News, QAPI, Regulations, Skilled Nursing Facility

Key takeaways of the new proposed rule

On July 17 CMS announced a proposed rule that would delay Phase 3 requirements, including QAPI and ethics and compliance standards. These changes, fueled by the Trump administration, will modify previous rules set forth between October 2016 and June 2017.


The first proposed rule, Medicare & Medicaid Programs; Requirements for Long-Term Care Facilities: Regulatory Provisions to Promote Efficiency and Transparency” (CMS-3347-P), would change the designation and training of the infection preventionist (483.80), QAPI (483.74), and compliance and ethics program (483.85) would be delayed.

Some key takeaways of CMS-3347-P:

  • Should the proposal be finalized, SNFs will be required to inform residents of his or her primary physician’s name and contact information only upon admission to the facility, or if there is a change of physician.
  • Records of grievances are currently required to be kept for a minimum of three years. CMS-3347-P would cut this in half by reducing the record-keeping period to 18 months.
  • If passed, the proposal would shorten the timeframe that nursing staffing data will need to be kept from 18 months to 15 months, or per state laws, whichever is longer.
  • In the event of resident transfer or discharge, CMS-3347-P would require that a resident receive a written report explaining why they are being moved, in terms that they can easily understand. Under the new rule, facilities would only need to notify the state ombudsman of “facility-initiated involuntary transfers and discharges” unless an emergency arises, and the resident is expected to return to the facility after the event.
  • Currently, PRN orders of psychotropic medications cannot be extended past 14 days without a physician or qualified practitioner evaluating the resident first. CMS-3347-P would allow an extension of prescriptions beyond the two-week mark without an examination of the resident, provided the physician has clear documentation as to why he or she is extending it.
  • The director of food and nutrition services at facilities would no longer be required to take additional food and safety courses, provided that they have either been in the director role for a minimum of two years and regularly consult with a dietitian, or they have completed a minimum course in food and safety.
  • If passed, SNFs would no longer be required to have an infection preventionist (IP) at the facility part time. The minimum requirement will be that the IP attend the facility only frequently enough to meet IPCP objectives.
  • CMS-3347-P would remove the requirement for facilities to have an ethics compliance officer. Currently, ethics and compliance programs are required to be reviewed annually, but the new proposal will only require a biennial review.
  • The new proposal would allow older existing facilities to use the 2001 Fire Safety Equivalency System (FSES) requirements, rather than the more recent 2012 FSES requirements.
  • New facilities would still be subject to the rule of two residents per room, with an attached bathroom; however, it’s proposed that older facilities not be subject to this requirement and would be allowed to occupy a room with an attached bathroom with up to four residents.
  • The proposal would increase the timeframe for facilities to report abuse of residents.
  • Facilities would be required to attempt to use alternatives before using bed rails. The risks and benefits of bed rails will need to be explained to the resident, and consent of the resident must be given before use.

If finalized, the changes could go into effect as early as November 28. CMS will be accepting comments on the proposed rule until September 16.