Expect the Unexpected: This week’s Top Newsmakers in Quality and Regulatory Affairs

Maine Adopts Regulations Related to CNAs
Effective January 30, 2019, the Maine State Board of Nursing adopted amendments to Ch. 5, Regulations Relating to Training Programs and Delegation by Registered Professional Nurses of Selected Nursing Tasks to Certified Nursing Assistants ADOPTED RULE NUMBER: 2019-017. The amendment provides certified nursing assistants trained in another jurisdiction a mechanism to be placed on the Maine CNA Registry and eliminates the bridging process for this purpose. According to Robert Carr, Department of Licensing and Certification's Program Manager Workforce Development: CNA Registry, "We know this is a very positive change for our Maine providers. We are aware of this amendment and are working to align our internal processes to reflect this change.” Carr explained that the current process for out of state training applicants is to establish a bridge exam and competencies assessment. With the absence of this process “we will need to adjust how these applicants are handled.” In the meantime, MHCA members who are looking to hire someone with training in other jurisdictions can take note of the documentation most likely needed from your potential hire upon application. Documentation is expected to include:
· Copies of training hours completed in pursuit of certification in previous jurisdiction
· Copies of held certifications
· Copies of continued education to comply with annual/bi-annual continued education requirement
Carr and his team will keep MHCA up to date on the process of implementing the changes necessary to comply with this amendment. To review the changes to Ch. 5 visit the Maine Board of Nursing.
OSHA Finalizes Rule Eliminating SOME Reporting Requirements for Large Employers

According to Lily Hammel of AHCA, last week the Occupational Safety and Health Administration (OSHA) finalized a regulation eliminating the obligation for employers of 250 or more employees to submit their forms 300 and 301. This reporting requirement was proposed under the Obama administration, but was never enforced. The final rule retains the requirement for them to submit their 300A annual summary. Employers with 20-250 employees in certain designated hazardous industries, including long term care, must also continue to submit 300As. In addition, the final rule adds a requirement for covered employers to electronically submit their Employer Identification Number with their information from Form 300A. Collection of Calendar Year 2018 information from the OSHA Form 300A began on January 2, 2019. The deadline for electronic submissions is March 2, 2019. Finally, this new regulation does not make any changes to the anti-retaliation provision.  That provision requires employers to have a “reasonable” program in place for employees to report injuries and safety violations, leaving open to interpretation what “reasonable” means.
PDPM May Put SNFs and Rehab Providers at Risk over Therapy Hours
Skilled Nursing News (1/28, Spanko) reports that because the Patient-Driven Payment Model (PDPM) "shifts incentives away from the volume of therapy hours, providers could find themselves accused of not providing enough rehabilitation time for residents," exposing them to legal pushback. While CMS "explicitly pointed to fraud reduction as a key selling point" of PDPM, Timothy Ford, partner at the firm Einhorn Harris, said, "Diligent plaintiffs' attorneys will try to use any reduction in the number of hours of therapy as evidence of neglect and malpractice." MHCA has partnered with AHCA to provide PDPM support which will kick off at the April 17th event here in Augusta, Maine.
CMS published memo summarizing inflation to CMP monies
Last week CMS published a  memo summarizing the inflation adjustments to the CMP amounts that may be imposed for noncompliance by nursing centers. The new CMP amounts and ranges can be found in the Appendix of the memo (linked above). The adjusted amounts apply to CMPs assessed on or after October 11, 2018. The Federal Civil Penalties Inflation Adjustment Improvements Act of 2015 required CMS to make annual inflation adjustments to the CMP amounts. For 2018, CMPs have been increased by a multiplier of 1.02041.
Staff Contact:
Danielle Watford
Director of Quality Improvement & Regulatory Affairs