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CMS Issues Final Rule on Requirements of Participation

CMS Issues Final Rule on Requirements of Participation

cms 082114Predispute Arbitration Clauses Banned

AHCA Member Briefing Scheduled for October 3, 4:30 pm

Yesterday CMS released an early inspection version of the final Requirements of Participation (ROP) rulemaking. These revisions to the Medicare and Medicaid participation requirements for long term care facilities are the most significant changes to the regulations governing nursing facilities since 1991. The rule will be published in the Federal Register on October 4, 2016 with a November 28 effective date.

On Monday, October 3, 2016, AHCA will hold a one-hour member briefing on the new requirements. It will include a high-level summary of the changes followed by a focus on the first phase of the three-year phase in.

AHCA Member Briefing on the ROP Final Rule
Monday, October 3, 4:30 – 5:30 pm
Click here to register.

CMS explains that the rule is targeted at reducing unnecessary hospital readmissions and infections, improving the quality of care, and strengthening safety measures for residents in these facilities.  However, AHCA and VHCA are extremely disappointed that CMS included in the final rule a provision banning all predispute arbitration agreements.

According to an alert from AHCA to state affiliates and in statements the association made to the media, the predispute arbitration provision clearly exceeds CMS’s statutory authority and is  wholly unnecessary to protect residents’ health and safety. AHCA and VHCA will consider the appropriate steps to take in light of this unjustified action by CMS.

AHCA has identified the following as positive changes in the final rule compared to the 2015 proposed rule:

  • Certain provisions of the rule are phased in over a three-year period. It is important to note that all regulations are effective 60 days following the date of public inspection of the final rule, Nov. 28, 2016, but the rule provides additional time for facilities to implement key areas. AHCA will provide members the details on the complicated phase-in provisions in an easy-to-understand format in the near future.
  • There is no required staffing ratio in the final rule.
  • There is no requirement for a physician or physician extender to conduct an in-person evaluation of a patient prior to an unscheduled transfer to a hospital.

This rule does not apply to assisted living facilities, including those that accept Medicaid.  In this context, a long term care (LTC) facility is defined as a skilled nursing facility or nursing facility.  CMS does acknowledge, however, the requirements in this rulemaking may be helpful to other health care and social service settings, but only LTC facilities are required to meet them.

AHCA and VHCA are appreciative of members’ efforts to weigh in on the proposed rule.  Providers in Virginia and across the country helped to submit over 9,800 comments to CMS, which did have a bearing on some elements of the final rule.

Over the coming days, AHCA staff will be carefully reviewing and analyzing the contents.  VHCA will relay the AHCA analysis, as well as other information about the rule as soon as it becomes available.  AHCA and VHCA are committed to helping members understand the rule and successfully implement the new requirements. 


CMS Press Release, September 28, 2016

Text of the Final Rule

Registration for October 3 AHCA Member Briefing

VHCA-VCAL Comments on the Proposed Rule, September 14, 2015