CMS Proposal to Cut Red Tape Needs to Be So Much More

CMS may have come out with a sweeping set of proposed changes to streamline regulations in the long-term care sector, but the draft rule could be so much more, says one expert, who said providers should push instead for a more significant cut in rules and regs.  

On Nov. 5, as reported here in Park Place, CMS released the “Medicare and Medicaid Programs; Cutting Administrative Requirements for Excellence in Patient Care (CARE) (CMS-3484-P)” proposal. The agency said the rule proposes regulatory revisions to the Conditions of Participation (CoPs), Conditions for Coverage (CfCs), and Requirements for Participation for Medicare- and Medicaid-participating providers and suppliers (collectively referred to as CoPs).

The proposed rule would alleviate what CMS called “unnecessary regulatory burden through deregulation in” the following ways for LTC facilities:

• Remove the COVID-19 vaccine requirements related to educating staff about the benefits and risks, offering the vaccine, and documenting these actions.

  
  

• Streamline the remaining COVID-19 vaccine requirements for residents.

  
  

• Remove the continuing respiratory illness data reporting requirement while retaining the requirement for specific reporting during a future Secretary-declared public health emergency (PHE).

  
  

• Modify the requirement for LTC facilities to provide a state ombudsman with notice of resident transfers related to emergent care.

  
  

• Revise the requirements for the active involvement of representatives of direct care staff in conducting the LTC facility assessment.

  
  

• Revise the physical environment requirements to exempt existing facilities from the room occupancy and bathroom facility standards.

Not Enough

But in analyzing what the proposed rule means to long-term care facilities, Steven Littlehale, chief innovation officer, Zimmet Healthcare Services Group, said while the CARE proposed rule represents a constructive step toward regulatory simplification, the nursing home industry should view it as an opportunity to advocate for more meaningful reform.

“Many of the proposed changes address discrete administrative requirements but leave largely untouched the more consequential intersection of clinical practice, documentation, and regulatory oversight,” he noted.

Littlehale said the industry's comments should focus on requirements that consume significant clinical resources without demonstrably improving resident outcomes.

“For example, the proposed facility assessment revision removes a specific requirement concerning direct care staff representation but does little to address how facilities can better integrate the assessment into existing clinical and operational processes,” Littlehale said.

“Similarly, eliminating duplicative reporting requirements is worthwhile, but CMS should consider how information already collected through the MDS, PBJ, and other federal systems can be used more effectively without imposing additional administrative work.”

Get Modern

Perhaps the greatest opportunity lies in modernizing clinical practice requirements, he said. CMS's solicitation regarding nurse practitioners and physician assistants provides an opening to reconsider whether prescriptive physician visit requirements reflect contemporary models of nursing home care, Littlehale said.

“Expanding appropriate practitioner flexibility could improve access to timely clinical assessment and treatment, offering benefits that extend well beyond reducing administrative burden,” he said.

The industry should also encourage CMS to reconsider how regulatory compliance is evaluated. Requirements that promote accurate assessment, individualized care planning, and effective clinical intervention are essential.

“However, duplicative documentation and procedural expectations that add little to resident care deserve scrutiny. Regulatory oversight should recognize effective clinical processes and measurable outcomes rather than inadvertently rewarding the production of documentation,” Littlehale said.

There is also an important responsibility for providers. “The industry cannot simply argue that fewer requirements will produce better care. It should be prepared to demonstrate how regulatory efficiencies translate into improved clinical responsiveness, more meaningful staff engagement, and better resident outcomes,” he said.

“The most meaningful regulatory reform is not the elimination of a requirement. It is the elimination of work that does not improve care, while strengthening the work that does. That should be the central message of the nursing home industry's response to CMS.”

AHCA Responds

After the proposal came out, AHCA/NCAL President and CEO Clif Porter said, “We appreciate CMS’ efforts to help long term caregivers put patients over paperwork and focus more on delivering quality care. Specifically, ending weekly reporting requirements that were tied to the public health emergency that ended more than three years ago is recognizing how far we’ve come since the pandemic and reducing redundant administrative tasks.”

He added that “we look forward to submitting comments, including on additional policies that will help address the nation’s growing caregiver shortage and build the caregivers for tomorrow. It’s time for a smarter, more effective oversight system focused on driving quality care, and we look forward to continuing to collaborate with CMS on this endeavor.” 

See the draft rule and how to comment at Medicare and Medicaid Programs; Cutting Administrative Requirements for Excellence in Patient Care (CARE) (CMS-3484-P) | CMS.

Comments or Questions? Contact Patrick Connole at pconnole@parkplacelive.com.