Proposed CMS Requirements for Long-Term Care Facilities: Broad Scope, Big Budget

August 27, 2015
Betsy Ballek
SmithAmundsen Health Care Alert



On July 16, 2015, CMS published proposed revisions to the requirements for long-term care facilities, the first comprehensive review of these rules since 1991. The proposed rules will touch upon nearly every aspect of long-term care, discussing topics from care plans to ethics, and nursing services to diagnostic testing. The proposed rule carries a big price tag as well, with an estimated a first year cost of $729 million overall or about $46,000 per facility.

The proposed rules, and CMS’s analysis of them, cover more than 100 pages in the Federal Register. Examples of the categories addressed include:

Resident Rights

Nursing Services

Rehab Services

Facility Responsibilities

Physician Services


Abuse and Neglect



Transitions of Care

Behavioral Health




Care Plans


Physical Environment


One example of the interplay between the rules and the reach and complexity of the proposed changes follows.

Transitions of Care

The Affordable Care Act focused, in part, on the hand-off of patients between facilities and the reduction of hospital readmissions. CMS cites to a report that 40% of nursing home to hospital transfers may be inappropriate. The proposed rules outline a multi-faceted approach to attempt to reduce these numbers.

Prior to admission to a facility, the proposed rules include provisions for patient notification of the facilities’ ability to provide for their specific needs. To improve quality of life, there are also practical proposals like measures to protect residents’ belongings. The new rules would clarify or restate prior rules regarding non-waiver of Medicare or state benefits as a condition of admission. Further, though the proposed rules require that the facility ask residents to accept binding arbitration, the proposed rules lay out specific guidelines as to how such information is communicated and documented. The rules are clear that agreeing to such arbitration cannot be a condition of admission, readmission or continued stay.

At discharge or transfer, the proposed rules would require an in-person evaluation of a resident by a physician or other advanced practice provider prior to an unscheduled transfer to a hospital, unless the transfer is emergent and delay would endanger safety. CMS acknowledges that such evaluations “often” take place, but when they do not, an avoidable hospital transfer may result. New requirements are also added for the type of information to be documented at the time of transfer to another facility, and the use of EHR and “certified health IT” is encouraged. The goal is effective communication between providers.

The above is just one example of the type of changes these rules encompass. Facilities would do well to use this time to look at their own processes and policies, but also to comment and give feedback to CMS. Though revisions may occur or sections may ultimately be stricken, proposed rules always offer an insight into the CMS’s view of the future for long-term care. The Proposed Rules can be found here.1

1 As a reminder, as these are proposed requirements, the notice and comment period is open, and will remain so until September 14, 2015. It may also be of interest to view the comments entities have already submitted at As of the publication of this article, more than 50 comments had been received.