Are you ready for Phase 3 of the Mega Rule?

In October 2016, the Centers for Medicare & Medicaid Services delivered one of the most sweeping changes to long-term care compliance in more than 30 years and turned up the heat on the industry’s already intense regulatory environment. Reform of Requirements for Long-Term Care Facilities, dubbed the Mega Rule, contains hundreds of compliance changes and clarifications for skilled nursing and nursing facilities. The rule applies to facilities that receive money from Medicare or Medicaid — which is most of them. This environment of ever-changing rules has also made attaining CMS’ coveted five-star rating for nursing homes even more complex. Last month, the 1-year countdown for the 2019 deadline for the Mega Rule’s final Phase 3 began. As 2018 comes to a close, let’s take a brief look at what lies ahead for the next year’s requirements.

What to expect
The main areas of the Mega Rule that Phase 3 addresses are: Quality Assurance and Performance Improvement (QAPI) implementation, Infection Control, Compliance and Ethics and Physical Environment. Some of the regulations in these areas have been partially implemented in the previous phases. For example, the Mega Rule addressed care planning earlier but in Phase 3, Section §483.21 (Comprehensive Person-Centered Care Planning) requires that care plans are culturally-competent and trauma-informed. However, all the regulations included in Phases 1 to 3 must be implemented by November 28, 2019.

Phase 3 adds to QAPI requirements in two ways. Section §483.12 (Freedom from Abuse, Neglect, and Exploitation) requires that facilities integrate abuse, neglect and exploitation into their QAPI program. Section §483.70 (Administration) requires that the responsibility for the QAPI program are included in the obligations of the governing body.

Phase 3 also focuses heavily on employee training and staff competencies. Section §483.25 (Quality of Care) mandates that training related to trauma-informed care be provided to staff. Also, Section §483.40 (Behavioral Health Services) requires the development and implementation of a process to assess staff competencies for caring for residents with a history of trauma and/or post-traumatic stress disorder. Finally, Section §483.95 (Training Requirements) calls for new training to be implemented for staff, contractors and volunteers for topics such as communication; resident’s rights, abuse, neglect, infection control and compliance and ethics.

The last phase also necessitates facilities add some new personnel responsibilities. Section §483.80 (Infection Control) calls for the hiring or the designation of an infection preventionist who is responsible for the Infection Prevention and Control Program. Section §483.85 (Compliance and Ethics Program) requires that a plan be developed for implementing components of a compliance and ethics program as well as putting a schedule in place to annually review and update the program.

Help is available
With the Phase 3 deadline looming, staying on top of regulatory changes and having all the proper tools to ensure compliance with all phases of the Mega Rule are a must. It’s important to have innovative solutions and resources to help manage compliance and organize information. The Compliance Store is the only web-based regulatory compliance management resource. To learn more about how The Compliance Store can help you with tools, templates and regulatory information, go to 


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