In a proposed rule regarding nursing home payment and other issues, the Centers for Medicare and Medicaid Services (CMS) has requested comments from stakeholders about possible changes to the revised Requirements of Participation (RoPs) for nursing homes. In its rationale underlying the request for comments, CMS noted concerns expressed by stakeholders regarding the cost and regulatory burden associated with the provisions of the final revised RoPs rule promulgated last October.
CMS has targeted three main areas for possible changes, including:
Grievance and Abuse/Neglect Reporting Processes
CMS states that it is important to maintain residents’ rights to voice grievances but also notes the cost and regulatory burden associated with the extensive expansion of the grievance process in the RoPs rule. CMS specifically mentions the burden and cost of maintaining evidence related to grievances for 3 years and staffing a grievance official to oversee the grievance process.
Quality Assurance and Performance Improvement (QAPI)
The final RoPs rule requires facilities to develop, implement, and maintain an effective comprehensive, data-driven QAPI program that focuses on systems of care, outcomes of care and quality of life. Feedback from stakeholders indicates that the QAPI requirements are too detailed and prescriptive, and significantly exceed the QAPI related requirements for other providers. CMS states that it is looking to achieve a balance between specificity and flexibility in the QAPI requirements.
Under the final RoPs rule, nursing facilities are required to send discharge notices to the state LTC Ombudsman.
Despite the specific areas identified by CMS for changes to effectuate a reduction in regulatory burden, the agency signaled that it is also interested in receiving feedback regarding any additional areas of burden reduction and cost savings that can be achieved through changes to the final RoPs rule. CMS stressed that it is particularly interested in data and analysis regarding associated costs and benefits. LeadingAge members are invited to comment directly to CMS (comments are due by 5:00 p.m. Eastern on June 26, 2017) or to have their recommendations included in LeadingAge’s comment letter. In the case of the latter option, LeadingAge requests that comments be received no later than June 19, 2017.