HAP Resource Center

Medicare CoP Final Rule for Skilled Nursing Facilities Phase 2 Implementation, October 2017


The Centers for Medicare & Medicaid Services (CMS) issued a final rule to improve the care and safety of residents in long-term care facilities that participate in the Medicare and Medicaid programs.

The policies in the final rule are targeted at reducing unnecessary hospital readmissions and infections, improving the quality of care, and strengthening safety measures for residents.

The rule implements a number of safeguards that have been identified by resident advocates and other stakeholders, and includes additional protections required by the Affordable Care Act (ACA). According to CMS, changes finalized in this rule include:

  • Strengthening the rights of long-term care facility residents, including prohibiting the use of pre-dispute binding arbitration agreements
  • Ensuring that long-term care facility staff members are properly trained in caring for residents with dementia and in preventing elder abuse
  • Ensuring that long-term care facilities take into consideration the health of residents when making decisions about the kinds and levels of staffing a facility needs to properly take care of its residents
  • Ensuring that staff members have the right skill sets and competencies to provide person-centered care to residents. The care plans developed for residents will take into consideration their goals of care and preferences
  • Improving care planning, including discharge planning for all residents with involvement of the facility’s interdisciplinary team and consideration of the caregiver’s capacity, giving residents information they need for follow-up after discharge, and ensuring that instructions are transmitted to any receiving facilities or service providers
  • Allowing dietitians and therapy providers the authority to write orders in their areas of expertise when a physician delegates the responsibility and state licensing laws allow
  • Updating the long-term care facility’s infection prevention and control program, including requiring an infection prevention and control officer and an antibiotic stewardship program that includes antibiotic use protocols and a system to monitor antibiotic use

These regulations are effective through the following implementation phases:

  • Phase 1:  November 28, 2016
  • Phase 2:  November 28, 2017
  • Phase 3:  November 28, 2019

This resource tool provides guidance for the implementation of Phase 2.



Topics: Federal Advocacy, Medicare, Regulatory Advocacy

Revision Date: 11/2/2017

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