DEPARTMENT OF HEALTH AND SOCIAL SERVICES

Division of Long Term Care Residents Protection

Statutory Authority: 16 Delaware Code, Section 1119C (16 Del.C. §1119C)

PUBLIC NOTICE

EMERGENCY

Nature of the Proceedings

This Emergency Regulation is being promulgated to amend the Division of Long Term Care Residents Protection Regulations in order to improve the nursing home survey process. Delaware Health and Social Services (“Department”) / Division of Long Term Care Residents Protection must take this action on an emergency basis without prior notice or hearing to ensure the health, safety, and welfare of the residents of Delaware’s long term care facilities.

Summary of Changes

Statutory Basis

16 Del.C. §1119C

Summary of Provisions

1) Effective immediately, the Division of Long Term Care Residents Protection shall maintain full compliance with CMS regulations and appendices regarding nursing home surveys as contained in 42 CFR 483.1 to 483.480 and 488.1 to 488.456.

2) No later than June 15, 2006, the Division of Long Term Care Residents Protection shall establish a Quality Assurance Review Team (QAR Team). The QAR Team shall consist of:

• The Director of the Division

• The Deputy Director of the Division

• The Medical Director of the Division

• The Quality Assurance Administrator of the Division

• The Health Facilities Certification Administrator of the Division

3) No later than July 1, 2006, the Division of Long Term Care Residents Protection shall retain the services of a licensed physician to perform the duties of Medical Director, which shall include but not be limited to reviewing medical records, advising the Division on medical issues, testifying on the Division’s behalf at Informal Dispute Resolution hearings, and participating in the QAR Team.

4) No later than July 15, 2006, all nursing home survey reports, whether generated as a result of annual, complaint, and/or surprise inspections, which recommend a nursing, pharmaceutical, nutritional, and/or environmental citation at “G” level or above shall be reviewed and approved by the QAR team within 5 working days of receipt of such report containing a “G” level or above citation. The Team shall review each such citation for application of the appropriate regulations, for accuracy of data, for adequacy of supporting documentation, and for consistent adherence to CMS regulations.

A written quarterly report shall be made to the Nursing Home Quality Assurance Commission regarding any upgrades to “G” level or above and downgrades to “G” level or below by the QAR Team, setting forth the number of such downgrades and upgrades at each facility and the reasons for each.

The report shall not identify facilities by name.

The first such report shall be submitted no later than June 15, 2006. Subsequent quarterly reports shall be submitted on the 15th of every September, December, March, and June.

5) No later than September 15, 2006, the Department of Health and Social Services shall reclassify a vacant position to a Nurse Supervisor for the Division of Long Term Care Residents Protection, to provide nurse supervision for the Division’s Wilmington office.

Findings of Fact

The Department finds that the proposed changes should be made in the best interest of the general public of the State of Delaware. The Department will receive, consider, and respond to petitions by any interested person for the reconsideration or revision thereof.

THEREFORE, IT IS ORDERED, that the emergency regulation proposed to improve the nursing home survey process is adopted as an emergency order with an effective date of June 15, 2006.

6/12/06

Date of Signature

Vincent P. Meconi, Secretary, DHSS

DLTCRP Emergency Order

1) Effective immediately, the Division of Long Term Care Residents Protection shall maintain full compliance with CMS regulations and appendices regarding nursing home surveys as contained in 42 CFR 483.1 to 483.480 and 488.1 to 488.456.

2) No later than June 15, 2006, the Division of Long Term Care Residents Protection shall establish a Quality Assurance Review Team (QAR Team). The QAR Team shall consist of:

• The Director of the Division

• The Deputy Director of the Division

• The Medical Director of the Division

• The Quality Assurance Administrator of the Division

• The Health Facilities Certification Administrator of the Division

3) No later than July 1, 2006, the Division of Long Term Care Residents Protection shall retain the services of a licensed physician to perform the duties of Medical Director, which shall include but not be limited to reviewing medical records, advising the Division on medical issues, testifying on the Division’s behalf at Informal Dispute Resolution hearings, and participating in the QAR Team.

4) No later than July 15, 2006, all nursing home survey reports, whether generated as a result of annual, complaint, and/or surprise inspections, which recommend a nursing, pharmaceutical, nutritional, and/or environmental citation at “G” level or above shall be reviewed and approved by the QAR team within 5 working days of receipt of such report containing a “G” level or above citation. The Team shall review each such citation for application of the appropriate regulations, for accuracy of data, for adequacy of supporting documentation, and for consistent adherence to CMS regulations.

A written quarterly report shall be made to the Nursing Home Quality Assurance Commission regarding any upgrades to “G” level or above and downgrades to “G” level or below by the QAR Team, setting forth the number of such downgrades and upgrades at each facility and the reasons for each.

The report shall not identify facilities by name.

The first such report shall be submitted no later than June 15, 2006. Subsequent quarterly reports shall be submitted on the 15th of every September, December, March, and June.

5) No later than September 15, 2006, the Department of Health & Social Services shall reclassify a vacant position to a Nurse Supervisor for the Division of Long Term Care Residents Protection, to provide nurse supervision for the Division’s Wilmington office.

10 DE Reg. 6 (07/01/06) (Emer.)