Despite CMS proposal, the push toward Phase 3 deadline moves on


In October 2016, the Centers for Medicare & Medicaid Services delivered one of the most sweeping changes to long-term care compliance in more than 30 years and turned up the heat on the industry’s already intense regulatory environment. “Medicare and Medicaid Programs; Reform of Requirements for Long-Term Care Facilities” (81 FR 68688), dubbed the Mega Rule, contains hundreds of compliance changes and clarifications for skilled nursing and nursing facilities. In a few weeks, the planned November 28, 2019 deadline for completing the last of the regulation’s three phases will be here.

However, in July, CMS announced a proposed change to the Mega Rule that is aimed at lessening the burden on facilities so they can focus more on care. If finalized, “Medicare & Medicaid Programs; Requirements for Long-Term Care Facilities: Regulatory Provisions to Promote Efficiency and Transparency” (CMS-3347-P) will remove requirements deemed unnecessary or excessive. The announcement also included a proposal to delay implementation of some Phase 3 requirements until the date specified in the rule. The period for public comment has ended, leaving the fate of Phase 3 hanging in the balance for now. Meanwhile, facilities must move forward with 2016’s requirements.

What’s needed?

Phase 3 addresses 10 areas, including: Quality Assurance and Performance Improvement (QAPI) implementation, Infection Control, Compliance and Ethics and Physical Environment. Some of the regulations in these areas have been partially implemented in the previous phases. For example, the rule addressed care planning earlier but in Phase 3, Section §483.21 (Comprehensive Person-Centered Care Planning) requires that care plans are culturally-competent and trauma-informed.

Phase 3 mandates development and implementation of an effective QAPI program that includes several elements. Section §483.70 (Administration) requires that the responsibility for the QAPI program are included in the obligations of the governing body. Section §483.12 (Freedom from Abuse, Neglect, and Exploitation) also requires that facilities integrate abuse, neglect and exploitation into their QAPI program.

Phase 3 focuses heavily on several employee training and staff competencies. For example, Section §483.40 (Behavioral Health Services) requires the development and implementation of a process to assess staff competencies for caring for residents with a history of trauma and/or post-traumatic stress disorder. Finally, Section §483.95 (Training Requirements) calls for new training to be implemented for staff, contractors and volunteers for topics such as communication, resident’s rights, abuse, neglect, infection control and compliance and ethics.

The last phase also necessitates facilities add some new personnel responsibilities. Section §483.80 (Infection Control) calls for the hiring or the designation of an infection preventionist who is responsible for the Infection Prevention and Control Program. Section §483.85 (Compliance and Ethics Program) requires that a plan be developed for implementing components of a compliance and ethics program as well as putting a schedule in place to annually review and update the program.

Help is available
At this time, CMS has not released any interpretative guidance on Phase 3 requirements. Thus, how these changes are implemented is left to the discretion of the facilities. Having an action plan and access to resources such as training materials and policies is useful for keeping preparations on track and in compliance. Find out how The Compliance Store can help at