CMS issues regulatory relief for hospitals, other providers Last Updated: August 13, 2014
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The Centers for Medicare and Medicaid Services (CMS) finalized a series of reforms intended to streamline regulations and reduce regulatory burden on healthcare providers, including hospitals. CMS estimates the regulatory changes contained in a final rule released on May 7 will save nearly $660 million annually and $3.2 billion over 5 years.

The final rule will be published in the May 12 Federal Register and will take effect July 11.

Among other provisions, the final rule would alter the following regulations

Hospital medical staff

Allow for either a unique medical staff for each hospital or for a unified and integrated medical staff shared by multiple hospitals within a hospital system, rather than require that each hospital have its own medical staff, even in multi-hospital systems, as CMS had initially proposed

Clarify the requirement that a hospital’s medical staff must be composed of doctors of medicine or osteopathy but that it may also include, in accordance with State laws (including scope-of-practice laws), other categories of physicians and non-physician practitioners who are determined to be eligible for appointment by the governing body.

Hospital governing body

CMS removes the requirement for a medical staff member, or members, to be on a hospital’s governing body. Instead, CMS adds a new provision to the “Medical staff” standard of the governing body CoP to require a hospital’s governing body to directly consult at least periodically throughout the calendar year or fiscal year with the individual responsible for the organized medical staff of the hospital, or a designee. For a multi-hospital system using a single governing body to oversee multiple hospitals within its system, this provision would require the single governing body to consult directly with the individual responsible for the organized medical staff, or designee of each hospital within its system in addition to the other requirements.

Critical access hospital (CAH) provision of services

The final rule would remove the CAHs CoPs requirement that a CAH must develop its patient care policies with the advice of “at least 1 member who is not a member of the CAH staff.” CMS believes that this provision is no longer necessary and that the original reasons for including this requirement have been effectively addressed.

CAH and rural health clinics (RHCs)/federally qualified health centers (FQHCs) physician responsibilities

CMS eliminates the requirement that a physician must be onsite in CAHs, RHCs and FQHCs at least once in every two-week period. CMS says the change is to accommodate providers in extremely remote areas or in areas with physician shortages and recognizes advancements in telemedicine.

Practitioners permitted to order hospital outpatient services: CMS revises the outpatient services CoP to allow for practitioners who are not on the hospital’s medical staff to order hospital outpatient services for their patients when authorized by the medical staff and permitted by state law.

Permits registered dietitians and qualified nutritionists to order patient diets directly without requiring the pre-approval of a physician or other practitioner.
Hospital reclassification of swing-bed services: CMS revises the requirements by relocating the swing-bed CoPs to subpart D, which would classify swing beds as an optional service. This revision will allow a hospital’s compliance with “swing bed” requirements to be evaluated during routine accrediting organization surveys. This would reduce the burden on hospitals by not requiring an additional survey specifically for “swing bed” approval.

The final rule is in response to President Obama’s January 2011 executive order that requires agencies to identify rules that may be outmoded, ineffective, insufficient, or excessively burdensome, and to modify, streamline, expand, or repeal them in accordance with what has been learned.

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