Heyl Royster

New Requirements for Long-Term Care Facility Participation in Medicare and Medicaid

OCTOBER 10, 2016

On October 4, 2016, the Department of Health and Human Services (HHS) and Centers for Medicare and Medicaid Services (CMS) published the final rule regarding recent reforms to the federal regulations governing the voluntary participation requirements that Long-Term Care facilities must meet to participate in the Medicare and Medicaid programs. The new rules and regulations will be implemented in phases. The regulations in Phase 1 must be implemented by November 28, 2016; the regulations in Phase 2 must be implemented by November 28, 2017; and the regulations in Phase 3 must be implemented by November 28, 2019.

The document containing the text and explanation of the new regulations is hundreds of pages long. One of the most notable changes in the rule is the apparent prohibition on arbitration agreements. According to a portion of §483.70, facilities must not enter into an agreement for binding arbitration with a resident or their representative until after a dispute arises between the parties. Pre-dispute binding arbitration agreements are prohibited. This regulation regarding binding arbitration agreements is to be implemented in Phase 1. Another new section concerns Comprehensive Person-Centered Care Planning (§483.21). It requires facilities to develop and implement a baseline care plan for each resident within 48 hours of admission. The regulations in this section are to be implemented in Phase 2.

These new regulations represent the most extensive and sweeping changes to the voluntary participation requirements since the enactment of the original regulations in 1989. The final rule is available here.

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