Did you read some of the preamble in the Federal Register, which included comments from the public, and the long term care community and other stakeholders, as well as Centers of Medicare and Medicaid (CMS)’s response? I downloaded the 185-page Federal Register / Vol. 81, No. 192/ Tuesday, October 4, 2016 / Rules and Regulations. It is interesting to read the comments and CMS responses.
This blog is based on one segment of the comments tom the proposed rule, published July 2015, listed in the preamble. I am assuming this comment was made by professionals from the LTC community.
Comment: “Some commenters also expressed concern that CMS may be unreasonably focused on regulating LTC facilities, to the point of not updating regulations and requirements for other types. Commenters also claimed that LTC facilities are “the most regulated industry in America” and that “the nuclear industry is less regulated” than the LTC facility industry.”
The response to this comment is that CMS “recognize that the proposed rule and this final rule are large, detailed documents, and that many individuals relied on summaries to learn about the proposed requirements. We understand that working professionals and family caregivers be very busy, but we are concerned by some of these misinterpretations. Most of the misconceptions fell into three categories: Unfamiliarity with the old requirements, misunderstanding of the proposed requirements, or confusion about which facilities must the LTC requirements. The comments displaying unfamiliarity with the existing requirements are troubling to us…..”
CMS pointed a few of the areas where they said that they are concerned about the confusion based on comments received.
- The resident’s right to choose his or her physician – CMS said that this has been a long standing part of the regulation or requirement
- The requirement that a RN be part of the interdisciplinary team – CMS said that this also has been long standing part of the old regulation or requirement
- The requirement that a plan of care be established within 48 hours of the resident’s admission – CMS said that this is intended to be a baseline plan of care not a full plan of care.
As long term care professionals we can argue the pros and cons of CMS’ response, but I believe that the points raised should be taken to heart, if concern is expressed about staffs unfamiliarity with the old regulations, and that we do not give detailed attention to the requirements or regulations. Facilities have their staff development directors. Facilities have general orientation when incoming staff are taught policies and procedures, and there are semi-annual or annual mandatory in-services to cover competencies, regulations, policies and procedures. Also there are seminars that staffs attend externally for continuing education that cover other aspects of the regulations. One of CMS observation is that people are busy, and yes we do get very busy in long term care facilities. With our busy work days, I am not sure how often we, as key personnel reference the LTC regulations during our tour of duty? The LTC Regulations Binder sits on the bookcases in our offices.
When regulatory issues or questions do come up during our busy days at our facilities, how do we balance getting to the immediacy of the situation and making sure we are in compliance with what the regulation states? For me during my time as administrator at my facilities, I usually add regulatory compliance to my agenda items for my monthly general staff meetings, and I would have the department director present or the staff development director present.
For the direct caregivers, staffing is sometimes problematic for some facilities, so when there is high turnover, or vacancies, or call-ins, then regularly scheduled in-services are negatively impacted.
Please note that CMS did take comments from provider community into consideration and made some modifications and changes to some proposals for the Final Rule.