By now, everyone operating a skilled nursing facility knows about CMS’ 2016 overhaul of the Requirements for Participation for Long-Term Care Facilities (“RoPs”). The final rule amending the RoPs was published on October 4, 2016. See 81 Fed. Reg. 68688 (Oct. 4, 2016). Many of the changes made by CMS do not impose new requirements on facilities, but instead clarify existing requirements. While CMS has been implementing the various changes in three phases over a three-year period, facilities should by now have implemented or taken steps to implement all of the new requirements.
We have reviewed the new RoPs and guidance documents issued by CMS to determine how the changes impact nursing facility admission agreements. There were changes or clarifications to a number of subjects that impact such agreements, including: resident discharge requirements, resident representative requirements, selection of attending physicians and other health care providers, room transfer and roommate requirements, visitation rights, facility liability for resident property, bed hold policies, etcetera.
If your facility currently has an admission agreement, it very likely requires some revision to comply with the new RoPs. It is imperative that the admission agreement used by the facility not run afoul of the new RoPs. Not only does this impact the enforceability of the agreement and the facility’s ability to pursue collection actions, surveyors are reviewing the admission agreements and issuing deficiencies related to the new RoPs. For instance, if your facility’s admission agreement includes a waiver of liability with respect to resident personal property (which is very common), your facility could be cited with violation of F620 (formerly F208; 42 C.F.R. § 483.15(a)). This is because the new RoPs prohibit facilities from requesting or requiring residents to waive facility liability for losses of personal property. These types of violations are low-hanging fruit for surveyors.
Our firm has developed a research memorandum that discusses the various new RoPs that impact admission agreements. This memorandum includes suggested language for admission agreements and can be used to facilitate your review of your current admission agreement. This research memorandum is offered to our clients at a flat rate. In addition to the memorandum, we also offer nursing facilities a full admission packet that includes our standard admission agreement and all necessary attachments. This packet is provided to facilities as a single fillable PDF file that admission staff have found easy and convenient to use. This packet is also offered through a flat fee proposal. We are also available to review your existing admission agreement for compliance with the various requirements, if that is your preference. Whatever route you choose, do not let the admission agreement fall to the wayside. While not required, it is an important document that helps to define and govern the relationship between nursing facilities, their residents, and their resident’s legal representatives.