The Centers for Medicare & Medicaid Services has officially delayed action on a three-year-old proposal to reduce some duplicative and “unnecessary” requirements for nursing homes another year, with no clear indication yet of how regulators will proceed when time runs out.
The 2019 proposal would have eliminated some care and reporting requirements for providers — and deliver an estimated cost savings of $616 million sector wide. But it fell by the wayside with COVID and a change in administration and was never finalized.
Earlier this month, CMS officials filed a notice in the Federal Register that the agency had received a one-year extension of its time to act on the burden-reduction rule. The agency could still ax it entirely.
When it was first published, the proposal promised to reform “long-term care requirements that the Centers for Medicare & Medicaid Services has identified as unnecessary, obsolete, or excessively burdensome.” Had it been enacted by now, it would have scaled back several compliance and infection control requirements outlined in Phase 3 of the updated federal Requirements of Participation. Instead, providers must continue to operate under those rules, including new guidance issued in late June.
The red tape-reduction rule came on the heels of a Trump executive order calling on the Department of Health and Human Services to propose several reforms to the Medicare program, largely seen as an effort to reduce paperwork and repetitive processes. The agency asked providers for their insights on possible elimination of Medicare regulations that require “more stringent supervision than existing state of scope of practice laws, or that limit health professionals.”
The rule would have directed more resources to “improving resident care,” the agency said when it was proposed.
Among more than a dozen requirements it would soften or eliminate are the issuance of notices to state ombudsman in all discharge cases; a hasty timeframe for posting daily nurse staffing data; the need for Pro re Nata, or PRN, prescription renewals to only be given following an evaluation by physician or prescribing practitioner; “prescriptive requirements” for QAPI programs; a minimum part-time infection preventionist requirement; and much of a facility’s compliance and ethics program, including the requirement for a compliance officer.
Many of those Trump-era proposals are in direct opposition to policies and guidelines that have been adopted by CMS under the Biden administration. In fact, several of the requirements that would have been softened by Trump were hardened in the latest Phase 3 guidance.
Taking an additional year to consider the proposed rule doesn’t necessarily mean CMS is planning to abandon the entire burden reduction rule, but it could, one observer noted.
LeadingAge approached CMS about its plans earlier this year, after several providers asked about apparent conflicts regarding which rules were in effect. Any rules that have been finalized – including the Rules of Requirement and its Phase 3 guidance – are the ones providers are beholden too for now, said Jodi Eyigor, director of nursing home quality and policy for LeadingAge.
“They say they are reviewing the provisions of that proposed rule … they’re reviewing the comments they received way back in 2019,” Eyigor told LeadingAge members on a conference call Monday. “We’re not really sure at this point what might happen.”
CMS could implement some of the proposed items; finalize a rule canceling the proposals; or re-open comments. Whatever the choice, the agency now has until July 18, 2023, to act.
