CMS Deregulation Efforts May Pay Off for Providers

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  • May 8, 2014
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The Centers for Medicare & Medicaid Services (CMS) issued a final rule May 7, reforming several Medicare regulations identified as “unnecessary, obsolete, or excessively burdensome” on healthcare providers and suppliers. According to CMS, this regulatory reform will save healthcare providers $660 million annually, and $3.2 billion over five years.
The final rule, Medicare and Medicaid Programs; Regulatory Provisions to Promote Program Efficiency, Transparency, and Burden Reduction; Part II, supports President Obama’s “regulatory lookback” initiative to modify, streamline, or eliminate excessively burdensome and unnecessary regulations on business. Part I of this initiative includes the final rule, “Regulatory Provisions to Promote Program Efficiency, Transparency, and Burden Reduction” (77 FR 29002), issued in 2012. Together, the two final rules will purportedly save providers an accumulative $8 billion.
A key provision in this final rule eliminates the requirement for very small critical access hospitals (CAHs), as well as rural health clinics and federally qualified health centers, that a physician must be onsite at least once every two weeks. Revised regulatory language states that a medical doctor (MD) or doctor of osteopathy (DO) must “periodically” review and sign a sample of outpatient records of patients cared for by nurse practitioners, clinical nurse specialists, certified nurse midwives, or physician assistants. Providers may have to dig deep to find CMS’ interpretation of “periodically.”
The rule also allows for registered dietitians and qualified nutritionists to order patient diets directly, without requiring the preapproval of a physician or other practitioner.
Also in the final rule, CMS:

  • Eliminates unnecessary requirements that ambulatory surgical centers (ASCs) must meet in order to provide radiological services that are an integral part of their surgical procedures. Specifically, regulation text has been changed from “A doctor of medicine or osteopathy who is qualified by education and experience in accordance with State law and ASC policy must supervise the provision of radiologic services” to “If radiologic services are utilized, the governing body must appoint an individual qualified in accordance with State law and ASC policies who is responsible for assuring that all radiologic services are provided in accordance with the requirements of this section.”
  • Permits trained nuclear medicine technicians in hospitals to prepare radiopharmaceuticals for nuclear medicine without the supervising physician or pharmacist constantly being present.
  • Eliminates a redundant data submission requirement and an unnecessary survey process for transplant centers.
  • Relocates the swing-bed services Conditions of Participation (CoP) to Subpart D, to classify swing beds as an optional service. This revision allows an accredited hospital’s compliance with swing bed requirements to be evaluated by a CMS-approved accrediting organization, and eliminates the additional state agency survey specifically for swing bed approval.
  • Allows long-term care facilities to apply for a deadline extension to install automatic sprinkler systems, not to exceed 2 years, if certain conditions apply. An additional extension may be granted for up to 1 year, depending on the need and particular circumstances. Facilities were originally given until Aug. 13, 2013 to become compliant.
  • Eliminates the CoP requirement that a CAH develop its patient care policies with the advice of “at least one member who is not a member of the CAH staff.”

These provisions are just a sampling of what you’ll find in the final rule. The final rule also makes a number of clarifications and changes to CMS regulations governing proficiency testing referrals under the Clinical Laboratory Improvement Amendments of 1988 (CLIA), removes regulations set out in the Code of Federal Regulations (CFR) that have become obsolete, and clarifies or corrects other provisions. We recommend you read the final rule to learn of all the regulatory changes that may affect you.
These changes go into effect 60 days after the final rule is published in the Federal Register, which we estimate to be July 12, 2014.

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Renee Dustman
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Renee Dustman, BS, AAPC MACRA Proficient, is managing editor - content & editorial at AAPC. She holds a Bachelor of Science degree in Media Communications - Journalism. Renee has more than 30 years' experience in journalistic reporting, print production, graphic design, and content management. Follow her on Twitter @dustman_aapc.

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