News, Skilled Nursing Facility

Lawmakers estimate CMS mandate will cost providers $50,000 annually, letters submitted to delay provisions

More than 100 lawmakers signed a letter submitted by the House to CMS Administrator Seema Verma and new Department of Health and Human Services Acting Secretary Eric Hargan last week, urging the agency to delay costly provisions implemented in a final rule published in October 2016 updating Requirements of Participation (RoPs) for skilled nursing facilities/nursing facilities. Phase 2 of these requirements take effect on November 28 of this year, and despite CMS’ action to delay penalties for Phase 2 requirements to November 2019, signees—including the American Health Care Association (AHCA)—expressed concern for the financial burden that meeting compliance will place on providers.

“The overall update of the RoPs is an important effort and the National Association for the Support of Long Term Care (NASL) supports it overall,” said Cynthia K. Morton, MPA, Executive Vice President of NASL, on Thursday. However, Morton notes that “CMS added multiple requirements for long term care providers, but with no linkage to providing the resources to meet those requirements. CMS finalized the SNF PPS payment update without discussion of the new mandates on long term care providers. Many of the requirements could support higher quality care but facilities cannot continue to accept more requirements without resources to fund them. This letter is important because it shows congressional acknowledgment of this.”

The letter, organized by Rep. Jim Renacci (R-OH), explains that “CMS estimates the nationwide first year implementation costs as $62,900 per facility and $55,000 in subsequent years, totaling $831 million in the first year and on-going annual costs of $736 million.”

Senior Vice President of Government Relations for AHCA, Clif Porter said earlier this week, “We appreciate the broad and diverse Congressional support for smart regulation that helps long-term care and post-acute care centers continue to improve quality care. We hope this effort helps reduce redundant regulation that creates unnecessary burdens and impedes our ability to provide quality care at the bedside.”

During AHCA/NCAL’s 68th Annual Convention & Expo that concluded in Las Vegas this week, Deputy Director of the nursing home division of CMS, Evan Shulman, addressed the timeline for phase 2 regulations, telling providers to continue to prepare for phase 2 regulations by focusing on the intent behind the regulations, which is to figure out what the resident needs. This message, said Shulman, is the same one CMS shares with surveyors.

Another speaker at the convention, Joint Commission Field Surveyor Oda Roozeboom, highlighted the importance of using data to prevent, assess, and treat pressure injuries. During her session titled “Data Overload: How to Understand and Use the Data You Have,” Roozeboom told attendees that there are an estimated 260,000 pressure injuries in long-term care. She emphasized the importance of assessing residents for pressure injuries upon admission, as many times the injuries are a result of a hospital stay, along with the importance of assessing residents after they have returned from dialysis, where they could have been sitting for hours.