CMS has proposed conditions of participation (CoPs) aimed to prevent discrimination, hospital-acquired conditions (HACs), and improper antibiotic use in hospitals and critical access hospitals (CAHs). The CoPs would incorporate antidiscrimination provisions, including those required by the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148), and promote antibiotic stewardship to help reduce antimicrobial infections, in addition to addressing workforce issues and improving overall quality of care. Comments on the agency’s Proposed rule are due 60 days after its publication in the Federal Register, which is scheduled for June 16, 2016.
Antidiscrimination. Despite the requirement that Medicare hospitals and CAHs comply with various federal laws addressing discrimination, the current CoPs do not contain explicit provisions prohibiting such discrimination. The Proposed rule would specifically prohibit discrimination on the basis of race, color, national origin, sex (including gender identity), age, or disability, as required by section 1557 of the ACA. It would also prohibit discrimination based on religion or sexual orientation, pursuant to its statutory authority under section 1861(e)(9) of the Social Security Act (SSA), which allows the Secretary to implement other requirements she deems necessary in the interest of health and safety. Hospitals and CAHs must implement written policies governing those requirements, inform patients and their support persons or representatives of the right to be free from discrimination in a language they can understand, and tell them how they can seek help if they encounter discrimination.
Infection prevention and antibiotic stewardship. According to CMS, the infection prevention control CoP has remained essentially unchanged since 1986. To address the increased threat of HACs, including hospital-acquired infections (HAIs) and infections due to antimicrobial resistance caused by multi-drug resistant organisms (MDROs) and the inappropriate use of antibiotics, the agency is proposing to require hospitals and CAHs to create and maintain infection prevention and control and antibiotic stewardship programs, led by infection preventionists/infection control professionals. The Proposed rule would grant hospitals and CAHs the flexibility to adhere to nationally recognized guidelines of their choice, rather than requiring them to adhere to specific guidelines or sets of guidelines. The Proposed rule would broaden providers’ focus from avoiding the transmission of infections "between patients and personnel" to the overall avoidance of transmission, acknowledging the increased transfer of patients to other facilities and patients’ and personnel’s interactions with visitors.
Workforce provisions. The Proposed rule would change terminology to allow additional personnel to take an active role in patient care. Currently, "licensed independent practitioners" may authorize the use of restraints or seclusion in hospitals. However, this has the effect of preventing physician assistants (PAs) from authorizing the use of restraints or seclusion, since they may not be considered "independent" under state law. The Proposed rule would eliminate "independent" from the title. Physcians or licensed practitioners would also be required to see and assess the patient after 24 hours, before writing a new order.
Currently, only practitioners responsible for the care of a patient may prescribe a therapeutic diet to CAH patients. The Proposed rule would allow any "qualified dietician," including any other clinically qualified nutrition professionals, regardless of title, to prescribe such diets in CAHs, provided they meet all state law and regulatory requirements and other professional standards.
QAPI. Currently, CAHs adhere to periodic evaluation and quality assurance review requirements. The Proposed rule would require CAHs to implement a quality assessment and performance improvement (QAPI) program appropriate for the complexity of its organization and services and would replace standards at current regulation 42 C.F.R. section 485.641 with parts governing definitions, design and scope, governance and leadership, program activities, performance improvement projects, and program data collection and analysis.
Other provisions. In addition to those already mentioned, the Proposed rule would include provisions governing patient access to medical records, medical records services, distinctions between inpatient and outpatient nursing services. With respect to CAHs, it would also cover organizational structure and periodic review of clinical privileges and performance.
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