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Phase 3 Nursing Home Regulations Go Into Effect Without Guidance

Published on December 12th, 2019

On October 26, 2016, CMS published the final revised federal nursing home regulations for nursing homes participating in Medicaid or Medicare programs (Requirements of Participation).  These requirements have been implemented in three phases: Phase 1 went into effect on November 28, 2016;  Phase 2 on November 28, 2017; and Phase 3 was implemented on November 28, 2019.

The Phase 3 regulations include:

§483.12 Freedom from abuse, neglect, and exploitation
(b)(4) Coordination with QAPI Plan

§483.21 Comprehensive person-centered care planning
(b)(3)(iii) Trauma-informed care

§483.25 Quality of care
(m) Trauma-informed care

§483.40 Behavioral health services
(a)(1) As related to residents with a history of trauma and/or post-traumatic stress disorder

§483.70 Administration
( d)(3) Governing body responsibility of QAPI program

§483.75 Quality Assurance And Performance Improvement
Entire section except for the following provisions implemented in Phases 1 and 2:
(a)(2) Initial QAPI Plan must be provided to State Agency Surveyor at annual survey.
(g)(1) QAA committee — All requirements of this section with the exception of subparagraph (iv), the addition of the IPCO
(h) Disclosure of information
(i) Sanctions

§483.80 Infection Control
(b) Infection preventionist (IP)
(c) IP participation on QAA committee

§483.85 Compliance and ethics program
Entire section

§483.90 Physical environment
(f)(1) Call system from each resident’s bedside

§483.95 Training requirements
Entire section except for the following provisions implemented in Phase 1:
(c) Abuse, neglect, and exploitation training
(g)(1) Regarding in-service training, (g)(2) dementia management & abuse prevention training, (g)(4) care of the cognitively impaired
(h) Training of feeding assistants

However, according to a memo issued by CMS, the Interpretive Guidelines for the regulations will not be released until the second quarter of 2020. CMS notes that until the guidance is released, “our ability to survey for compliance with these requirements will be limited.”  At the same time, the agency emphasizes that facilities are still required to comply with these regulations even without guidance.

Joe Pioletti
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