Policy & Regulation News

CMS Posts Patient-Centered Rules for Long-Term Care Facilities

A new CMS rule will require long-term care facilities to remove arbitration clauses from their contracts, helping to improve patient-centered care, patient safety, and care quality.

By Sara Heath

For the first time since 1991, CMS has revamped its rules for long-term care facilities, working to drive patient-centered care, patient safety, and healthcare quality, according to a press release.


One portion of the rule advocates for patient and family rights by prohibiting the use of arbitration clauses in long-term care facilities, which may discourage patients and caregivers from bringing concerns about services and care quality to the relevant authorities.

In a CMS blog post, CMS Acting Administrator Andy Slavitt and Director of the CMS Center for Clinical Standards & Quality Kate Goodrich, MD, MHS, explained that long-term care facilities usually include arbitration clauses in patient contracts. Should a dispute between the patient and facility arise, these clauses require patients to use arbitration rather than settle the dispute in court, which could keep regulators from understanding quality issues.

On November 28, 2016, arbitration contracts will be prohibited. According to CMS, they enacted this rule in order to protect patient and family rights.

“Today’s rules are a major step forward to improve the care and safety of the nearly 1.5 million residents in the more than 15,000 long-term care facilities that participate in the Medicare and Medicaid programs,” Slavitt and Goodrich wrote.

“These changes are an integral part of CMS’s commitment to transform our health system to deliver better quality care and spend our health care dollars in a smarter way, setting high standards for quality and safety in long-term care facilities.”

Going forward, patients will still have the option to settle disputes via arbitration. In these cases, the long-term care facility will be required to fully explain to patients and their families the details of an arbitration, emphasizing that choosing arbitration is completely voluntary and that patients and families should not feel pressured into doing so.

Facilities will also need to explain to patients and families that arbitration agreements should not discourage them from speaking with authorities about care quality concerns.

CMS set these rule changes into motion in July 2015 when it solicited public comment on long-term care facility “rules of the road.” After reviewing over 10,000 public comments, Slavitt and Goodrich said, the agency noticed a trending concern about arbitration clauses in facility contracts.

These public comments also informed several other rule updates, according to CMS. These other rules are targeted at delivering quality care for patients, reducing hospital readmissions, and strengthening patient safety measures.

Long-term care facilities will need to ensure that their staff is trained to provide care for patients with dementia and trained in patient-centered care techniques. Staff training must also include elder abuse prevention and instructions on how to honor patient rights.

The rules also require long-term care facilities to improve their care planning strategies, including discharge planning. Discharge planning must include follow-up care and self-care instructions for patients.

Long-term care facilities will need to allow clinicians to practice at the top of their training. Primarily, this means allowing dieticians and therapy providers to write orders in their areas of expertise, increasing care access for patients and reducing physician burden.

According to Slavitt and Goodrich, these rule changes will improve healthcare for patients by helping to promote patient-centered care throughout all long-term care facilities. Ultimately, this should drive positive outcomes industry-wide.

“This is part of our ongoing commitment at CMS to making sure that health care becomes more person-centered for Medicare and Medicaid beneficiaries and their family members,” Slavitt and Goodrich concluded.

“These changes further that goal by protecting the health and safety of residents, particularly during vulnerable and critical times like when moving into a long-term care facility.”

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