Final R

ule?

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&!

© Arete Rehab 2016

The Good, the Bad, and the Ugly

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Released October 4th, 2016

Reinforces patient centered care approach

Key detrimental elements were removed from the final rule

Phased in over 3 years

Greatest changes in regulations affecting SNF’s since OBRA ’87

Average cost per facility year 1 to implement changes= $62,900

Average cost per facility per year thereafter to implement changes= $55,000

Adds new requirements to the conditions of participation

The final rule is a large, detailed document

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Changes, What Changes?

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PHAS

E 1 PHASE 3

PHASE 2

§ 483.1 Basis and scope§ 483.5 Definitions§ 483.10 Resident Rights § 483.12 Freedom from abuse, neglect, & exploitation§ 483.15 Admission, transfer, & discharge rights§ 483.20 Resident Assessment§ 483.21 Comprehensive person centered care plan§ 483.24 Quality of life§ 483.25 Quality of care§ 483.30 Physician services§ 483.35 Nursing services§ 483.40 Behavioral health services§ 483.45 Pharmacy Services§ 485.50 Laboratory, radiological, other diagnostics § 483.55 Dental services§ 483.60 Food and nutrition services§ 483.65 Specialized rehab services§ 483.70 Administration§ 483.75 Quality assurance§483.80 Infection control§ 483.85 Compliance§483.90 Physical environment

§ 483.10 Resident Rights (g)(4)(ii-v)§ 483.12 Freedom from abuse, neglect, & exploitation (b)(5)§ 483.15 Admission, transfer, & discharge rights (c)(2)§ 483.21 Comprehensive person centered care planning (a)§ 483.35 Nursing services facility assessment§ 483.40 Behavioral health services (a)(1) § 483.45 Pharmacy Services (c)(2), (e), § 483.55 Dental services (a)(3), (a)(5), (b)(3), (b)(4),§ 483.60 Food and nutrition services (a)(2)(I)§ 483.70 Administration (e)§ 483.75 Quality assurance (a)(2)§ 483.80 Infection control (a), (a)(3)§483.90 Physical environment (h)(5)

§ 483.10 Resident Rights (g)(4)(ii-v)§ 483.12 Freedom from abuse, neglect, & exploitation (b)(4)§ 483.21 Comprehensive person centered care planning(b)(3)(iii)§ 483.25 Quality of care (m)§ 483.60 Food and nutrition services (a)(1)(iv) § 483.70 Administration (d)(3)§ 483.75 Quality assurance (g)(1)§483.80 Infection control (b), (c)§483.90 Physical environment (f)(1)

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The Devil is in the Details

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• Resident Rights Updates language only

• Freedom from Abuse, Neglect, and Exploitation Requires facility to investigate and report all allegations of abusive conduct Prohibits employing individuals with disciplinary action against their professional license for

abuse, neglect, mistreatment, and/or misappropriation of property• Admission, Transfer, and Discharge

Requires facility to document all transfers/discharges in the medical record Requires facility to provide specific information to be exchanged with receiving provider/facility

upon transfer• Resident Assessments

Clarifies coordination of resident assessment with PASARR • Comprehensive Person Centered Care Planning

Requires facility to develop and implement a baseline care plan within 48 hours of admission that includes instructions to provide effective patient care that meets professional standards of quality care

Requires facility to include nursing assistant & food/nutrition staff in care plan development Requires facility to develop & implement discharge planning process that focuses on patients

discharge goals Requires facility to include patients as active partners in discharge care and effective transitions

to reduce preventable re-admissions.

The Details

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• Quality of care Requires facility to provide the necessary care and services to attain or maintain highest

practicable level of physical, mental, and psychosocial well-being consistent with care plan• Quality of life

Requires facility to ensure resident care & treatment is in accordance with professional standards, care plan and resident choices.

• Physician services Allows facility physician to delegate order writing to clinically qualified professionals, i.e. dietary,

rehab• Nursing services

Requires facility to add a competency requirement for determining the sufficiency of nursing staff• Behavioral Health services

Requires facility to provide necessary behavioral health care Allows facility to add gerontology to the list of possible human service fields for minimum

educational requirement of a social worker. • Pharmacy Services

Requires facility pharmacist to review medical record during monthly drug regime review Requries “antipsychotic” drugs to refer to “psychotropic” drugs Requires several provisions to reduce, eliminate the need for psychotropic drugs to safeguard a

resident’s health, if not clinically contraindicated.

More Details

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• Laboratory, Radiological, & Other Diagnostic services Clarifies that a facility PA, NP or clinical nurse specialist may order lab, imaging, and other

diagnostic services within their scope of practice• Dental

Prohibits facility from charging Medicare recipient for the loss or damage to dentures determined to be facility responsibility

Requires policy identifying when denture loss is facility responsibility Requires facility to assist residents to apply for dental service reimbursement under Medicaid. Clarifies “promptly” to mean a referral made in 3 days.

• Food and Nutrition Requires facility to offer a nourishing, palatable well-balanced diet that meets the residents daily

nutritional and special dietary needs. Requires facility to consider resident preferences Requires facility to provide sufficient staff, including designation of a director of food and nutrition

service.• Specialized Rehabilitation Services

Adds respiratory services as specialized rehab services

Even More Details

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• Administration Requires facilities to conduct, document, and annually review a facility wide assessment to

determine needed resources to competently care for its residents, during day to day and during emergency operations

Prohibits pre-dispute binding arbitration agreements• Quality Assurance and Performance Improvement

Requires facility to develop, implement, and maintain data driven QAPI program that focuses on systems, outcomes and quality of life

• Infection control Requires facility to develop infection prevention and control program with antibiotic stewardship

program with at least one identified Infection Preventionist• Compliance and Ethics Program

Requires facility to have a compliance and ethics program with written compliance and ethics standards, policy and price

• Physical environment Requires constructed, re-constructed, or newly certified facility to accommodate no more than 2

patients to a room with a bathroom with at least a commode and sink in each room • Training

Requires facility to develop, implement, and maintain an effective training program for all new staff and existing staff, individuals under contractual relationships, and volunteers consistent with role.

Finally, the end of the details

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When does this need to be done?

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Effective Date

3 Years1 Year

EFFECTIVE DATE:60 Days from Publication

PHASE ONE 90%DATA

PERCENTAGE

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look like when placed in this area.

AVG.EVALUATION

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look like when placed in this area.

Phase 1 Phase 3

Phase In Time Line

EFFECTIVE DATE: 1 Year From Phase 1

PHASE TWO

EFFECTIVE DATE: 3 Years from Phase

1

PHASE THREE

Phase 2

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