list of conditions of participationsales compensation surveys

The continuing annual costs (survey process-recertifications, enforcement by states or accredited organizations, appeals, AO) will not change from current levels. CAHs are to ensure that adequate patient medical records are maintained and transferred as required when patients are referred. We also agree that the proposed terminology lacked clarity in a manner that could make surveying for compliance difficult and potentially inconsistent. The discharge plan must be updated, as needed, to reflect these changes. The necessary medical information would have to include: Final Decision: After consideration of the comments we received on the proposed rule, as discussed in the hospital section at section II.C.7 of this final rule, we are finalizing 485.642(e) with modifications. If the patient's stay was less than 24 hours, the discharge-related needs of the patient would be identified prior to the patient's discharge home or transfer to another facility and without unnecessarily delaying the patient's discharge or transfer. We note that we do not expect providers to give overly detailed and complex analyses of the quality and resource use data, which may only serve to confuse patients and/or their caregivers, nor do we expect providers to attempt to provide patients and their caregivers with data that do not exist regarding PAC facilities. We believe that these requirements address these important concerns. Therefore, the estimates we provide in the RIA section of this final rule are essentially identical to those we would estimate under the PRA with respect to the elements set out in section 1899B of the Act. Comment: Most commenters supported the proposed requirement that hospitals send a copy of the discharge instructions and the discharge summary, pending test results, and other necessary information to the practitioner(s) responsible for follow-up care, if the practitioner is known and has been clearly identified, and cited the importance of this information for these practitioners. CoPs are the minimum requirements that CMS sets to protect the health and safety of patients and to improve quality of care. It also updates one provision regarding patient rights in hospitals, intended to promote innovation and flexibility and to improve patient care. Comment: Some commenters recommended that CMS require HHAs to ensure that the patient and caregiver receive discharge education and a copy of the discharge summary. Removing 482.43(c), (d), and (e) for hospitals and 485.642(c), (d), and (e) for CAHs, and replacing these standards with revised and redesignated standards at 482.43(b) and 485.642(b), respectively, entitled Discharge and transfer of the patient and provision and transmission of the patient's necessary medical information for each section. We are also including a requirement at 484.58(b)(2) for HHAs to comply with requests for additional information as may be necessary for treatment of the patient made by the receiving facility or health care practitioner. We proposed at 482.43, Discharge planning introductory paragraph, to require that a hospital have an effective discharge planning process that focuses on the patients' goals and preferences and on preparing patients' and, as appropriate, their caregivers/support person(s) to be active partners in their post-discharge care, ensuring effective patient transitions from hospital to post-acute care while planning for post-discharge care that is consistent with the patient's goals of care and treatment preferences, and reducing the likelihood of hospital readmissions. It is not an official legal edition of the Federal Comment: One commenter requested that we clarify that one way HHAs could demonstrate compliance with the proposed requirement to involve physicians in discharge planning is by documenting any outreach to the physician to coordinate his or her involvement. In addition, some commenters stated that PDMPs could work if there were a national or standardized PMDP database. Comment: Several commenters requested clarification on whether the proposed requirements would apply to certain provider types or programs that are not mentioned in the proposed rule. However, we noted the importance of ensuring that CAHs follow-up, post-discharge, with their most vulnerable patients, including those with behavioral health conditions. The commenter recommended that CMS explicitly state which Start Printed Page 51839provider types would be required to comply with the discharge planning CoPs. o Voice grievances. Response: While we have revised and relocated some of the proposed requirements in this final rule, we have essentially retained (with some clarifying modifications as well as the addition of some important elements of the proposed requirements for this section) the current requirement that the hospital must transfer or refer the patient, along with his or her necessary medical information, to appropriate facilities, agencies, or outpatient services, as needed, for follow-up or ancillary care upon discharge. It was not our intent to impose a process that may not align with current HHA processes or may be otherwise unduly burdensome. Several commenters