The latest news in the Federal and State Regulation of the Senior Care Industry.

Federal News

CMS to Revamp Nursing Home Five Star Quality Rating System

Beginning in 2015, CMS will implement the following changes to the Nursing Home Five Star Quality Rating System:

  • Nationwide Focused Survey Inspections: Effective January 2015, CMS and states will implement focused survey inspections nationwide for a sample of nursing homes to enable verification of both the staffing and quality measure information that is part of the Five-Star Quality Rating System.
  • Payroll-Based Staffing Reporting: Using new funding provided by the IMPACT Act of 2014, CMS will implement a system of quarterly electronic reporting that is auditable back to payrolls to verify staffing information. This new system will calculate the quality measures for staff turnover, retention, types of staffing, and levels of different types of staffing.
  • Additional Quality Measures: CMS will increase both the number and type of quality measures used in the Five-Star Quality Rating System. The first additional measure, starting January 2015, will be the extent to which antipsychotic medications are used. More measures will be added later, including data on re-hospitalization and community discharge rates.
  • Timely and Complete Inspection Data: CMS will strengthen requirements to ensure that states complete timely and accurate inspections of nursing homes for inclusion in the rating system.
  • Revised Scoring Methodology: In 2015, CMS will revise the scoring methodology by which they calculate each facility’s quality measure rating, which is used to calculate the overall Five Star rating.

CMS Proposes Changes to Home Health Conditions of Participation

CMS recently released substantive proposed changes to the Home Health Conditions of Participation. According to the Agency, “the proposed requirements would focus on the care delivered to patients by home health agencies, reflect an interdisciplinary view of patient care, allow home health agencies greater flexibility in meeting quality care standards, and eliminate unnecessary procedural requirements.”

The proposed rules stress patient-centered assessment, patient rights, care planning, service delivery, and quality assessment and performance improvement (QAPI), including infection control.

Comments are due to CMS by December 8, 2014.

Enforcement Delayed for New Home Care Minimum Wage & Overtime Rules  

The Labor Department announced this week that it plans to delay enforcement of its new minimum wage and overtime protections for home care workers.

For six months, from January 1, 2015 to June 30, 2015, the department will not bring enforcement actions against any employer who fails to comply with a Fair Labor Standards Act obligation. During the subsequent six months, from July 1, 2015 to December 31, 2015, the department will exercise its discretion in determining whether to bring enforcement actions, giving strong consideration to good faith efforts to bring home care programs into FLSA compliance.

New Hydrocodone Rule Now In Effect

The U.S. Drug Enforcement Agency’s final rule regarding hydrocodone rescheduling went into effect this week. The rule—which reclassified hydrocodone combination products (HCPs), such as hydrocodone and acetaminophen, from Schedule III to the more restrictive Schedule II—means that HCPs are now subject to additional requirements related to security protocols, labeling and packaging, inventory, and recordkeeping and reporting.

Numerous pharmacist groups, including the American Society of Consultant Pharmacists (ASCP) and the American Pharmacists Association (APhA), along with the National Association of Chain Drug Stores, criticized the rescheduling. Their concerns included the additional costs for patients and the healthcare system overall, as well as the potential delays in pain relief for the millions of Americans who legitimately rely on HCPs for short-term and chronic pain.

Hospice Nursing Shortage “Extraordinary Circumstance” Exemption Extended

Acknowledging that the nation’s nursing shortage is affecting some hospices’ abilities to hire and retain nursing staff, CMS recently announced a temporary extension of the “extraordinary circumstance” exemption. The measure will allow individual hospices to contract for nurses until September 30, 2016, if the hospice can demonstrate that the nursing shortage is creating an extraordinary circumstance that prevents it from hiring an adequate number of nurses directly. The measure, does not, however, extend to counseling services and medical social services, which are the other core hospice services.

In order to qualify for an “extraordinary circumstance” exemption, a hospice must notify the State Survey Agency (SA) responsible for licensing and certification that it intends to elect an exception under the “extraordinary circumstance” authority. The SA will maintain copies of each exception notification and validate the hospice’s stated need for an exemption during complaint and standard surveys. Of particular importance will be the extent to which the hospice nurses have been trained in the hospice philosophy and are able to effectively provide care to the patient that is consistent with the plan of care established by the attending physician, the medical director or physician designee and interdisciplinary group.