The Centers for Medicare & Medicaid Services (CMS) on May 10 released a final regulation to revise the existing Conditions of Participation (CoPs) for hospitals and critical access hospitals (CAHs). In addition, it released a final rule that addresses more than two dozen regulatory requirements for a broader range of providers, including hospitals, ambulatory surgical centers, end-stage renal disease facilities and durable medical equipment suppliers.
Together, CMS says the rules aim to promote efficiency and transparency, and to reduce health care providers' overall regulatory burden. CMS estimates the rules will save $5 billion over five years.
Key highlights of the changes to the hospital and CAH CoPs follow.
REFORM OF HOSPITAL AND CAH CONDITIONS OF PARTICIPATION
Governance and Medical Staff. CMS finalized its proposal to recognize a single governing body over multiple hospitals within a health system. However, the rule does not allow a multi-hospital system to elect to have a single organized medical staff. The preamble to the proposed rule issued in October read: "We do not believe that the current medical staff CoP language implies that we require a single and separate medical staff for each hospital within a multi-hospital system." However, in the preamble to the final rule, CMS says that the above statement was included to highlight the ambiguity of the CoP language, and now states: "We continue to interpret the current CoP to require that each hospital, regardless of whether it is a part of a multi-hospital system, have a single and separate medical staff, as a matter of CMS Policy." In other words, CMS will not allow multi-hospital systems to have a single organized medical staff.
CAH Services. CMS finalized its proposal to allow CAHs to provide certain services (diagnostic, therapeutic, laboratory, radiology and emergency services) under service arrangements. Previously, CAHs were required to provide these services directly.
- Finalized its proposal to eliminate the current criteria requiring hospitals to maintain an infection control log.
- Removed the requirement for a sole director over all outpatient services.
- Removed the requirement for a separate nursing care plan and allows for the use of a single interdisciplinary care plan across the hospital.
"Today's announcement provides some much-needed regulatory relief for an overburdened health care system," said American Hospital Association President and CEO Rich Umbdenstock. "But CMS misses some important opportunities to further modernize the rules to better reflect how care is organized and delivered today."
He noted that AHA is pleased that CMS will allow multi-hospital systems to have one governing board, but expressed disappointment that CMS "did not allow hospitals in such systems to have single integrated medical staff structures if that's how those providers choose to be organized. Hospitals and medical staff members across the country are working together to streamline all areas of operation and CMS should not let antiquated organizational structures stand in the way."
The final rules will be published in the May 16 Federal Register.