HHS Proposes Substantial Changes to Long-Term Care Medicare and Medicaid Requirements

By on 4:58 AM

The U.S. Department of Health & Human Services (HHS) has announced a proposed rule that would substantially revise the requirements that long-term care (LTC) facilities must meet to participate in the Medicare and Medicaid programs.

According to the proposed rule, which was announced July 13, 2015, HHS is proposing to add new requirements, eliminate duplicative or unnecessary provisions, and reorganize the regulations with the intent of aligning requirements with current clinical practice standards.

If approved, the revisions would mark the first major rewrite of LTC conditions of participation since 1991.

HHS indicated the objective of these major changes is to improve safety and overall care of the nation's 1.5 million residents that reside in more than 15,000 long-term care facilities or nursing homes that participate in the Medicare and Medicaid programs.

Infection Control Changes
LTC infection control changes proposed include updating the nursing home's infection prevention and control program, including requiring an infection prevention and control officer, and an antibiotic stewardship program that includes antibiotic use protocols and a system to monitor antibiotic use.

The key to improving processes in the infection control department begins with strong support from upper management, a knowledgeable infection prevention leader, relevant committees and department management support.

In addition, a written infection control program is essential to the effective function of the department and education of employees. An up-to-date program should clearly spell out the nature of the facility, its population, services offered and risk of infection in residents. Prevention strategies based on risks should follow, using nationally recognized guidelines. 

Additional Background
In 2008, HHS formed a steering committee for the purpose of developing an action plan to eliminate healthcare-associated infections (HAIs) throughout the nation. In 2009, the action plan was developed by key stakeholders who met in Washington, D.C., at various intervals to brainstorm the process. Known as the "National Action Plan to Prevent Healthcare-Associated Infections: Road Map to Elimination (HAI Action Plan)," hospitals were the first tier of healthcare providers to be impacted. At the time of development of this plan, nursing homes were next in line.

However, owing to some unfortunate breaches in practice within the ambulatory surgery center (ASC) setting that were uncovered in 2009, nursing homes were temporarily set aside to make way for a change in practices within the ASC setting and dialysis centers.

With this week's announcement from HHS of proposed reform of requirements for LTC facilities, nursing homes are now receiving the attention they deserve.

Infection Control Consulting Services is a leading provider of long-term care infection control consulting services and has been providing written infection control programs and services to nursing homes since 2005. If you are in need of a nursing home infection control expert, please contact ICCS today.

Phenelle Segal, RN, CIC, FAPIC

Phenelle Segal, RN, CIC, FAPIC, is the founder and president of Infection Control Consulting Services LLC (ICCS). Phenelle has more than 30 years' experience providing customized comprehensive infection control and prevention services to healthcare facilities nationwide. Her services focus on assisting hospitals, ambulatory surgery centers, dental office and oral surgery practices, doctor's offices, nursing homes and other organizations with implementing and maintaining an infection control program that: complies with The Joint Commission, AAAHC, Centers for Medicaid and Medicare Services (CMS) and other regulatory agencies; respond to situations of noncompliance; and improve the processes for reducing risk.