CMS has announced a proposed rule to revise the applicable conditions of participation (CoPs) for providers and conditions for coverage (CfCs) by removing unnecessary, obsolete, duplicative, or burdensome Medicare compliance requirements for health care facilities in accordance with the January 30, 2017, Executive Order "Reducing Regulation and Controlling Regulatory Costs" (EO 13771). According to CMS, the proposed changes to the current regulatory requirements would increase provider flexibility and allow health care professionals to devote resources to improving patient care by eliminating or reducing requirements that impede quality of patient care or divert resources away from furnishing high quality patient care.
Projected savings. CMS addressed 55 percent (624) of the burden topics raised. Additionally, 16 percent (185) of the topics are under consideration, and 29 percent (337) have been referred to another agency or did not require further action. CMS projects savings of nearly $5.2 billion and a reduction of 53 million hours through 2021 as a result of final rules adopted in 2017 and 2018 and current proposed rules that reduce burdens for providers. In addition, CMS projects that these updates would save health care providers an estimated $1.12 billion annually.
Proposed changes. The proposed rule reduces the frequency of certain required activities and, where appropriate, revise timelines for certain requirements for providers and suppliers. Topics addressed in the advance release of the proposed rule include:
- Emergency preparedness. Under the proposed rules, CMS would (1) allow facilities to review their emergency program every two years or more often at their own discretion (CMS reasoned that a comprehensive review may not yield significant change in one year); (2) eliminate the emergency plan requirement to include documentation of efforts to contact local, tribal, regional, state and federal emergency preparedness officials and participate in collaborative and cooperative planning efforts, which is found in other regulations; (3) revise training requirements to allow facilities to provide training annually or more often at their own discretion; (4) provide flexibility in the method one of the two annually-required testing exercises, including desk top exercises or workshops that meet the needs of the facility and its patients; and (5) reduce testing for outpatient providers from two testing exercises to one testing exercise annually (42 C.F.R. §482.15(a) and similar regulatory provisions).
- Hospital requirements. The proposed rule would allow multi-hospital systems to have unified and integrated Quality Assessment and Performance Improvement (QAPI) (42 C.F.R. §482.21(f)) and infection control programs (42 C.F.R. §482.42(c)) for all of the member hospitals, allow discretion on when an autopsy is indicated deferring to state requirements (42 C.F.R. §482.22(d)); create flexibility to establish a medical staff policy for pre-surgery assessment for an outpatient instead of a comprehensive medical history and physical examination (42 C.F.R. §§482.22; 482.24; and 482.51); and clarify the psychiatric hospital requirement that allows for nonphysician practitioners or medical doctors or doctors of osteopathy to document patient progress notes (42 C.F.R. §482.61(d)).
CMS would reduce the frequency that critical access hospitals (CAHs) are required to perform a review of their policies and procedures from annually to biennial (42 C.F.R. §485.635(a)(4)), remove cross references to requirements for long term care facilities that do not apply to swing-bed providers (42 C.F.R. §§482.58(b)(1); §482.645(d)(4)), and remove the duplicative COP requirement for CAHS to disclose the names of people with a financial interest in the CAH, which is collected elsewhere (42 C.F.R. §485.627(b)(1)).
- Rural health clinics, federally qualified health clinics, and comprehensive outpatient rehabilitation facilities (CORFs). The frequency of review of patient care polices and evaluation would be reduced from annually to every two years (42 C.F.R. §§491.9(b)(4); 491.11(a)). CORFs’ utilization review requirements would be reduced from quarterly to annually (42 C.F.R. §485.66).
- Ambulatory surgical centers. The proposed rule removes the provisions requiring ASCs to have a written transfer agreement with a hospital that meets certain Medicare requirements or ensure physicians performing surgery in the ASC have admitting privileges in a hospital that meets Medicare requirements (42 C.F.R. §416.41(b)) and the requirements that a physician or other qualified practitioner conduct a complete comprehensive medical history and physical assessment on each patient not more than 30 days before the date of the scheduled surgery (42 C.F.R. §416.52(a)).
- Transplant centers. CMS has proposed to update the terminology in the regulations to conform to terminology widely used in the transplant community and remove requirements for transplant centers to re-submit clinical experience, outcomes, and other data to receive Medicare re-approval (42 C.F.R. §§482.82 and 488.61(f)).
- Hospices. CMS would remove the requirement that the hospice staff include an individual with specialty knowledge of hospice medications (42 C.F.R. §418.106(a)(1)) and replace the requirement that hospices provide a copy of medication policies and procedures to patients and caregivers.
- Religious nonmedical health care institutions (RNHCIs). CMS proposes to simplify the discharge process for patients of RNHCIs that require an evaluation and discharge plan to assess the need for a discharge plan for patients (42 C.F.R. §403.736).
- Portable x-ray technology. The proposed rule aligns current qualifications for radiological technologists in hospitals at 42 C.F.R. §486.104(a) with §482.26(c)(2), which focuses on the qualifications of the individual performing the services and revises the requirements for portable x-ray orders, which requires orders for portable x-ray services to be written and signed, to simplify the ordering process to include such methods as electronic orders (42 C.F.R. §486.106(a)(2)).
The proposed rule will be published in the Federal Register on September 20, 2018.
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