The Centers for Medicare and Medicaid Services (CMS) issued QSO-20-03-NH that gives the final status for Phase 3 of the Requirements of Participation, arbitration, improvements in infection prevention and control and the release of toolkit 3. These are all important issues that the providers have been waiting on direction from CMS.
The first item of communication is for the implementation of Phase 3 and the Interpretive Guidance. CMS will be releasing updated Interpretive Guidance and training for the Requirements for Participation for Long-Term Care Facilities in the second quarter of 2020. The Phase 3 requirements went into effect November 28, 2019, and facilities are required to comply with these and all requirements. However, the surveyor’s ability to survey for compliance with the Phase 3 requirements will be limited until the Interpretive Guidance is released.
As a reminder, the Phase 3 Requirements are culturally competent and trauma-informed care, QAPI program additional requirements, Infection Preventionist, compliance and ethics, call system from bedside and training program additional requirements. For more detailed information on the requirements, review my previous Pulse article on the Phase 3 requirements.
All the Phase 3 requirements have needed extensive preparation and implementation and most providers are prepared for the additional regulations. FHCA’s Quality Affairs Team has received numerous inquiries about the call system regulation. Here is the regulation from the SOM:
- 483.90(g) Resident Call System
The facility must be adequately equipped to allow residents to call for staff assistance through a communication system which relays the call directly to a staff member or to a centralized staff work area –
It would have been good to have the interpretive guidance to fully understand what will be required with this regulation, but without it, the facility must interpret as read. Either upgrade the call system to communicate directly to staff, or at least have staff at a centralized work area at all times to communicate call-light activation.
The Department of Health and Human Services published a final rule establishing requirements related to the use of binding arbitration agreements. The final rule changes the requirements that Long-Term Care facilities must meet to participate with Medicaid and Medicare. The rule aligns with CMS’ initiative to increase transparency in nursing homes. The requirements for arbitration agreements were effective on September 16, 2019, and facilities are required to comply with this rule and all requirements. CMS will publish guidance for surveyors in the upcoming weeks on the arbitration survey portion.
Infection Control and Prevention is one of the largest parts of the Rules of Participation. Infection Control is woven throughout every section and every department regulation. CMS has created a nursing home antibiotic stewardship program training, updated the Nursing Home Infection Control Worksheet as a self-assessment tool for facilities; and is reminding facilities of available infection control resources. These actions have been implemented due to the recent reports of healthcare-associated infections in nursing homes, such as adenovirus and Candida auris. Facilities should have an effective infection prevention and control program to mitigate the onset and spread of infections. The CMS memo has listed the basic practices for infection control and prevention. Providers should review these and compare to facility policies to ensure all are covered.
CMS has also included the available resources for the providers to stay current on outbreaks, newest recommendations and guidance. The resources are:
- Centers for Disease Control and Prevention: For example, infection prevention and control information for C. auris is currently located here, and resources for nursing homes, including information about the “Nursing Home Infection Preventionist Training Course” is available here.
- Healthcare-associated infection and antibiotic resistance (HAI/AR) programs in local and state health departments. These programs offer numerous resources directed at improving infection prevention practices and preventing the spread of antibiotic resistant organisms, including performing on-site infection prevention assessments at nursing homes. Nursing homes should develop a relationship with their state and/or local health department as a resource for providing assistance in the implementation of infection prevention practices to increase resident safety.
- CMS infection control requirements for nursing homes.
- Antibiotic Stewardship Program for Nursing Homes created by CMS to support compliance with the requirements for an ASP and to improve appropriate antibiotic usage. The training will be available starting December 2, 2019.
- Nursing Home Infection Control Worksheet (ICWS) created in conjunction with CDC and is a voluntary self-assessment tool for facilities to use to improve infection control and prevention.
- Civil Money Penalty Reinvestment Program (CMPRP) Toolkit 3: Guide to Improving Nursing Home Employee Satisfaction has now been released. This toolkit has been developed by CMS to assist nursing home teams with improving staff competency and employee satisfaction. The toolkits already available are Nursing Home Staff Competency Assessment and Nursing Home Employee Satisfaction Survey. Toolkit 3 is a repository of evidence-based approaches, solutions and interventions to address challenging areas discovered through the Nursing Home Employee Satisfaction Survey (toolkit 2). These toolkits are to help facilities improve their staff’s competency and reduce turnover.