CMS Issues Final Rule for Hospice in Nursing Centers

AHCA Lyn Bentley in Clinical & Quality

Today the final rule Medicare and Medicaid Programs; Requirements for Long Term Care Facilities; Hospice Services was published in the Federal Register.  According to the preamble of the regulation, “This final rule sets forth requirements consistent with requirements in the June 5, 2008 final rule (73 FR 32088) titled ‘‘Medicare and Medicaid Program: Hospice Conditions of Participation.’’  Also in the preamble: “This final rule also supports current LTC requirements that protect a resident’s right to a dignified existence, self-determination, and communication with, and access to, persons and services inside and outside the facility.”
The rule primarily focuses on the information that must be contained in an agreement for hospice services between a hospice and nursing center and is effective August 26, 2013.
Following is the CMS summary of the changes to the proposed rule:
We are adopting the provisions of this final rule as proposed, with the following changes:

  • We originally proposed the standard regarding LTC facility/Hospice cooperation at §483.75(r); however, during the process of finalizing this rule, CMS published a separate interim final rule, Requirements for Long- Term Care (LTC) Facilities; Notice of Facility Closure (76 FR 9503). The interim final rule added standards §483.75(r) and (s). Since the standards at §483.75(r) and (s) are now in use, we are finalizing this standard at §483.75(t).
  • In consideration of public comments, we are making three substantive changes in this final rule. We have made a revision at 483.75(t)(3) to clarify that the LTC representative must have a clinical background, function within their State scope of practice act, and have the ability to assess the resident or have access to someone that has the skills and capabilities to assess the resident. We have also made a revision to the requirement at §483.75(t)(3)(iii) removing the phrase “other physicians” and replacing it with “other practitioners.” Lastly, we have made a revision to the requirement at §483.75(t)(2)(ii)(E)(3) by removing the phrase “that is not related to the terminal condition.”

Technical Correction

  • We are finalizing the proposed technical correction which would fix an incorrect citation at §483.10(n). In §483.10(n), we are revising the reference “§483.20(d)(2)(ii)” to read “§483.20(k)(2)(ii).”
  • We are also finalizing the proposed technical correction which would fix an incorrect citation at proposed §483.75(r)(4). In §483.75(t)(4), we are revising the reference “483.20(k)” to read “483.25.”

Lyn Bentley, MSW
Sr. Director of Regulatory Services
1201 L St., NW
Washington, DC  20005



Nancy Leveille, RN, MS
Sr. Director, Member Operational Support
518-462-4800 x20
  Karen Morris, RN, MS
Director, Clinical & Quality Services
518-462-4800 x15