Final Rules Reduce Fed Control for Hospitals
In accordance with President Obama’s regulatory reform initiative to reduce unnecessary burdens on business and cut unnecessary spending, the Centers for Medicare & Medicaid Services (CMS) finalized two rules May 9. The first rule, Reform of Hospital and Critical Access Hospital Conditions of Participation, revises the requirements that hospitals and critical access hospitals (CAHs) must meet to participate in the Medicare and Medicaid programs. CMS estimates that this rule will save hospitals and CAHs approximately $900 million in the first year. The second rule, Medicare Regulatory Reform, identifies and reduces or eliminates Medicare and Medicaid regulations that CMS has deemed unnecessary, obsolete, or excessively burdensome. CMS estimates this rule will cut costs by as much as $200 million in the first year and $100 million each year thereafter.
More specifically, the Reform of Hospital and Critical Access Hospital Conditions of Participation final rule will:
- Allow one governing body to oversee multiple hospitals in a multi-hospital system; and add a requirement for at least one member of the hospital’s medical staff to be included on a governing body.
- Permit CAHs to partner with other providers to provide diagnostic and therapeutic services, laboratory services, and radiology services, as well as emergency procedures.
- Grant all eligible candidates—including advanced practice registered nurses (APRNs) and physician assistants (PAs)—the same privileges, rights and responsibilities as appointed medical staff, upon medical staff review and appointment.
- Allow a patient or a patient’s caregiver to administer certain medications; and allow hospitals to use a single, interdisciplinary care plan that supports coordination of care through nursing services. Programs must address the safe and accurate administration of medications, ensure a process for medication security, address self administration training and supervision, and document medication self administration.
- Remove the single director of outpatient services requirement.
- Allow non-physician practitioners (NPPs) to have complete management over drugs and biologicals in accordance with hospital policy and state law.
- Allow hospitals to use standing orders; and add a requirement for medical, nursing, and pharmacy staff to approve written and electronic standing orders, order sets, and protocols.
- Eliminate the requirement for authentication of verbal orders within 48 hours, deferring state law to establish timeframes.
- Replace the requirement that hospitals must report deaths that occur while a patient is only in soft, two-point wrist restraints with a requirement that hospitals must maintain a log of all such deaths. This log must be available to CMS upon request.
- Permit podiatrists to be responsible for the organization and conduct of medical staff.
- Eliminate the requirement for non-physician personnel to have special training in administering blood transfusions and intravenous medications.
- Make permanent a previous temporary requirement that all orders (including verbal) must be dated, timed, and authenticated by either the ordering practitioner or another practitioner who is responsible for the care of the patient and who is authorized to write orders by hospital policy in accordance with state law.
- Eliminate the requirement for a hospital to maintain an infection control log.
- Eliminate the requirement for an organ recovery team working for the transplant center to conduct a blood type and other vital data verification before organ recovery when the recipient is known.
The Medicare Regulatory Reform final rule will:
- Eliminate obsolete regulations, including outmoded infection control instruction for ambulatory surgical centers (ASCs), outdated medical qualification standards for physical and occupational therapists, and duplicative requirements for governing bodies of organ procurement organizations.
- Require only end-stage renal disease (ESRD) facilities located adjacent to highly hazardous occupancies to comply with the full national Fire Protection Agency Life Safety Code requirements.
- Eliminate the specific list of emergency equipment ASCs must have, and allow them to develop their own policies and procedures specifying required emergency equipment appropriate for the services they provide.
- Replace the term “mental retardation” with “intellectual disability;” and replace time-limited agreements with open-ended agreements for Medicaid-participating intermediate care facilities for individuals with intellectual disabilities (ICF/IID); and add a requirement that a certified ICF/IID must be surveyed, on average, every 12 months.
- Update e-prescribing technical requirements so Medicare prescription drug plans meet current standards.
- Eliminate the enrollment bar for providers and suppliers when it is based on a failure to respond timely to revalidation or other requests for information.
See the final rules for more information on these provisions and for other obsolete or duplicate regulations CMS is removing, and for clarifying information about certain existing provisions.