May 16, 2012 | 1 Comment
Posted by Beth Christian
Last week, the Centers for Medicare and Medicaid Services published notice of its adoption of amendments to the Medicare Conditions of Participation for Hospitals, 42 C.F.R. Parts 482 and 485. The following represents a summary of some of the more significant amendments to the Conditions of Participation:
1. CMS will allow one governing body to oversee multiple hospitals in a multi-hospital system. CMS has also added a requirement that a member, or members, of the hospital’s medical staff be included on the single governing body as a means of ensuring communication and coordination between a single governing body and the medical staffs of individual hospitals in the health care system.
2. CMS has implemented a requirement that hospitals maintain a log of all deaths occurring while patients are in restraints. The log must be made available to CMS immediately upon request. Previously, hospitals were required to report deaths that occurred while a patient was in soft, 2-point wrist restraints. The amended regulations will remove the current requirement for hospitals to notify CMS of a patient’s death for patients who die when no seclusion has been used and the only restraints used on the patient were soft, non-rigid, cloth-like materials, which were applied exclusively to the patient’s wrists. Reporting will also be eliminated for patients who died within 24 hours of having been removed from such restraints.
3. CMS has broadened the definition of the term “medical staff” and will allow hospitals the flexibility to include other nonphysician practitioners (such as advanced practice nurses, physician assistants, etc.) as eligible candidates for medical staff membership in accordance with state law. All such practitioners will function under the rules of the medical staff. The medical staff will be required to examine the credentials of all eligible candidates and make recommendations for privileges and medical staff membership to the governing body.
4. CMS has broadened the potential leadership role of podiatrists by allowing podiatrists to be responsible for the organization and conduct of the medical staff.
5. The amendments will allow hospitals the option of having either a stand-alone nursing care plan or a single interdisciplinary care plan that addresses nursing and other disciplines.
6. CMS will permit hospitals to have an optional program for patient/support person administration of appropriate medications. The program must address the safe and accurate administration of specified medications; must ensure a process for medication security; must address self-administration training and supervision; and must include documentation of medication and self-administration.
7. CMS has eliminated the requirement for nonphysician personnel to have specialized training in administering blood transfusions and intravenous medications and has clarified that those who administer blood transfusions and intravenous medications must do so in accordance with state law and approved medical staff policies and procedures.
8. CMS has amended the Conditions of Participation to allow for drugs and biologicals to be prepared and administered on the orders of a practitioner other than a physician in accordance with hospital policy and state law. Orders for drugs and biologicals ordered by nonphysician practitioners may also be documented and signed by the nonphysician practitioner in accordance with hospital policy and state law.
9. The amendments will allow hospitals the flexibility to use standing orders. The amended Conditions of Participation will require the medical staff, nursing staff, and pharmacy to approve written and electronic standing orders, order sets and protocols. Orders and protocols must be based on nationally recognized and evidence-based guidelines and recommendations.
10. The requirement of authentication of verbal orders within 48 hours has been eliminated. Instead, CMS will defer to applicable state law to establish authentication time frames.
11. CMS has made permanent the previous temporary requirement which specified that all orders, including verbal orders, must be dated, timed and authenticated by either the ordering practitioner or another practitioner who is responsible for the care of the patient and who is authorized to write orders by hospital policy in accordance with state law.
12. Hospitals will no longer be required to maintain an infection control log.
13. Hospitals will also no longer be required to maintain a single director of outpatient services position that oversees all outpatient departments in the hospital.
14. CMS has eliminated the requirement that an organ recovery team that is working for a transplant center conduct a “blood type and other vital data verification” before organ recovery where the recipient is known.
15. Language has been added to the Conditions of Participation specifying that drug administration errors, adverse drug reactions, and incompatibilities must be immediately reported to the attending physician and, if appropriate, to the hospital’s quality assessment and performance improvement program.
One Response to “CMS Adopts Final Rule Implementing Changes to the Medicare Conditions of Participation for Hospitals”
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