On August 2, 2013, the Centers for Medicare and Medicaid Services (“CMS”) issued an update to the State Operations Manual (“SOM”) regarding the process for notification of a facility closure. The updates to the SOM are the result of a final rule published in the Federal Register on March 19, 2013 and can be found at 42 CFR 483.75(r) and (s). CMS noted that the August 2nd update to the SOM may differ slightly when published in the online version of the SOM.
The administrator of a skilled nursing facility (“SNF”), nursing facility (“NF”) or a duly-certified skilled nursing facility/nursing facility (“SNF/NF”) must provide written notification (“Notification”) a minimum of 60 days prior to the closing. The Notification must include a relocation plan and be provided to the following parties: (i) CMS; (ii) the state long-term care ombudsman; (iii) all residents of the facility; and (iv) the legal representative(s) of a resident or any other responsible party(ies).
If a facility’s closure is due to its termination from the Medicare and/or Medicaid programs by the Secretary of the Department of Health & Human Services, the same parties listed in (i) through (iv) above must be notified by the date the Secretary determines is appropriate.
The August 2nd update to the SOM added two new tags, F523 and F524. More specifically, F203 is revised to add a reference to a notice of transfer or discharge due to a facility closure. F204 requires the facility provide sufficient preparation and orientation to a resident to ensure a safe and orderly transfer or discharge from the facility. Additionally, the administrator, or an individual acting on behalf of the administrator, should notify the following parties of the anticipated closure: (i) the Medical Director; (ii) a resident’s primary physician; (iii) the CMS Regional Office; and (iv) the State Medicaid Office.
F523 requires the administrator not only provide notice to the above-referenced parties but must also ensure there are no new admissions on or after the date the Notification is submitted and that residents are appropriately transferred. F524 requires a facility have in place policies and procedures pertaining to any non-emergency voluntary or involuntary facility closure. Such policies and procedures should be developed from input of key facility personnel and should include: (i) the administrator’s duties and responsibilities and notification practices for informing residents’ physicians and the state Medicaid Agency of the pending closure to ensure continuity of care; (ii) provisions for transferring a resident to the most appropriate facility for his/her needs and care requirements; and (iii) provisions for providing to the receiving facility a complete medical record, care guidelines and assessments and orders for each resident. Although not required, CMS recommends these provisions be a part of each facility’s Emergency Preparedness Plan.
The Memorandum can be accessed here.
If you have questions or concerns regarding the foregoing or would like additional information, please contact Todd Selby at tselby@wp.hallrender.com or 317.977.1440, Brian Jent at bjent@wp.hallrender.com or 317.977.1402, David Bufford at dbufford@wp.hallrender.com or 502.568.9368 or your regular Hall Render attorney.
