Ask the payment expert ... about the observation stay loophole

What do we need to do to prepare for the new regulations and survey process?

The first phase of the new requirements of participation went into effect Nov. 28, 2016, and the second phase is effective Nov. 28, 2017. After a two-year break, the final phase’s implementation deadline is Nov. 28, 2019.

The most important aspect of these regulatory changes is that many of these requirements have already been in place, but the Centers for Medicare & Medicaid Services is now organizing them differently. Most of the initial work for Phase 1 was making sure your policies and procedures were in place with new language and making sure resident choice was in place.

The other challenge we have is that the interpretive guidelines for these new requirements will not be out until this summer. This presents an interesting challenge for those facilities that are being surveyed this spring.

CMS also indicated the new survey process will go into effect this October. We expect details will be published by this summer. 

In the new survey, we anticipate a combination of the traditional survey process with the Quality Indicator Survey (QIS) process. The QI Survey is very focused on resident choice. If you are not yet in the QIS process in your state, the forms are published on the CMS website and you can access the resident interview questions and other QI forms. You should start using these forms now to solicit your residents’ feelings about their choices in your facility. 

Additional areas to evaluate for Phase 1 are your abuse policy wording, completing baseline assessments and evaluating competency-based staff.  As you can see, there is a lot of work to do over the coming year to make sure you are in compliance for phases 1 and 2.