5 Things You Need to Know About How the New Proposed Rule Will Impact Skilled Nursing Facilities

For the first time in 25 years, on July 2015, the Centers for Medicare and Medicaid Services (CMS), published the first major set of proposed changes to the requirements for participation for long-term care facilities.

CMS’ purpose is to require each facility to have a compliance and ethics program that “must be effective in preventing and detecting criminal, civil, and administrative violations…and in promoting quality of care.”¹

This will add an entirely new section to the requirements for nursing facilities to participate in Medicare and Medicaid (42 C.F.R. §483.30). And these requirements will apply to all nursing facilities, from those that belong to a large national chain or corporation, to those that might be owned by a single individual, or small group of individuals such as the family-owned facility.

Below are the five biggest takeaways from the new proposed rule and what would be required of your organization moving forward.

1. Establish A Compliance Program: Your nursing facility would be required to develop, implement and maintain an effective compliance program. Implementing an “effective,” compliance program is not the same as simply throwing a program together. There are detailed standards for what constitutes an “effective,” versus “ineffective,” program.
2. Write Down Your Compliance Standards: Hop on your computer, grab a pen, or dust off your typewriter. CMS expects nursing facilities “to establish written compliance and ethics standards, policies, and procedures to follow that are reasonably capable of reducing the prospect of criminal, civil, and administrative violations.”
3. Tell Everyone: Now that you’ve written your policies down, you need to tell everyone about them. CMS wants you to effectively communicate your written standards, procedures, and policies and it will be required under the proposed rule. Communicate your policies to the entire staff, including individuals providing services under a contractual arrangement, and volunteers, consistent with the volunteers’ expected roles. And why stop there? Hang it from the walls, put it online, tell the world.
4. Compliance Officer: If you have five or more facilities, you would be required to have a designated compliance officer. In addition, each facility must have a compliance liaison. For organizations with fewer than five facilities, each facility must have a compliance contact. Essentially, everyone needs to have a go-to compliance person.
5. No Conflicts, Please: The proposed rules prohibit compliance officers from having any conflicts of interest at all, whatsoever. For example, in a game of blackjack, you wouldn’t want the person dealing cards to also be playing the game.

For more detailed coverage of how the new proposed rule will impact nursing facilities, download our free whitepaper, "How The New CMS Proposed Rule Will Impact Your Nursing Facility." 

Reference:

¹ Federal Register / Vol. 80, No. 136 / Thursday, July 16, 2015 / Proposed Rules, Pg 42178.