The Centers for Medicare & Medicaid Services (CMS) has issued an "omnibus burden reduction" rule that finalizes a September 20, 2018 proposed dominion intended to streamline various Medicare and Medicaid regulatory requirements, in alignment with the Administration'southward "Patients over Paperwork" initiative.  The omnibus regulation too finalizes a November 4, 2016 proposed rule on burn safe requirements for certain dialysis facilities, along with June 16, 2016 proposed rule updating conditions of participation (CoPs) for hospitals and critical access hospitals (CAHs) to promote innovation, flexibility, and improvement in patient care.  CMS estimates that the dominion will salve providers more $800 million annually, although certain provisions (including the hospital CAH quality of care provisions) are expected to increase provider costs.

Major provisions of the terminal rule include the post-obit:

  • Emergency Preparedness Requirements. The final rule allows facilities (other than long-term care (LTC) facilities) to review and provide training on their emergency programs every 2 years, rather than annually.  The rule also reduces testing frequency for outpatient providers; provides more flexibility regarding testing methods; and eliminates certain documentation requirements.
  • Hospitals. The rule updates requirements for hospital Quality Cess and Functioning Improvement (QAPI) programs and infection command programs, and allows multi-hospital systems to have unified and integrated QAPI and infection control programs for all member hospitals if the organization meets all applicable state and local laws.  In add-on, the rule requires hospitals to establish and maintain antibody stewardship programs.  The final rule allows hospitals to found a medical staff policy describing the circumstances under which a pre-surgery/pre-procedure assessment for an outpatient could be utilized instead of a comprehensive medical history and concrete examination.  In add-on, the rule streamlines sure swing-bed provider requirements and allows discretion regarding when an autopsy is indicated in sure instances.
  • CAH, RHC, and FQHCs.The final rule requires CAHs to implement QAPI, infection prevention and command, and antibiotic stewardship programs.  In addition, the rule reduces the frequency with which CAHs, Rural Health Centers (RHCs) and Federally Qualified Wellness Centers (FQHCs) must perform reviews of certain policies and procedures.  The rule also removes the CoP requirement for CAHs to disclose the names of people with a financial involvement in the CAH, in light of duplicative plan integrity requirements.
  • Convalescent Surgical Centers (ASCs). The final dominion replaces the current requirement that ASCs have written transfer agreements or privileges with the local infirmary with a requirement that ASCs periodically provide the local infirmary with written notice of its functioning and patient population served.  The dominion also removes the requirement that a physician or other qualified practitioner conduct a complete comprehensive medical history and concrete (H&P) assessment on each patient within 30 days of the scheduled  Instead, each ASC must develop and maintain a policy that identifies patients who require an H&P assessment prior to surgery, the timeframe for H&P assessment completion, and certain patient and surgery characteristics, based on nationally recognized standards of practice and guidelines and applicable state and local laws.  Upon admission, each patient must have a presurgical assessment completed by a physician or other qualified practitioner who volition be performing the surgery.
  • Hospices. The dominion removes federal qualification standards for hospice aides and defers to state licensure requirements; removes the requirement that the hospice staff include an individual with instruction and training in drug management; and addresses requirements for consultation between hospice and LTC facility staff.
  • Other Provisions. The final dominion accost numerous other policies, including:  home health agency verbal notification of patient rights and dwelling health aide requirements; frequency of comprehensive outpatient rehabilitation facility utilization reviews; requirements for portable x-ray orders and atmospheric condition for coverage for portable ten-ray technologists; organ transplant program re-approving requirements; community mental health center client assessment requirements; and discharge planning in religious nonmedical wellness intendance institutions.

The terminal dominion is scheduled to be published on September thirty, 2019.  The rule is effective 60 days later publication, although hospitals and CAHs accept half-dozen months to implement the antibody stewardship programs and CAHs take eighteen months to implement required QAPI programs.