This rule also allows intermediate care facilities for individuals who are intellectually disabled to operate under open-ended agreements for conditions of participation in the Medicare program instead of time-limited ones. These facilities must now be surveyed every 12 to 15 months.
Nursing Care Plan Rules
The third greatest savings of $110 million comes in a change of nursing care plan rules, in which hospitals now have the option of having a stand-alone nursing care plan or an interdisciplinary plan rather than several.
In several instances, the rule defers to the state, or what it calls "nationally recognized and evidence-based guidelines and recommendations" or on state laws, instead of setting a national standard. For example, hospitals now have flexibility to use standing orders, as long as they comply with accepted practice standards.
Other changes include:
A redefinition of condition of program participation requirements for hospitals so that patients and their caregivers can administer their own medications.
Allowance of one governing board to set policy for all hospitals within one healthcare system instead of requiring one body for each.
Elimination of a reporting requirement of deaths among patients in soft, two-point restraints, which are often used among terminally ill patients to avoid inadvertent removal of tubes or IVs. Instead, an internal log must be kept and made available to investigators upon request.
The final rules are available here.