On September 30, 2019, CMS published Final Rules in the Federal Register (linked below) that affect acute care hospitals, critical access hospitals, and ambulatory surgery centers, as well as other deemed status healthcare facilities.

All regulations are effective November 29, 2019 with the exceptions of those regarding QAPI in CAHs and the antibiotic stewardship programs in acute care hospitals and CAHs, which are effective at later dates, as noted.

HFAP is evaluating the documents to identify revisions in our standards or required elements. Proposed revisions in HFAP standards will be provided in pre-publication form pending CMS approval.

Medicare and Medicaid Programs; Regulatory Provisions To Promote Program Efficiency, Transparency, and Burden Reduction; Fire Safety Requirements for Certain Dialysis Facilities; Hospital and Critical Access Hospital (CAH) Changes To Promote Innovation, Flexibility, and Improvement in Patient Care“ is a 103-page document that addresses changes to Conditions (except those related to discharge planning.)

Medicare and Medicaid Programs; Revisions to Requirements for Discharge Planning for Hospitals, Critical Access Hospitals, and Home Health Agencies, and Hospital and Critical Access Hospital Changes to Promote Innovation, Flexibility, and Improvement in Patient Care” is a 49-page document related to discharge planning.

Summary of the Updates

Hospitals

  1. §482.13 Patient’s rights: Various requirements regarding the use of restraints or seclusion have been revised.
  2. §482.15 Emergency preparedness: Several aspects of the requirements have been revised.
  3. §482.21 Quality assessment and performance improvement program. New requirements addressing a unified and integrated QAPI program for multi-hospital systems.
  4. §482.22 Medical Staff: Revised requirements regarding pre-surgical assessments for outpatients.
  5. §482.23 Nursing Services: Several revisions, including that the hospital must have policies and procedures establishing which outpatient departments, if any, are not required under hospital policy to have a registered nurse present.
  6. §482.24 Medical record services: Revisions to support the new requirements regarding pre-surgical assessments as described in §482.22.
  7. §482.27 Laboratory Services: Revisions regarding notification timeframe.
  8. §482.42 Infection prevention and control and antibiotic stewardship programs: The governing body must ensure a hospital-wide antibiotic program.  Guidelines for a unified and integrated infection prevention and control and antibiotic stewardship programs for multi-hospital systems.
  9. §482.51 Surgical Services: A provision permits a policy for requiring only a pre-surgical assessment in lieu of a history and physical within 30 days. The policy must address specific parameters.
  10. §482.58 Special requirements for hospital providers of long-term care services (swing beds):  Some cross references to other CFRs have been removed.
  11. §482.61 Special medical record requirements for psychiatric hospitals: Revisions to clarify requirements regarding documentation of progress notes.
  12. §482.13 Patient’s rights: This revision clarifies the requirements for a patient’s access to his/her own medical records.
  13. §482.43 Discharge planning: Revision with the addition of new requirements and significant revisions of current requirements. The revised and new requirements apply to all types of hospitals.

Critical Access Hospitals

  1. §485.625 Emergency preparedness: Several aspects of the requirements have been revised.
  2. §485.631 Staffing and staff responsibilities: Relocating some requirements from the current QAPI Condition of Participation.
  3. §485.635 Provision of services: Revisions to assessment of nutritional needs.
  4. §485.640 Infection prevention and control and antibiotic stewardship program: Establishment of a hospital-wide antibiotic stewardship program and other requirements regarding oversight and leadership of the infection prevention and control program.
  5. §485.641 Quality assessment and performance improvement program: The new requirements and revision steer the QAPI program from being reactive to proactive and integrated in all services and departments.
  6. §485.645 Special requirements for hospital providers of long-term care services (swing beds):  Some cross references to other CFRs have been removed.
  7. §485.635 provision of services: Revision to support new requirements for discharge planning.
  8. §485.642 Discharge Planning: Revision with the addition of new requirements and significant revisions of current requirements. These revisions mirror revisions for hospitals under the Condition of Participation §482.43.

Ambulatory Surgery Centers

  1. §416.41 Governing body and management: Procedures for transferring patients to hospitals have been revised. Note:  HFAP may retain our current standard which would exceed the new CMS requirement.
  2. §416.47 Medical records: Revision to support new requirements regarding pre-surgical assessments as described in §416.52.
  3. §416.52 Patient admission, assessment, and discharge: This revision permits a policy for requiring only a pre-surgical assessment in lieu of a history and physical within 30 days. The policy must address specific parameters.
  4. §416. 54 Emergency preparedness: Several aspects of the requirements have been revised.

Questions? Please contact us at info@hfap.org.