agreed that many PDMPs still encounter legal, policy, and technical challenges. The DEL furthers CMS' goal of data standardization and interoperability, which is also a goal of the IMPACT Act. The hospice must make reasonable efforts to arrange for visits of clergy and other members of religious organizations in the community to patients who request such visits and must advise patients of this opportunity. Jul 1, 2022. We also believe facilities should have discretion to send the most relevant information within the required necessary medical information, consistent with clinical relevance as defined in the Medicare and Medicaid Electronic Health Record Incentive Program final rule (80 FR 62761, October 16, 2015) (2015 Meaningful Use Rule). (2) A discharge planning evaluation must include an evaluation of a patient's likely need for appropriate post-CAH services, including, but not limited to, hospice care services, post-CAH extended care services, home health services, and non-health care services and community based care providers, and must also include a determination of the availability of the appropriate services as well as of the patient's access to those services. daily Federal Register on FederalRegister.gov will remain an unofficial The hospital's discharge planning process must identify, at an early stage of hospitalization, those patients who are likely to suffer adverse health consequences upon discharge in the absence of adequate discharge planning and must provide a discharge planning evaluation for those patients so identified as well as for other patients upon the request of the patient, patient's representative, or patient's physician. The following is a discussion of each of the proposed standards. 1503 & 1507. Effects on Patients and Medical Care Costs, PART 482CONDITIONS OF PARTICIPATION FOR HOSPITALS, PART 485CONDITIONS OF PARTICIPATION: SPECIALIZED PROVIDERS, https://www.federalregister.gov/d/2019-20732, MODS: Government Publishing Office metadata, https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Post-Acute-Care-Quality-Initiatives/IMPACT-Act-of-2014/IMPACT-Act-of-2014-Data-Standardization-and-Cross-Setting-Measures.html, https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Post-Acute-Care-Quality-Initiatives/IMPACT-Act-of-2014/Submit-a-Question-or-Feedback.html;, https://www.thinkculturalhealth.hhs.gov/clas/standards, https://protect2.fireeye.com/url?k=44af3763-18fa3e70-44af065c-0cc47adb5650-601d6acb74373f82&u=https://www.healthit.gov/isa, https://www.healthit.gov/isa/us-core-data-interoperability-uscdi, http://dashboard.healthit.gov/evaluations/data-briefs/non-federal-acute-care-hospital-ehr-adoption-2008-2015.php, https://www.medicare.gov/inpatientrehabilitationfacilitycompare/, https://www.medicare.gov/homehealthcompare/search.html, https://www.medicare.gov/nursinghomecompare/search.html, https://www.medicare.gov/longtermcarehospitalcompare/, https://www.cms.gov/Medicare/Fraud-and-Abuse/PhysicianSelfReferral/advisory_opinions.html, https://oig.hhs.gov/compliance/advisory-opinions/index.asp, http://www.hhs.gov/hipaa/for-professionals/privacy/guidance/access/#newlyreleasedfaqs, http://www.hhs.gov/hipaa/filing-a-complaint/index.html, https://www.hhs.gov/hipaa/for-professionals/faq/2051/under-the-ehr-incentive-program-participating-providers/index.html, https://www.hhs.gov/hipaa/for-professionals/privacy/guidance/access/index.html, https://www.medicaid.gov/medicaid/financing-and-reimbursement/downloads/no-wrong-door-guidance.pdf, https://www.hhs.gov/civil-rights/for-individuals/special-topics/emergency-preparedness/index.html, https://www.ahrq.gov/professionals/systems/hospital/engagingfamilies/strategy4/index.html, https://innovations.ahrq.gov/qualitytools/care-transitions-program-toolkit, https://caretransitions.org/tools-and-resources/, https://www.ahrq.gov/professionals/systems/hospital/red/toolkit/index.html, https://www.cms.gov/Medicare/Fraud-and-Abuse/PhysicianSelfReferral/index.html?redirect=/PhysicianSelfReferral/, https://www.bls.gov/oes/2017/may/oes_nat.htm, https://iom.nationalacademies.org/Reports/1999/To-Err-is-Human-Building-A-Safer-Health-System.aspx, https://www.whitehouse.gov/sites/whitehouse.gov/files/omb/circulars/A4/a-4.pdf, HHAs: Discharge Planning Process(484.58), HHAs: Requests for Information (484.58), BenefitsQualitative not quantitative or monetized. 2. The new Interoperability and Patient Access Rule, which CMS finalized in March 2020, and published to the Federal Register on May 1, 2020, creates a new CoP provision which requires hospitals, psychiatric hospitals, and Critical Access Hospitals to share electronic event notifications, or e-notifications, with other providers across the continuum of care whenever patients have inpatient or emergency department care events. The transition may be to a patient's home (with or without PAC services), skilled nursing facility (SNF), nursing facility (NF), long term care hospital (LTCH), rehabilitation hospital or unit, assisted living center, substance abuse treatment program, hospice, or a variety of other settings. We note hospitals, HHAs, and CAHs are required to send certain discharge information to the PAC provider or practitioner(s) responsible