The Center for Medicare & Medicaid Services (CMS) issued a proposed rule on September 20, 2018 entitled Medicare and Medicaid Programs; Regulatory Provisions to Promote Program Efficiency, Transparency, and Burden Reduction.  CMS aims to reduce regulatory burden with this proposed rule, which includes two main issues of importance to skilled nursing centers and Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID): Emergency Preparedness and Hospice.

What You Should Know

This proposed rule impacts regulations for 12 different types of health care providers and suppliers that must comply with the CMS requirements related to Emergency Preparedness. The following are the Emergency Preparedness provisions of the proposed rule that will impact nursing centers:

• There is no longer a need to document efforts to contact local, tribal, regional, state, and federal emergency preparedness officials related to their participation in collaborative and cooperative planning efforts.
• A training program for the emergency plan must be provided biennially (every 2 years), rather than annually, after the initial training for the emergency program. Additional training must occur when the plan is significantly updated.
• The types of acceptable testing exercises that may be conducted is expended so one of the two annually required testing exercises may be an exercise of the provider’s choice. This may include one community-based, full-scale exercise, if available, an individual facility-based functional exercise, a drill, or a tabletop exercise or workshop that includes a group discussion led by a facilitator.
• Providers must review their emergency plan, policies and procedures, communication plan, and training and testing at least every two years (rather than annually).
  

Other Changes Proposed

There are proposed changes to the Hospice regulations when operating in a nursing center or an ICF/IID that relate to providing orientation to the nursing center and ICF/IID staff about the hospice philosophy and its approach to care. It is also important to note that under this proposal, ICF/IIDs must develop and maintain an emergency preparedness plan that must be reviewed and updated at least every two years. The ICF/IID must also conduct exercises to test the emergency plan at least twice per year.

Further, there are changes proposed to Long Term Care Hospitals and Critical Access Hospital Providers of Long-Term Care Services (“Swing Beds”). 

Additional Regulatory Reform Recommendations Requested 

CMS is also asking for public comments on additional regulatory reforms for burden reduction in future rulemaking. Specifically, they are seeking public comment on additional proposals or modifications to the proposals set forth in this rule that would further reduce the burden on Medicare and Medicaid participating providers and suppliers and create cost savings, while also preserving the quality of care and patient health and safety. CMS notes that suggestions could include or expand on comments submitted in response to requests for information that were included in the 2017 prospective payment regulations for most provider types. 

Comments to CMS

AHCA and the AHCA Emergency Preparedness Committee will be reviewing the proposed rule more carefully in the next few weeks and will provide more detailed information. Comments are due to CMS by 5:00 pm on November 19, 2018.  

For questions or comments relating to issues impacting nursing centers, please contact AHCA’s Erin Prendergast at eprendergast@ahca.org. For feedback relating to the ICF/IID provisions, please contact AHCA’s Dana Halvorson at dhalvorson@ahca.org.