Medicare and Medicaid Programs; Reform of Requirements for Long-Term Care Facilities
Final rule; correction and correcting amendment.
CFR Part: "42 CFR Parts 405, 409, 431, 447, 482, 483, 485, 488, and 489"
RIN Number: "RIN-0938-AR61"
Citation: "82 FR 32256"
Document Number: "CMS-3260-F2"
Page Number: "32256"
"Rules and Regulations"
SUMMARY: In the
DATES: This document is effective
FOR FURTHER INFORMATION CONTACT:
SUPPLEMENTARY INFORMATION:
I. Background
In FR Doc. 2016-23503 which appeared in the
II. Summary of Errors
A. Summary of Errors in the Preamble
We inadvertently made technical and typographical errors in the preamble as follows:
On page 68725, fourth full paragraph of the second column, we inadvertently referenced proposed
On page 68729, second paragraph of the third column, we inadvertently referenced
On page 68736, second full paragraph of the second column, we inadvertently referenced
Under the Implementation Timeframe table we made technical and typographical errors as follows:
On page 68696, under
On page 68697, we inadvertently designated existing requirements at
On page 68697, we inadvertently designated existing requirements at
B. Summary of Errors in the Regulations Text
On page 68847, we inadvertently omitted a conforming change to revise cross-references to part 483 found in part 409. Sections 409.20 and 409.26 include incorrect cross-references to
On page 68847, we made technical errors in the regulations text for
On page 68848, we made technical errors in the regulations text of
On page 68854, we inadvertently designated a cross-reference at
On page 68856, we made a technical error in the regulations text of
On page 68863, we made a technical error in the amendatory instruction for
On page 68863, we made a technical error in the regulations text of
On page 68865, we made a technical error in the amendatory instruction for
On page 68868, we made a technical error in the regulations text for
On page 68869, we made a technical error in the regulations text for
On page 68870, we made technical errors in the regulations text for
On page 68871, we made a technical error in the amendatory instruction for
On page 68871, we made technical errors in the regulations text for
On page 68871, we made a technical error in the regulations text for
III. Waiver of Proposed Rulemaking and Delay in Effective Date
We ordinarily publish a notice of proposed rulemaking in the
Section 553(d) of the APA ordinarily requires a 30-day delay in effective date of final rules after the date of their publication in the
Our revisions to the requirements for Long-Term Care (LTC) facilities found in part 483 subpart B have previously been subjected to notice and comment procedures. These corrections are consistent with the discussion of the policy in the
For the same reasons, we are also waiving the 30-day delay in effective date for this correcting amendment. We believe that it is in the public interest to ensure that the
IV. Correction of Errors in the Preamble
a. On page 68725, in second column; in the fourth paragraph, line 21 remove "482.11" and add in its place "483.11".
b. On page 68729, in the third column; in the second paragraph, line 11 remove "482.15(a)" and add in its place "483.15(a)".
c. On page 68736, in the second column; in the second paragraph, line 58 remove " 482.20(k)(4)" and add in its place "483.20(k)(4)".
d. On page 68696, in the table under the "Implementation deadline" heading, second column, in the second bullet, after the word "QAPI," remove the word "Plan" and add "Program" in its place.
e. On page 68697, in the table under the "Implementation deadline" heading, second column--
1. In the sixth bullet, remove the phrase "(e) Psychotropic drugs--Implemented in Phase 2" and add "(e)(3), (4), and (5) Psychotropic drugs--Implemented in Phase 2" in its place.
2. In the sixteenth bullet--
A. Remove the reference to "(g)(1)" and add "(g)" in its place.
B. Remove the phrase "with the exception of subparagraph (iv), the addition of the ICPO, which will be implemented in Phase 3" and add "with the exception of aragraphs (g)(1)(iv) (the addition of the IP) and (g)(2)(iii) (regarding the use of QAPI data), which will be implemented in Phase 3".
C. Remove the acronym "ICPO" and add "IP" in its place.
List of Subjects
42 CFR Part 409
Health facilities, Medicare.
42 CFR Part 482
Grant programs--health, Hospitals, Medicaid, Medicare, Reporting and recordkeeping requirements.
42 CFR Part 483
Grant programs--health, Health facilities, Health professions, Health records, Medicaid, Medicare, Nursing homes, Nutrition, Reporting and recordkeeping requirements, Safety.
42 CFR Part 485
Grant programs--health, Health facilities, Medicaid, Medicare, Privacy, Reporting and recordkeeping requirements.
42 CFR Part 488
Administrative practice and procedure, Health facilities, Medicare, Reporting and recordkeeping requirements.
For the reasons set forth in the preamble, the
PART 409--HOSPITAL INSURANCE BENEFITS
1. The authority citation for part 409 continues to read as follows:
Authority: Secs. 1102 and 1871 of the Social Security Act (42 U.S.C. 1302 and 1395hh).
2. In
3. In
PART 482--CONDITIONS OF PARTICIPATION FOR HOSPITALS
4. The authority citation for part 482 continues to read as follows:
Authority:
Secs. 1102, 1871 and 1881 of the Social Security Act (42 U.S.C. 1302, 1395hh, and 1395rr), unless otherwise noted.
5. In
* * * * *
(b) Skilled nursing facility services. The facility is substantially in compliance with the following skilled nursing facility requirements contained in subpart B of part 483 of this chapter.
(1) Resident rights (
(2) Admission, transfer, and discharge rights (
(3) Freedom from abuse, neglect, and exploitation (
(4) Patient activities (
(5) Social services (
(6) Discharge planning (
(7) Specialized rehabilitative services (
(8) Dental services (
PART 483--REQUIREMENTS FOR STATES AND LONG TERM CARE FACILITIES
6. The authority citation for part 483 continues to read as follows:
Authority:
Secs. 1102, 1128I and 1871 of the Social Security Act (42 U.S.C. 1302, 1320a-7j, 1395hh and 1396r).