for follow-up care, if the practitioner is known and has been clearly identified. A few commenters asked for clarification on the documentation requirements for patients that leave against medical advice. With regards to EHRs, we note that as of 2015, nearly all (96 percent) of non-federal acute care hospitals reported possessing a certified EHR system. One commenter recommended that hospitals review a patient's need for the use of technology and whether or not technology is necessary to maintain a patient's health and safety or individual goals. Or, in the rare instance when a hospital does not have internet access, the hospital can call 1-800-MEDICARE (1-800-633-4227) to request a printout of a list of HHAs or SNFs in the desired geographic area. Other commenters noted that HHAs do not prescribe controlled substances or other types of medications. A few commenters questioned the use of the Nursing Home Compare and Home Health Compare websites. In the Discharge Planning proposed rule, we encouraged providers to consider using their state's Prescription Drug Monitoring Program (PDMP) during the evaluation of a patient's relevant co-morbidities and past medical and surgical history (80 FR 68132). We believe that hospitals, HHAs and CAHs will be in compliance with this requirement if they present objective data on quality and resource use measures specifically applicable to the patient's goals of care and treatment preferences, taking care to include data on all available PAC providers, and allowing patients and/or their caregivers the freedom to select a PAC provider of their choice. Furthermore, many commenters questioned the usefulness of much of the proposed minimum information that would be included in the transfer or discharge summary, as compared to the burden of compiling all of the required information. Final Decision: After consideration of the comments we received on the proposed rule, we are finalizing 482.43(e) with modifications. The hospice must document active and ongoing efforts to recruit and retain volunteers. Accordingly, we have prepared an RIA that to the best of our ability presents the costs and benefits of the rulemaking. QIPP Year 5: List of Nursing Facilities Not Meeting Conditions of Individuals, including former patients, health care professionals, and advocacy groups strongly supported more stringent, detailed discharge planning requirements that focus on person-centered care and on the patient's treatment preferences and goals of care. PDF Medicare Hospice Conditions of Participation (CoPs) - NHPCO Table 2Accounting Statement: Classification of Estimated Costs and Benefits. Surveys, or compliance audits, are unannounced and can either be conducted by the designated State Survey Agency or a CMS-approved Accreditation Organization. CoPs are qualifications developed by CMS that healthcare organizations must meet in order to begin and continue participating in federally funded healthcare programs (Medicare, Medicaid, CHIPS, etc. For patients who are transferred to another HHA or who are discharged to a SNF, IRF or LTCH, the HHA must assist patients and their caregivers in selecting a post-acute care provider by using and sharing data that includes, but is not limited to HHA, SNF, IRF, or LTCH data on quality measures and data on resource use measures. In doing so, we identified obsolete and burdensome regulations that could be eliminated or reformed to improve effectiveness or reduce unnecessary reporting requirements and other costs, with a particular focus on freeing up resources that health care providers, health plans, and states could use to improve or enhance patient health and safety. Response: Our use of the broad term practitioner encompasses all practitioners, including non-physician practitioners, which may be operating within a hospital. A few commenters recommended deferring to the local state requirements while others specified the importance of addressing restrictions under the HIPAA Privacy Rule at 164.510. Other commenters requested specific clarifications of potentially ambiguous terms, such as active partner, preventable readmissions, and effective transfers. However, many commenters expressed concern regarding the burdens that would be imposed upon HHAs, should the proposed requirements become final, particularly because they believe there is no evidence that engaging in the extensive discharge process that we proposed would improve patient safety, HHA-physician communications, or post-HHA care delivery. Commenters recommended that the discharge planning requirements include a nutritional component and that specific language regarding food and nutritional services during the discharge planning process be included in the regulations. They also recommended that providers be required to provide patients with a discharge planning fact sheet. We are finalizing the requirement from proposed 482.43(c)(3) with modifications at 482.43(a)(6) in this final rule to require regular re-evaluation of the patient's condition to identify changes that require modification of the discharge plan. CMS established requirements for the Essential Access Community Hospital (EACH) and Rural Primary Care Hospital (RPCH) providers that