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New Compliance Requirements for Long Term Care Facilities


A new proposed rule (42 C.F.R. Part 483, Subpart B) from CMS is highlighting the Federal government’s increased scrutiny on post-acute facilities and includes new training requirements.  This new rule details stringent compliance requirements that long term care facilities must follow in order to participate in the Medicare and Medicaid programs.

Of specific interest to administrators responsible for training in their facilities are two requirements of the rule.

1. An LTC facility’s operating organization must develop, implement, and maintain a compliance and ethics program

The proposed rule emphasizes the requirement for Long Term Care facilities to implement an effective compliance program as defined in the “seven elements” of compliance programs as originally described in the 2000 Office of the Inspector General’s (OIG) guidance to nursing facilities.  This proposed rule puts teeth into requirements that establish the creation of a formal compliance program which includes annual compliance training and appointment of a compliance officer.  Post-acute and long term care organizations must now ensure the effectiveness of the training delivered for Corporate Compliance, HIPAA, Sexual Harassment and other Federal regulations.

2. LTC facilities must develop, adopt, and maintain certain training programs for all new and existing staff

Training topics must include the following:

  • effective communication methods for direct care staff, (ii) rights of residents and responsibilities of the facility
  • activities that constitute abuse
  • neglect, exploitation and misappropriation of resident property, and how to report such incidents
  • the goals and elements of the QAPI program
  • infection prevention and control
  • required in-service training for nurse aides
  • required training for feeding assistants
  • behavioral health training

In addition to these training requirements, the Proposed Rule covers more the following key provisions:

  • Implementing a “competency based” staffing approach to ensure that LTC facilities are appropriately staffed;
  • Restructuring the residents’ rights section of the requirements for participation regulations;
  • Specifying that a resident’s attending physician must be licensed in the state where the facility is located and satisfy the credentialing requirements of the facility;
  • Requiring LTC facilities to adopt certain written policies and procedures, including policies and procedures prohibiting and preventing abuse, neglect, and mistreatment of residents or misappropriation of their property, and policies and procedures regarding visitation rights of residents;
  • Mandating “open visitation” in LTC facilities, similar to the hospital conditions of participation (“CoPs”);
  • Requiring a facility-wide assessment to determine the resources necessary to care for the LTC facility’s residents; Client Alert 15-266 September 2015
  • Mandating that LTC facilities provide certain specified clinical information to a provider or facility receiving a patient discharged from the LTC facility;
  • Requiring LTC facilities to develop, adopt, and maintain certain training programs for all new and existing staff;
  • Requiring all LTC facilities to develop, implement, and maintain an effective, comprehensive, and data-driven quality assistance and performance improvement (“QAPI”) program (which would include certain disclosure requirements to state surveyors or CMS);
  • Mandating a pharmacist review of a resident’s medical chart every six months (or at a greater frequency) and in instances where the resident is new to the facility, a prior resident returns to the facility, or is transferred from a hospital or other facility;
  • Requiring that an LTC facility’s operating organization develop, implement, and maintain a compliance and ethics program satisfying certain specific requirements; and
  • Limiting an LTC facility’s use of binding arbitration agreements.

See a full summary here.