantly implementing these requirements would be difficult, CMS has given facilities up to 18 months to become compliant.

Noteworthy Additions to Nursing Home Regulations
The most significant addition was the requirement for nursing homes to create something called a baseline care plan for each resident. The care plan would cover all aspects related to a resident’s plan of care, including dietary and mobility restrictions, necessary therapy and social services, required medications, and physician orders. This plan must be developed within 48 hours of a resident’s admission to a facility.

Another noteworthy change is the requirement of a facility assessment, a nursing home-maintained document with the intent of constant evaluation of the needs of residents and the types of resources available and needed at the facility. While the rule states the assessment should be updated at least annually, the purpose is to ensure that nursing homes are continually taking stock of new and current residents and how best to meet their health and wellness needs.

A review of all phase 2 additions and modifications to the Federal Requirements of Participation for Nursing Homes is available here, courtesy of The National Consumer Voice for Quality Long-Term Care.

About Nursing Home Surveys and Punishment for Violations
While any tightening of rules and regulations surrounding nursing homes can only be seen as a step in the right direction, many will likely take advantage of the 18 month grace period before actually implementing any changes. Facilities are monitored for their compliance with nursing home regulations through state-conducted unannounced surveys that are required to be within no more than 15 months of the last survey. Fines are typically levied for violations, but as we’ve seen over the years, the fines are typically minimal and punishment is notoriously inconsistent. If a facility has been surveyed and found to be severely deficient, they are placed on CMS’ Special Focus Facilities (SFF) list. Only upon showing improvement through more frequent inspections can a facility be moved from the list and placed back under regular observation. Facilities who fail to improve can potentially lose their ability to receive payments from Medicare and Medicaid.

While the practice of unannounced surveys, fines, and SFF lists are good in theory, the threat of fines is not enough for all nursing homes to change their procedures for the long term. In fact, a study by Kaiser Health News found that over half of the facilities that have graduated from the SFF list since 2014 have seriously harmed and even killed residents since being removed from the list. Only 16% of facilities placed on the list have ever lost CMS funding. Less than 5% of the facilities that met the requirements to be placed on the SFF list are actually identified as such, likely due to a lack of resources required to frequently survey and monitor such a large number of facilities.

Find out If and Why Your Nursing Home Has Been Fined 
Curious if your nursing home or a loved one’s nursing home or assisted living facility has been fined by CMS? The information is available to the public through Nursing Home Compare, a website operated by CMS. After searching for the facility, click the Health Inspections tab to read the report(s) detailing why penalties were assessed. The dollar amount of fines can be found under the Penalties tab.

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