participated in the seven-state demonstration program in 1993. We understand that the information required may vary based on the circumstances of a patient's discharge to home or transfer to another health care facility, including the urgency of the transfer. As previously noted, ONC finalized the 2015 Edition final rule, which sets out the current criteria for health IT to be certified under the ONC Health IT Certification Program. We proposed at 484.58(a)(1) to require that the discharge planning process include re-evaluation of patients to identify changes that require modification of the discharge plan, in accordance with the timeframes for updating the patient assessment as set forth at 484.55. The commenter stated the hospital CoP proposed language at 482.43(c)(1), requires that a registered nurse, social worker, or other qualified personnel must coordinate the discharge needs evaluation and development of the discharge plan. The commenters recommend that a comparable requirement be included in the HHA CoPs, as it would help clarify the respective roles of HHA staff and the patient's physician. Therefore, we estimate that the total cost of reviewing this rule, assuming two reviewers per affected entity, is $16.1 million ($856 18,853 affected entities). In the proposed rule, we had awkwardly and inadvertently placed the phrase further along so it stated that the patient has the right to access their medical records, upon an oral or written request, in the form and format requested by the individual, if it is readily producible in such form and format (including in an electronic form or format when such medical records are maintained electronically); or, if not, in a readable hard copy form or such other form and format as agreed to by the facility and the individual, including current medical records, within a reasonable time frame. Finally, another commenter noted that providers would need support in implementing and understanding the finalized discharge planning requirements. Research cited earlier in this preamble strongly Start Printed Page 51881suggests that there would be reductions in morbidity and mortality from improving services to these patients through improved discharge planning. are not part of the published document itself. Section 484.60(c)(3)(ii) of the current HHA CoPs require that any revisions related to plans for the patient's discharge must be communicated to the patient, representative, caregiver, all physicians issuing orders for the HHA plan of care, and the patient's primary care practitioner or other health care professional who will be responsible for providing care and services to the patient after discharge from the HHA (if any). We simply are using well-understood terms that are consistent across all of our regulations. While we are not mandating that providers include information on a patient's DME needs in the patient's discharge instructions at this time, we encourage providers to do so where appropriate. o Be protected from discrimination or reprisal for exercising their rights. Redesignating the requirements in proposed 482.43(c)(10) as 482.43(a)(7), which would still require hospitals to assess their discharge planning processes on a regular basis, which would include ongoing, periodic review of a representative sample of discharge plans, including those patients who were readmitted within 30 days of a previous admission, to ensure that the plans are responsive to patient post-discharge needs. Comment: One commenter stated that the regulation should be specific in requiring that the updates envisioned in 484.58(a)(1) include re-checking goals and preferences of the patient. Comment: Several comments stated that the CAH discharge planning requirements should be identical to the hospital discharge planning requirements. We note that we do not estimate costs for the newly added requirement to present quality and cost information to those hospital patients who face a decision on selection of post-discharge providers. Some commenters explained that there are additional challenges for providers whose patients cross multiple state lines, since PDMPs vary by state. This reduction of costs by more than half reflects some downward re-estimates, but mainly our efforts to remove overly prescriptive and costly process requirements that had originally been proposed. Last updated on 5/15/2023 HHSC has published the following two lists of nursing facilities (NFs) that have not yet met the conditions of participation (CoP) for the Quality Incentive Payment Program (QIPP) SFY 2023 program year. The great majority of hospitals and most other health care providers and suppliers are small entities, either by being nonprofit organizations or by meeting the SBA definition of a small business. Sudden participation does not bring any fruit. Proposed 482.43(c)(2): We proposed to require that a hospital must begin to identify anticipated discharge needs for each applicable patient within 24 hours after admission or registration, and the discharge planning process is completed prior to discharge home or transfer to another facility and without unduly delaying the patient's discharge or transfer.

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