| AMDA Responds to Proposed New SNF Regulations |
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by Karl Steinberg MD, CMD, HMDC CMS published a sweeping set of revisions to the nursing home regulations in the Code of Federal Regulations under 42 CFR §483 (sometimes referred to as Conditions of Participation or Requirements of Participation) in summer 2015. This is the first revision of these regulations since OBRA was initially implemented in 1990. Because of the sheer amount of material covered, CMS responded to requests to extend the deadline, and the final comments were due October 14, 2015. Many individual CALTCM members, and AMDA state chapters, submitted comments about these proposed new regulations. AMDA’s Board of Directors and Public Policy Committee, on which I have the honor of serving, designated a few of our members to craft AMDA’s response to these regulations. Past AMDA President Steve Levenson, MD, CMD, did the bulk of the writing, but many dozens of hours were also spent by AMDA’s Immediate Past President, Len Gelman, MD, CMD, AMDA’s President-Elect, Susan Levy, MD, CMD, and yours truly. This 130+ page document starts out with AMDA’s general comments, then includes the new proposed regulations and AMDA’s suggested changes and specific comments. Without getting into excessive detail, it can be said that in general the new regulations are well-intentioned, but perhaps overly prescriptive and process-oriented. A few of the areas that AMDA had concerns about included: · A proposed requirement that before any resident could be sent to the hospital, an in-person evaluation by a physician or NPP would have to occur “except in an emergency.”
· Re-definition of psychotropic drugs, to now include opioids.
· Requirement for an Infection Prevention Control Officer, for whom a majority of their time is spent on the Infection Prevention Control Program.
· 48-hour limit on prn psychotropic medications.
· Notifying the ombudsman’s office of every discharge or transfer, whether planned or unplanned, voluntary or involuntary.
· Requirements for “behavioral health” competencies without any clear definition of what that actually means.
AMDA and other stakeholder organizations have asked CMS to postpone final publication of the new rules to allow for more interaction and give-and-take, considering the impact of these new regulations for many years to come. Unfortunately, CMS appears to have decided to proceed without further dialogue, and we believe they have already entered the rulemaking process, considering the written comments already submitted. Ultimately, we are all hopeful that the revamping of the nursing facility regulations will result in overall improvement in the quality of the care we provide to our residents. Exactly how that will occur, and at what cost, remains to be seen. Click here to view AMDA's response Click here to discuss this article in the CALTCM Blog |
