Information on Medicare and Medicaid Reforms for Long-Term Care Providers

Contributed by LeadingAge.

As most of you have heard, the Centers for Medicare and Medicaid Services (CMS) recently issued a proposed rule updating the contract expectations for participation in Medicare and Medicaid.

It is important that all service providers understand the changes that have been proposed, because they will affect residents and clients who use nursing homes and they will have an impact on your relationship with nursing homes in your community.

This proposed rule, Medicare and Medicaid Programs: Reform of Requirements for Long-Term Care Facilities, is the biggest overhaul of nursing homes since the Federal Nursing Home Reform Act (or OBRA) of 1987. The new requirements are expected to take effect sometime in 2016, though the exact date is has not been revealed.

Nevertheless, it’s all hands on deck in the coming weeks and months for the entire LeadingAge family:

• For us to make sure any new requirements will not make it difficult or impossible for LeadingAge members to provide high-quality nursing home care.
• Once the final rule is issued, to help members understand the changes it requires.
• For members to let us know how the proposed rule could affect their operations and to successfully implement all changes once the rule becomes final!

We have advocated for years that the rules for excellent care have been increasingly antiquated for the complex, contemporary, and tailored care vulnerable seniors deserve from the nursing home sector of health care delivery.

Consequently, we have worked closely with CMS to:

• Advance resident-centered culture transformation.
• Implement quality assurance and improvement processes.
• Iimprove continuity in transitions between nursing homes and hospitals.
• Recognize the importance of staff retention/development/stability.
• Improve resident rights.
• Minimize neglect and abuse.
• Increase transparency and accountability.

And, we have worked with the Advancing Excellence in America’s Nursing Homes campaign to show improvement on valid measures. Nursing homes have made much progress and the new CMS requirements address changing trends.

So, it is time to see if the new rules are consistent with continued improvement and avoiding unintended consequences!

Here are the steps we plan to take:

Deep Dive into the Proposed Requirements. That work is underway as we speak. We ask help from member and business experts to make sure we understand the new rules and that we think thru the implications. This is priority 1 for our public policy and advocacy team. You will receive specifics about gathering input in the near future, though we are happy to take your input now. Please contact Evvie Munley, 202-508-9478, by Sept. 9 with your suggestions.

Submit Comments to CMS. Comments are due to CMS by the deadline of September 14. The next few weeks will be an intense time of work. The draft CMS document exceeds 400 pages!

Create Forums with CMS. Let’s make sure we understand each other. Participate in LeadingAge/CMS policy forums at the 2015 Annual Meeting in Boston.

Implement for Success. As is our practice, once the final rule is issued, there will multiple educational events at both the state and national association levels to help members successfully deliver quality nursing home care for the next generation.

At first glance, we size up the CMS document in the following way: Some of the proposed new requirements reflect the transformation in nursing home care that has been underway for more than a decade.

We should not be surprised by these requirements, and if we have done our homework, they should be relatively easy to implement. Providers who haven’t kept up with the times will find even these components more difficult.

Other requirements seem out of the blue and these will require thoughtful scrutiny. Some may be impossible to implement, particularly for smaller and rural providers.

And, of course, there is the ever-present conflict between requirements and resources. We also do not know how the survey and certification process will change to accommodate new rules.

We continue to believe there should be 2 kinds of nursing home providers: the excellent and the non-existent! Many of our members have already achieved sustained levels of quality. And the nursing home sector has made remarkable, demonstrated progress through Advancing Excellence.

Here is our next hurdle: Define the requirements around emerging need.

We all have much work to do, but I am confident that future nursing home care will be a much improved experience if we continue to work with CMS and the business sector on improving the process of care delivery.