CMS Issues Medicare and Medicaid Final Rule: Significant Changes to Conditions of Participation

On Wednesday, the Centers for Medicare and Medicaid Services (“CMS”) issued a second round of long-awaited red tape reduction initiatives aimed at ameliorating overly burdensome provider regulations.  The changes, memorialized within a Final Rule scheduled for publication on May 12, 2014 (available for review here: http://federalregister.gov/a/2014-10687) (“Unpublished Final Rule”)  include significant easing of Conditions of Participation (“CoPs”) related to medical staffs and governing boards, as well as other changes targeted toward provider operational efficiencies.  The changes include, notably:

• Removal of the CoP requirement that individually certified hospitals, even within integrated health systems, retain separate medical staffs.  Under the Unpublished Final Rule, a multi-hospital system may now have a “unified and integrated” staff, subject to certain restrictions (including a requirement that staff members of individually certified hospitals vote to participate, or opt out, of the unified staff structure).
• Removal of the requirement that a hospital’s governing body must include a member of the medical staff, and insertion of a requirement that the governing body consult from time to time with the medical staff representative.
• Removal of the requirement that Critical Access Hospitals (“CAHs”), Rural Health Clinics (“RHCs”) and Federally Qualified Health Centers (“FQHCs”) have a physician present at least once every two weeks.
• Removal of the requirement that a CAH develop its policies and procedures with at least one individual who is not a member of the CAH staff.
• Reduction of requirements that ambulatory surgical centers (“ASCs”) must satisfy in order to provide radiological services to patients, and removal of the requirement that a doctor of medicine or osteopathy supervise all radiological services in an ASC setting.
• Revision of the outpatient services CoP to permit practitioners who are not members of a hospital’s medical staff to order outpatient services for their patients, when authorized by the medical staff and permitted by state law.
• Removal of redundant data submission requirements for transplant centers.

Squire Sanders (US) LLP has specific expertise in guiding clients through the medical staffing, structure, governance and policy issues that have arisen though out the health reform era, and particularly in the context of integrated  and accountable care settings.  If you have questions about the Unpublished Final Rule, and would like to position your organization to take best advantage of it, please contact us.