Comments to CMS on Proposed Rule – How to Submit

Karen Morris in Clinical & Quality

CMS issued a proposed rule change for the SNF/NF Medicare and Medicaid Requirements for Participation on Monday July 13th 2015.  The rule is very large in scope and contains both new requirements and some requirements that have already been issued by CMS via Survey & Certification memoranda.  The formatted version of the NPRM proposing changes to the SNF Requirements for Participation is available in the Federal Register, with a deadline for comments submission of 5:00 pm on September 14, 2015.

To provide you with a "Cliff's Notes" version, as well as AHCA comments regarding some of the changes, we have developed a summary of all the proposed changes. Click HERE to view the summary. The actual language in the Requirements for Participation CMS is proposing are contained on pages 42246 to page 42269.  Although CMS will review comments on all components of the rule, CMS has requested specific "solicitation for comments" from stakeholders for areas that CMS has not made a specific proposal or recommendation about implementation timelines.  These requests appear on pages 10 - 11 of the summary.

Some of the proposed changes/requirements that stand out:

  1. Quality Assurance and Performance Improvement (QAPI) programs;
  2. Baseline care plan for each resident within 48 hours of admission;
  3. Compliance and ethics programs;
  4. Discharge planning;
  5. Facility assessment which aims to determine what resources are necessary to care for its residents competently during both day-to-day operations and emergencies; and
  6. A more comprehensive Infection Prevention and Control Program including an Infection Prevention and Control Officer.
  7. Comments on the use of arbitration agreements.


We strongly encourage all members to submit comments themselves, given the impact these changes will have on nursing centers.  We need as many members to submit comments as possible to show the importance and concerns raised by CMS. Tips on how to submit comments are below.

Additionally, we encourage members to send their concerns and any suggested changes to this rule no later than August 6 to Lyn Bentley, so we can consider them for inclusion in AHCA's comments to CMS.

Tips on Organizing Your Comments

  • When submitting comments you need to refer to file code CMS-3260-P.
  • Organize your comments by major section heading in the proposed rule (see below for list) and then by the outline format used in the rule. For example if you wanted to comment on part of the proposed changes to Resident Rights you would say: "In section Residents Rights (483.10), we have comments about the proposed language in (a) 3. (i.) about "The resident representative has the right to exercise the resident's rights to the extent those rights are delegated to the resident representative."
  • Organize each of your comments in into three sections: First site the section of the proposed rule change, followed by your comments/discussion about the rule change, followed by your recommendation or suggested changes to CMS's proposed changes.
  • Section of proposed rule (site Federal Registry page number and section headings - see list of section headings below).  It is also ok to copy specific language you are commenting on.
  • Comments/Discussion
  • Recommendations/suggestions
  • General comments about the changes in general or that do not contain recommended changes often have little impact on the final rule issued by CMS.

Section Reference of the Proposed Rule

  • Resident rights (§483.10)
  • Facility responsibilities (§483.11)
  • Freedom from abuse, neglect, and exploitation (§483.12)
  • Transitions of care (§483.15)
  • Resident assessments (§483.20)
  • Comprehensive resident-centered care plans (§483.21)
  • Quality of care and quality of life (§483.25)
  • Physician services (§483.30)
  • Nursing services (§483.35)
  • Behavioral health services (§483.40)
  • Pharmacy services (§483.45)
  • Laboratory, radiology, and other diagnostic services (§483.50)
  • Dental services (§483.55)
  • Food and nutrition services (§483.60)
  • Specialized rehabilitative services (§483.65)
  • Administration (§483.70)
  • Quality assurance and performance improvement (§483.75)
  • Infection control (§483.80)
  • Compliance and ethics program (§483.85)
  • Physical environment (§483.90)
  • Training requirements (§483.95)

Where and How to submit your comments:

  • When submitting comments you need to refer to file code CMS-3260-P.
  • CMS will NOT accept comments by facsimile (FAX) transmission.
  • You may submit comments in any one of three ways but only need to use one method (we recommend submitting comments electronically):

1. Electronically. You may submit electronic comments on this regulation to http://www.regulations.gov.  Follow the ''Submit a comment'' instructions.

2. By regular mail. You must allow sufficient time for mailed comments to be received before the close of the comment period (NOT postmarked).  You can mail written comments to the following address:

Centers for Medicare & Medicaid Services
Department of Health and Human Services
Attention: CMS-3260-P
P.O. Box 8010
Baltimore, MD 21244.

3. By express or overnight mail. You must allow sufficient time for mailed comments to be received before the close of the comment period (NOT postmarked). You may send written comments to the following address only:


Centers for Medicare & Medicaid Services
Department of Health and Human Services
Attention: CMS-3260-P
Mail Stop C4-26-05
7500 Security Boulevard
Baltimore, MD 21244-1850


NYSHFA CONTACT:

Karen Morris, RN, MS
Director, Clinical & Quality Services
518-462-4800 x15