Nursing Home Regulatory Developments

Regulation | March 05, 2019 | by Janine Finck-Boyle

The week of March 4, 2019 has seen a number of regulatory developments for nursing homes, including a new EPA rule on pharmaceutical disposal, new reports for skilled nursing facilities on the status of their data submissions for quality reporting, and 5 Star changes just announced by the Centers for Medicare and Medicaid Services (CMS).

First proposed in 2015, the Environmental Protection Agency's final rule on pharmaceutical waste disposal will eliminate the practice of "sewering", flushing pharmaceuticals down toilets or sink drains as a means of disposal. Skilled nursing and nursing facilities, nursing centers of life plan communities, and hospices are covered by the final rule; assisted living facilities are not. The rule

lists the kinds of pharmaceuticals that are subject to the new disposal requirements. Health care providers will have to stop sewering pharmaceuticals as of August 22, 2019. 

CMS has released a long-awaited, crucial new report for the Skilled Nursing Facility Quality Reporting Program (SNF QRP) called the Provider Threshold Report (PTR). The report will give SNFs advance notice if they are meeting the 80% reporting threshold requirement on the SNF QRP measures during a calendar year. SNFs not meeting the threshold for reporting between October 1 and December 31, 2018 have until May 15, 2019 to correct their data submissions to reach compliance.  However, to avoid the 2% Medicare rate reduction in FY2020 SNFs must be in compliance for all of calendar year 2018.

On March 5, CMS announced that the April 2019 Nursing Home Compare update will lift the Five Star freeze and make some major changes in the Five Star process. Changes will include revisions to the inspection process, enhancement of new staffing information, and implementation of new quality measures.

CMS is setting higher thresholds and evidence-based standards for nursing homes’ staffing levels. Currently, facilities that report seven or more days in a quarter with no registered nurse onsite are automatically assigned a one-star staffing rating. In April the threshold for the number of days without an RN onsite in a quarter that triggers an automatic downgrade to one-star will be reduced from seven days to four days.

According to the CMS announcement, the April Nursing Home Compare update will include the addition of measures of long-stay hospitalizations and emergency room transfers, and removal of duplicative and less meaningful measures. CMS also is establishing separate quality ratings for short-stay and long-stay residents and revising the rating thresholds to better identify the differences in quality among nursing homes

LeadingAge is analyzing the announced changes as to potential impact on our nursing home and life plan community members and welcomes your comments and concerns.