October 2016

October 2016

Final Rule for Long-Term Care Facilities

On September 28, the Centers for Medicare & Medicaid Services (CMS) issued a final rule updating the requirements for long-term care (LTC) facilities to reflect current practice standards of person-centered care, provide added flexibility for providers, and improve resident safety and quality of life. After the first comprehensive review since 1991, CMS now requires a comprehensive, data-driven quality assurance and performance improvement (QAPI) program, an infection prevention and control program (IPCP), and a compliance and ethics program at all Medicare-certified skilled nursing facilities and Medicaid-certified nursing facilities. In total, these new requirements will cost about $65,000 per LTC facility in the first year and $57,000 per year thereafter, including about $3,000 annually for the QAPI, $19,000 annually for the IPCP, and $16,000 for the compliance and ethics program. In a change from the proposed rule, CMS withdrew its requirement for a physician or non-physician practitioner to conduct a medical evaluation before all non-emergency resident transfers. In addition, CMS continues its practice of not requiring 24-hour registered nurse (RN) staffing in every LTC facility. Of note for rural providers, the rule updates the subset of provisions applicable to swing beds at CAHs and PPS hospitals including policies related to resident rights, patient activities and discharge planning.  
For more information, see the CMS press release. These regulatory changes are effective November 28, 2016, but will be implemented in phases over three years. 

Final Rule for Child Care and Development Fund (CCDF) Program

On September 30, the Administration for Children and Families (ACF) published a final rule updating the Child Care and Development Fund (CCDF) to strengthen requirements to protect the health and safety of children in child care settings. The CCDF is the primary Federal funding source devoted to providing low-income families that are working or participating in education and training with help paying for child care and improving the quality of care for all children. In the first major update to CCDF rules since 1998, the final rule requires states to implement more robust standards for child care providers, including mandatory background checks for all current and prospective child care staff; annual monitoring for all CCDF-funded childcare providers, including license-exempt providers; and training for the early education workforce on 10 key health and safety topics such as first aid, CPR, medication administration and the prevention of sudden infant death syndrome (SIDS). Of note for rural communities, many of which face shortages of child care providers, the rule requires states, territorial or tribal entities or other agencies applying for CCDF funds to describe strategies to increase the supply and improve the quality of child care services for children in underserved areas. For more information, please see the ACF fact sheet.  Rule changes are effective November 29 and states and territories are expected to be in full compliance by the end of the Fiscal Year (FY) 2016—2018 CCDF Plan period. 

Proposed Rule for Supplemental Nutrition Assistance Program (SNAP)

On September 29, the USDA Food and Nutrition Service (FNS) issued a proposed rule for changes for the delivery of Supplemental Nutrition Assistance Program (SNAP) benefits (formerly known as Food Stamps). Of note for rural communities, the rule would implement a statutory mandate requiring states to issue households’ ongoing monthly SNAP benefits in one lump sum. In rural communities where SNAP beneficiaries are often older and must travel long distances to reach grocery stores, lump sum benefits may allow for making only one large shopping trip during the month. Under these proposed changes, FNS defines situations when households’ benefits are “off-line” to mean that benefits are being removed from the EBT account and the EBT system; however, unlike a permanent expungement, states must maintain information about “off-line” SNAP benefits (e.g., amount, availability date, last used date, etc.) so that benefits can be reissued upon timely contact by households.  

The proposed rule also solicits comment from states, advocates, and EBT processors regarding the possibility of changing the current benefits expungement process such that states must wait 12 months from the date each benefit allotment was issued to a household before expunging benefits. This proposed policy is meant to prevent high balances under on an EBT account for households.  Under the current,  states could expunge benefits only after a household’s account has been inactive for 12 months policy, thus as long as the account is active, no benefits would be expunged regardless of when the benefits were issued, and benefits could continue to accumulate as long as the household remains eligible for benefits. Comments can be submitted through the Federal Register by November 28. 

CMS Finalizes the New Medicare Quality Payment Program

On October 14, CMS rolled out its finalized policy implementing the Merit-Based Incentive Payment System (MIPS) and the Advanced Alternative Payment Model (APM) incentive payment provisions in the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), collectively referred to as the Quality Payment Program (QPP). CMS also launched a new QPP website http://qpp.cms.gov to explain the new program and help clinicians identify the measures most meaningful to their practice or specialty. Of note for rural providers, the final rule allows for flexibility in participating in the program during the first year; sets a low volume threshold that would exclude clinicians from participating in MIPS, if they have less than or equal to $30,000 in Medicare Part B allowed charges or less than or equal to 100 Medicare patients; and allows for Rural Health Clinics and Federally Qualified Health Centers to voluntarily report under MIPS. The rule will also be displayed in the Federal Register.  CMS will also host a Quality Payment Program Final Rule MLN Connects® call on Tuesday, November 15 from 1:30 to 3 pm ET.  To register or for more information, visit MLN Connects Event Registration.  

CMS Rural Health Solutions Summit 
Wednesday, October 19, 2016
9:00 a.m. – 4:00 p.m.
CMS Grand Auditorium

The CMS Rural Health Solutions Summit will be held on October 19, 2016, at CMS headquarters in Baltimore, Maryland, and via the ten CMS Regional Offices. The CMS Rural Health Council will bring together stakeholders from all sectors of the health care industry to engage in in-depth discussions about ways to improve access to care in rural America and to support local solutions and innovation in care delivery. For more information, including the agenda, visit: https://register.mitre.org/CMS_Rural_Health_Solutions_Summit/index.html