December 2006

Conditions of Participation Requirements Expanded for Hospitals in Final CMS Rule

The Joint Commission has released for comment three draft standards and a draft of the 2008 National Patient Safety Goals. In addition to the Potential 2008 National Patient Safety Goals, the three standards posted for review are the Proposed Conflict Management Standards, the Proposed Disruptive Behavior Standards, and the Proposed Revisions to Emergency Management Standards.

Each of these standards and goals will have an effect on medical staff organization and on continued efforts to provide quality patient care. Therefore, NAMSS encourages all members to participate in these field reviews.

NAMSS is currently reviewing the standards and goals and will notify the membership if official comments will be sent to JCAHO for any or all of the field reviews.

JCAHO is accepting comments on the draft standards until January 19, 2007. Comments on the Potential 2008 National Patient Safety Goals will be accepted until January 26, 2007.

To learn more about the proposed standards and goals and to participate in the field reviews, visit JCAHO’s website here: http://www.jointcommission.org/Standards/FieldReviews/default.htm.

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In a final rule released Dec. 7, CMS increased qualifications for staff working in a program designed to keep Medicare beneficiaries out of nursing homes, including requiring the development of a training program for some.

Staff of the Programs of All-Inclusive Care for the Elderly (PACE) must have the "knowledge of geriatric practices and skill to work with these individuals," CMS said in the final rule.

Personnel having direct contact with enrollees must have a minimum of one year of experience working with the frail or elderly population, meet standardized competencies, be medically clear of communicable diseases, and current with immunizations, the final rule said.

PACE organizations (POs) must also develop a training program for personal care attendant where there are competency deficits and the attendants must demonstrate competence before performing certain services.

The Balanced Budget Act of 1997 authorized PACE. The latest rule finalizes an interim final regulation, published in 1999, that established the program in which pre-paid capitated plans deliver comprehensive health care to certain elderly beneficiaries.

The program is geared to those who live in a PACE service area, are at least 55, and are eligible for nursing home care under state law.

The regulation will become effective Jan. 8, 2007.

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CMS issued a final rule expanding requirements for hospitals admitting Medicare and Medicaid patients, including increasing the timeframe for completing an examination before admission and changing requirements for professionals permitted to perform the examination (71 Fed. Reg. 68671).

The final rule takes effect Jan. 26, 2007. The changes to four "conditions of participation" (COP) respond to the health care community's concern that the current regulations are contrary to common practice and unduly burdensome, CMS said in a press release.

The COP changes affect aspects of medical staff, nursing services, medical record services, pharmaceutical services, and anesthesia services.

"This final rule will ensure that CMS requirements are consistent with current standards of practice, to provide hospitals and practitioners greater flexibility in meeting the needs of patients, and to reduce unnecessary regulatory burden for hospitals ," CMS said in a statement.

History and Exams

As in its 2005 proposed rule, CMS said that the history and physical (H&P) examination requirement will be extended from no more than seven days before or 24 hours after admission to no more than 30 days before or 24 hours after admission.

In the proposed rule, CMS removed the reference to specific physicians who can perform the medical history and exam and instead stated that it must be performed by a physician or other qualified individual who has been granted privileges by the medical staff of the admitting hospital in accordance with state law.

In the final rule, CMS said it deleted the requirement that to conduct the H&P the practitioner must be credentialed and privileged by the medical staff. Instead, the agency added the language "in accordance with state law and hospital policy."

CMS said that commenters expressed concern that the H&P is frequently conducted by the patient's primary care provider who may not be credentialed and privileged by the admitting hospital.

In another area, CMS said that it is keeping the current requirement that orders be "dated, timed, and authenticated promptly by the prescribing practitioner," but will also set out a temporary exception. For the next five years, these requirements may be recorded by another practitioner responsible for the care of the patient, even if the order did not originate with him or her.

This is intended to increase flexibility for hospitals until health information technology is sufficiently advanced to allow the prescribing practitioner to authenticate his or her own orders promptly, CMS said.

The rule also requires that drugs and biologicals be kept in secure areas and locked when appropriate and that postanesthesia evaluations for inpatients may be completed and documented by an individual qualified to administer anesthesia, instead of only the administering individual.

The rule is available at http://frwebgate4.access.gpo.gov/cgi-bin/waisgate.cgi?WAISdocID=04334726191+0+0+0&WAISaction=retrieve. For more information on the final rule, contact the following CMS officials: Patricia Chmielewski, (410) 786-6899; Monique Howard, (410) 786-3869; or Jeannie Miller, (410) 786-3164.

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