January 27, 2021

Volume XI, Number 27


January 27, 2021

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Catching Up With the Times: CMS Reforms Long-Term Care Facility Requirements

On Oct. 4, CMS published the biggest overhaul to federal long-term care regulations since 1991.

The lengthy Final Rule reforms the requirements for long-term care facilities participating in Medicare and Medicaid. CMS will implement the new and revised regulations in three phases, with Phase 1 regulations having an implementation date as early as Nov. 28 and Phase 3 three years later on Nov. 28, 2019.

Executive Summary of Final Rule

The Final Rule outlines new and/or revised provisions that govern the following key areas, among others:

  • Arbitration, prohibiting a facility from entering into an arbitration agreement prior to a dispute arising;

  • Compliance Plan, requiring the implementation of a compliance and ethics program;

  • Training, setting forth requirements of a training program for facility staff, contractors, and volunteers;

  • Abuse, imposing required investigations and reports, and prohibiting certain hiring practices;

  • Administration, requiring an annual self-assessment of facility resources, resident population, and a facility-based and community-based risk assessment;

  • Quality Assurance and Performance Improvement (QAPI), addressing the development and maintenance of a QAPI program for systems of care, outcomes of care, and quality of life;

  • Resident Assessment, clarifying what is appropriate coordination of resident assessments with the PASARR program under Medicaid;

  • Care Planning, imposing requirements on the development of care plans and discharge planning;

  • Nursing Service, adding a competency requirement for determining the sufficiency of nursing staff;

  • Pharmacy Service, requiring pharmacists' monthly review of medical charts and implementing measures to reduce or eliminate the use of psychotropic drugs; and,

  • Infection Control, requiring the development of an Antibiotic Stewardship Program.

Acknowledging that the last time requirements for participation were reviewed and updated was 25 years ago, CMS passed the Final Rule for a variety of reasons, including:

  • The substantial changes in the delivery of long-term care over the years;

  • The emergence of significant innovations in resident care and quality assessment practices;

  • The increase in a more diverse and clinically complex population; and,

  • Enhanced research and knowledge of resident safety, health outcomes, individual choice, and quality assurance and performance improvement.

CMS' stated goal of the new regulations is to improve the quality of life, care, and services in long-term care facilities, optimize resident safety, reflect current professional standards, and improve the logical flow of the regulations.

© Polsinelli PC, Polsinelli LLP in CaliforniaNational Law Review, Volume VI, Number 279



About this Author

Anne Cooper, Polsinelli Law Firm, Health Care Attorney

Anne Cooper bases her practice not only on her law experience but also on her eight years as an accountant and financial analyst at a major St. Louis health care system. Her meticulous attention to detail benefits clients in every aspect of her practice, which includes health planning, Medicare and Medicaid audit appeals, and health care compliance.

Anne counsels clients on the Illinois Certificate of Need process, including preparation and submission of certificate of need and certificate of exemption applications, representation of clients...

Meredith A. Duncan, Polsinelli PC, Government Regulation Attorney, Medical Licensing Lawyer,

A litigator at heart, Meredith Duncan has the skills and experience to advocate for clients before government regulators, administrative law judges and courtrooms alike. She uses those skills to focus mainly on the compliance and operational issues facing health care providers, including long-term care providers, senior housing entities and hospitals. From licensing to contracts, to risk management and regulatory compliance, she responds to all issues that arise in all aspects of a health care provider’s practice. 

Dayna C. LaPlante, Polsinelli PC, Chicago, Complex Healthcare Matters Attorney, Administrative Compliance Lawyer,

Dayna LaPlante works with clients who benefit from her diligence, enthusiasm and strong grasp of the complex health care legal sector. She represents a range of health care providers, including hospitals, pharmacies, and long term care providers. Dayna focuses her general practice on helping clients maintain compliance with state and federal law, and represents clients in civil and administrative litigation should disputes arise. She also serves as regulatory counsel for health care transactions, helping clients remain in regulatory compliance post-closing. 

Jason T. Lundy, Polsinelli PC, Healthcare regulatory matters Lawyer, Provider Defense Attorney

Jason Lundy strategically guides health care providers through fast-changing and uncertain regulatory environments. When disputes arise, he aggressively defends providers in administrative and civil litigation.

Jason concentrates his practice on long-term care. He regularly represents skilled nursing, assisted living, independent living, continuing care retirement communities, intermediate care facilities for the developmentally disabled, home health agencies, and hospice. 

Matthew J. Murer, Polsinelli, Survey Issues Lawyer, Reimbursement Attorney
Shareholder/Practice Chair

Matthew Murer chairs the firm's national health care practice, and has worked hard to build a strong team of health care lawyers with experience that spans virtually every aspect of the health care continuum, as well as virtually every niche of practice. Matthew emphasizes a focus on collaboration and opportunity both within the group, as well as with the firm’s health care clients. Matthew firmly believes that these collaborative efforts yield more creative, powerful, practical solutions to today’s pressing legal problems. Now more than ever, health care providers need...