This is Part 1 of a two-part article on post-acute compliance
issues. Part 2 will be published in the February issue of
2016 and 2017 were momentous years for compliance issues that impacted long-term care LTC facilities, leaving
LTC facilities with significant challenges
and burdens to operate successfully and
avoid citations and penalties. The substantive changes include finalizing the first major
overhaul since 1991 of the Requirements of
Participation (RoPs) for LTC facilities.1 CMS
also made significant revisions to the State
Operations Manual (SOM) Interpretative
Guidelines and Survey Protocol based on
the new RoPs. 2
Long-term care Requirements
LTC facilities will continue to
face challenges implementing
the RoPs, which became final on
September 28, 2016. The revisions to
the RoPs will be implemented in three
phases. Phase 1, which contained
most of the RoP changes, was effective on November 28, 2016. Phase 2
was effective on November 28, 2017.
Phase 3 will become effective on
November 28, 2019.
With regard to the Phase 2
RoP implementation date, on
November 24, 2017, CMS issued a
program memorandum that would
delay certain enforcement remedies for
some Phase 2 RoPs. 3 The CMS memorandum
imposed an 18-month moratorium on civil
monetary penalties, denials on payment for
by Todd Selby and Robert W. Markette, Jr.
Post-acute care compliance
issues, Part 1: Long-term care
» Long‑term care (LTC) facilities are required to implement annual, facility‑wide, and community‑based assessments to
determine what resources are necessary for day‑to‑day and emergency care for their residents.
» The Quality Assurance and Performance Improvement (QAPI) Requirement of Participation requires all LTC facilities to
develop, implement, and maintain an effective, comprehensive, data‑driven QAPI program that focuses on systems of
care, outcomes of care, and quality of life.
» CMS released a revised version of the State Operations Manual, which provides valuable insight on how state surveyors
will interpret and conduct surveys under the new Requirements of Participation (RoPs).
» CMS also revised the Survey Protocol for LTC facilities to combine the best aspects of the current traditional survey
process and the Quality Indicator Survey.
» LTC facilities must track the results of interventions to ensure that desired improvements are realized and sustained.
Todd J. Selby ( email@example.com) is an Attorney at and
Robert W. Markette, Jr. ( firstname.lastname@example.org) is Of Counsel at Hall,
Render, Killian, Heath & Lyman, PC in Indianapolis, IN.