On July 13, 2015, CMS issued a proposed rule to reform the requirements for long term care facilities participating in Medicare and Medicaid. The 400-page proposed rule recommends the biggest overhaul to nursing home requirements since 1991. The rule was published in the Federal Register on Thursday, July 16, 2015, marking the opening of a 60-day period for comments.

Long term care providers and other interested entities should carefully review the proposed rule and submit any comments to the proposed rule to CMS/HHS by 5:00 pm ET on September 14, 2015.

To see a copy of the proposed rule, click here.

Executive Summary of Proposed Rules

CMS asserts that it drafted the proposed rule to adapt to the significant innovations in resident care and quality assessments as well as the changing population in the nation's long term care facilities. The goal of the new and revised rules is to improve residents' quality of life, optimize safety and reflect current professional standards. The Department of Health and Human Services Secretary Sylvia Mathews Burwell believes the proposed rule "set[s] high standards for quality and safety in nursing homes and long-term care facilities." Some industry trade groups and organizations have expressed concerns about the unfunded mandate and the cost to each facility for implementing such changes. The American Health Care Association estimates the cost of these proposed rules could exceed $730 million in the first year and $640 million thereafter, or approximately $40,000 per year for each individual nursing home.

In addition to implementing mandated provisions under the Affordable Care Act, the proposed rule also outlines new provisions for quality and ethics rules, clinical requirements, comprehensive person-centered care planning processes, staff competency requirements, pharmacy records reviews, and additional mandatory physical plant conditions.

The proposed rule also contemplates new lifestyle measures for residents, including requirements that providers:

• Allow residents to choose their own roommates
• Offer expanded visitation periods
• Limit bedrooms to no more than two residents
• Include in each room a toilet, sink and shower
• Accommodate residents' food allergies
• Provide arrangements for religious and cultural preferences.

Upcoming Information for You

This alert is the first in a series of four communications. In the coming days, Polsinelli will provide additional information outlining the significant new rules and proposed revisions for each of the following areas:

• Resident Rights
• Clinical Requirements
• Facility Administration

The summaries will be designed to provide additional information about the new provisions that have been proposed and how existing requirements may be revised.

What You Should Do

Long term care providers and other interested entities should review the upcoming e-alerts, carefully review the proposed rule and submit any comments to the proposed rule to CMS/HHS by 5:00 pm EST on September 14, 2015. Comments may be submitted electronically here or by regular mail to CMS/HHS, Attn: CMS-3620-P, P.O. Box 8010, Baltimore, MD 21244.