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CMS Updates Nursing Home Regulations

August 10, 2022

On August 3, 2022, the Center for Medicare & Medicaid Services (CMS) published updated nursing homes regulations, which included changes to the requirements for the Director of Food and Nutrition Services and updates to the Life Safety Code.  CMS also announced changes to the Skilled Nursing Home Quality Reporting Program (QRP) and the Value Based Purchasing Program (VBP).

In 2019, CMS proposed changing the regulations regarding the qualifications for directors of food and nutrition services to allow a director of food and nutrition services to either have two years of experience working in that position or have completed a minimum course of study in food safety. Prior to the proposed change, a director of food and nutrition services was required to be a certified dietary manager, a certified food manager, have a similar certification in food service management and safety, or have an associate’s degree or higher in food service management or hospitality. 

In response to the 2019 proposed regulation, Consumer Voice submitted comments strongly opposing this change, noting that “two years or more years of experience as a director of food and nutrition services does not mean a person is adequately equipped for this position,” and “the proposed alternative qualification, a ‘course of study’ is extremely vague.” Consumer Voice argued that CMS’s justification for watering down the qualification requirements - there being a burden on nursing homes - was far outweighed by the safety and health of residents.

After reviewing public comments, CMS acknowledged that the proposed qualification requirements were insufficient.  They revised the regulation to state that the director must have “two or more years of experience in the position of director of food and nutrition services in a nursing facility setting and has completed a course of study in food safety and management, by no later than October 1, 2023.” Unlike the 2019 proposed regulation, the new qualification requirements cannot be met by having taken a course of study alone but must be accompanied by two years of experience as the director of food and nutrition services.  

Additionally, CMS finalized 2019 proposed changes to 42 C.F.R. §483.90(a), the Life Safety Code.  The new regulations allow long term care facilities, certified before July 5, 2016, to use an alternative scoring system to meet fire safety requirements.  CMS noted that allowing this system does not lower facility safety standards. 

CMS also announced the adoption of several previously proposed measures for the Skilled Nursing Home Quality Reporting Program (QRP) measures and the Value Based Purchasing Program (VBP).

The QRP measure, Influenza Vaccination Coverage Among Healthcare Personnel measure, requires nursing homes to annually report data on the rate of influenza vaccination of healthcare staff in the facility.  This measure will be publicly available on Care Compare. After public comment, CMS adopted the use of this measure beginning in fiscal year 2024.

CMS adopted several additional measures for the Value Based Purchasing program. The program seeks to incentivize good care through a variety of measures that financially reward nursing homes for good performance.

The new measures adopted include:

  • Skilled Nursing Facility Health-Care Association Infections Requiring Hospitalizations: This measure identifies nursing homes with higher rates of infections acquired during the resident’s stay at a facility. It will go into effect in fiscal year 2026.
  • Total Nursing Hours per Resident Day Staffing Measure: This measure uses payroll data from nursing homes to calculate total direct care nursing hours per resident each day and is already used on the Care Compare website. It goes into effect in fiscal year 2026.
  • DTC-PAC Measure: This measure looks at a facility's successful discharge of residents to the community using two years of discharge data.

These measures were included in CMS’ wide-ranging Notice of Proposed Rulemaking issued on April 15, 2022, which also included several requests for information, including on a proposed minimum staffing standard.  Read Consumer Voice’s response to these requests. In the August 3, 2022 notice, CMS offered broad summaries of the public responses to its request for information, but offered no insight into any forthcoming actions it may be taking.

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