Mega-Rule: 30 Years in the Making

In October, CMS delivered one of the most sweeping changes to long-term care compliance in nearly 30 years and turned up the pressure on the industry’s already intense regulatory environment. Reform of Requirements for Long-Term Care Facilities, dubbed the Mega Rule, is effective Nov. 28 and is the latest in hundreds of compliance changes and clarifications that have been added this year alone for skilled nursing and nursing facilities (SNF/NF). The rule applies to facilities that receive money from Medicare or Medicaid — which is most of them. Needless to say, these changes have caused a stir in the long-term healthcare community that leaves many professionals wondering how their bottom line will be impacted.

This environment of ever-changing rules has also made attaining CMS’ coveted five-star rating for nursing homes even more complex. As a result, compliance programs have climbed up to the top of many facilities’ administrative priority lists.

Prior to releasing the Mega Rule, CMS clarified its reasoning behind the changes in a September blog: “These changes are an integral part of CMS’s commitment to transform our health system to deliver better quality care and spend our health care dollars in a smarter way, setting high standards for quality and safety in long-term care facilities.”

The last time CMS released such a comprehensive set of updated regulations for long-term care was in 1991. With the Mega Rule, the agency addresses nearly 30 years of significant healthcare and technology changes in long-term care that facilities have had to adjust to on their own. Split into three phases of implementation dates, the new rule is expected to keep facilities busy for the next few years as they work to have them completed by Nov. 28, 2019.

Staying on top of regulatory changes can be a complicated balance that has many administrators worried about being able to provide quality resident-centric care while devoting the time to ensure the facility stays in compliance. Now, more than before, facilities need to turn to innovative solutions to help manage their compliance programs. Having these tools in place is a must for having a credible book of evidence. Providers need a reliable solution to proactively assess, communicate, and — most importantly — mitigate risks. This will allow them to spend more time focusing on the quality and financial health of their facilities so their residents will benefit.

– Teri R. Sumbry, Marketing & Communications Coordinator