7. In
* * * * *
Composite distinct part --* * *
(2) Requirements. In addition to meeting the requirements of specified in the definition of "distinct part" of this section, a composite distinct part must meet all of the following requirements:
* * * * *
Distinct part --(1) Definition. A distinct part SNF or NF is physically distinguishable from the larger institution or institutional complex that houses it, meets the requirements of this paragraph and of paragraph (2) of this definition, and meets the applicable statutory requirements for SNFs or NFs in sections 1819 or 1919 of the Act, respectively. A distinct part SNF or NF may comprise one or more buildings or designated parts of buildings (that is, wings, wards, or floors) that are: In the same physical area immediately adjacent to the institution's main buildings; other areas and structures that are not strictly contiguous with the main buildings but are located within close proximity to the main buildings; and any other areas that CMS determines on an individual basis, to be part of the institution's campus. A distinct part must include all of the beds within the designated area, and cannot consist of a random collection of individual rooms or beds that are scattered throughout the physical plant. The term "distinct part" also includes a composite distinct part that meets the additional requirements specified in the definition of "composite distinct part" of this section.
* * * * *
8. In
9. In
a. Amend paragraph (a)(7) by removing the reference "paragraph (b)(10)" and adding in its place "paragraph (c)(9)".
b. Amend paragraph (b)(2) by removing the reference to "
c. Amend paragraph (c)(2)(ii)(B) by removing the reference "paragraph (b)(1)(i)(C) or (D)" and adding in its place "paragraph (c)(1)(i)(C) or (D)".
d. Amend paragraph (c)(2)(iii)(F) by removing the word "residents" and adding in its place "resident's".
e. Amend paragraph (c)(3)(iii) by removing the reference to "paragraph (b)(5)" and adding in its place "paragraph (c)(5)".
f. Amend paragraph (c)(4)(i) by removing the reference "paragraphs (b)(4)(ii) and (b)(8)" and adding in its place "paragraphs (c)(4)(ii) and (8)".
g. Amend paragraph (c)(4)(ii)(A) by removing the reference to "paragraph (b)(1)(ii)(C)" and adding in its place "paragraph (c)(1)(i)(C)".
h. Amend paragraph (c)(4)(ii)(B) by removing the reference to "paragraph (b)(1)(ii)(D)" and adding in its place "paragraph (c)(1)(i)(D)".
i. Amend paragraph (c)(4)(ii)(C) by removing the reference "paragraph (b)(1)(ii)(B)" and adding in its place "paragraph (c)(1)(i)(B)".
j. Amend paragraph (c)(4)(ii)(D) by removing the reference "paragraph (b)(1)(ii)(A)" and adding in its place "paragraph (c)(1)(i)(A)".
k. Amend paragraph (c)(5) introductory text by removing the reference "paragraph (b)(3)" and adding in its place "paragraph (c)(3)".
l. Amend paragraph (d)(1)(iii) by removing the reference "paragraph (c)(3)" and adding in its place "paragraph (e)(1)".
m. Amend paragraph (d)(1)(iv) by removing the reference "paragraph (c)(3)" and adding in its place "paragraph (e)(1)".
n. Amend paragraph (d)(2) by removing the reference "paragraph (c)(1)" and adding in its place "paragraph (d)(1)".
10. In
* * * * *
(c) * * *
(5) The facility must develop and maintain policies and procedures for the monthly drug regimen review that include, but are not limited to, time frames for the different steps in the process and steps the pharmacist must take when he or she identifies an irregularity that requires urgent action to protect the resident.
* * * * *
11. In
12. In
* * * * *
(i) Medical records. * * *
* * * * *
13. In
14. In
* * * * *
(b) General rule. Beginning
* * * * *
15. In
* * * * *
(c) Emergency power. (1) An emergency electrical power system must supply power adequate at least for lighting all entrances and exits; equipment to maintain the fire detection, alarm, and extinguishing systems; and life support systems in the event the normal electrical supply is interrupted.
(2) When life support systems are used, the facility must provide emergency electrical power with an emergency generator (as defined in NFPA 99, Health Care Facilities) that is located on the premises.
* * * * *
PART 485--CONDITIONS OF PARTICIPATION: SPECIALIZED PROVIDERS
16. The authority citation for part 485 continues to read as follows:
Authority: Secs. 1102 and 1871 of the Social Security Act (42 U.S.C. 1302 and 1395(hh)).
17. In
18. In
a. Revise paragraph (d)(1).
b. Remove paragraph (d)(2).
c. Redesignate paragraphs (d)(3) through (10) as paragraphs (d)(2) through (9), respectively.
d. Revise newly redesignated paragraphs (d)(2) through (9).
The revisions read as follows:
* * * * *
(d) * * *
(1) Resident rights (
(2) Admission, transfer, and discharge rights (
(3) Freedom from abuse, neglect and exploitation (
(4) Patient activities (
(5) Social services (
(6) Comprehensive assessment, comprehensive care plan, and discharge planning (
(7) Specialized rehabilitative services (
(8) Dental services (
(9) Nutrition (
PART 488--SURVEY, CERTIFICATION, AND ENFORCEMENT PROCEDURES
19. The authority citation for part 488 continues to read as follows:
Authority: Secs. 1102, 1128l, 1864, 1865, 1871 and 1875 of the Social Security Act, unless otherwise noted (42 U.S.C 1302, 1320a-7j, 1395aa, 1395bb, 1395hh) and 1395ll.
20. In
Dated:
Secretary,
[FR Doc. 2017-14646 Filed 7-12-17;
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