CMS proposes to cut administrative requirements for hospitals, other providers

A newly proposed rule would roll back administrative and operational requirements for hospitals and other Medicare- and Medicaid-participating providers.

The rule focuses on eliminating requirements that CMS considers duplicative, outdated or disproportionately burdensome, particularly for smaller and rural facilities. Proposals arose from a “comprehensive review of the CoPs [conditions of participation] for all 21 provider and supplier types, as well as some payment policies, to identify opportunities to reduce administrative burden while maintaining patient safety and quality care,” according to a fact sheet.

The agency estimates that the proposed changes would generate roughly $320 million per year in reduced expenditures and lower administrative burden across providers, suppliers, states and the federal government. Per estimates, staff time saved would amount to 3.26 million hours. Savings would total $123.2 million per year for hospitals and $16.6 million for critical access hospitals.

Hospital emergency readiness and transfer training requirements

The rule would reverse requirements established in a Biden administration final rule for hospital outpatient departments and ambulatory surgical centers going into 2025. The requirements are scheduled to begin Jan. 1, 2027, and because finalization of the new rule won’t happen sooner, CMS expects the mandates to take effect before recission can happen.

“We would request our surveyors that conduct surveys after that date to focus on those CoPs that are not potentially subject to imminent revision,” CMS wrote in the rule.

Among the affected provisions are mandatory annual staff training on emergency services readiness and patient-transfer protocols, along with obstetrical quality-improvement requirements.

With respect to patient transfers, hospitals would no longer face the training requirement but would need to maintain written policies and procedures for transferring patients.

“The broader existing regulatory requirements, including Emergency Medical Treatment and Labor Act (EMTALA) requirements for emergency department transfers, the existing discharge planning CoPs requirements, and accrediting organization standards collectively support staff competency in transfer processes without the need for a separate annual training requirement,” the proposed rule states.

CMS similarly says requirements for training in emergency services readiness, including protocols for obstetrical emergencies, complications and immediate post-delivery care, can be safely eliminated.

The agency emphasized that hospitals would still have to meet existing CoPs pertaining to the responsibility to provide appropriate emergency care.

Obstetrical quality requirements and birth tissue consent

The proposed rule would overturn requirements that the Biden administration set to start Jan. 1 for hospitals providing obstetrical (OB) services. Among various rescinded requirements would be to analyze quality indicators by patient subpopulation, measure and track outcomes and disparities in OB care, and develop and implement interventions to address disparities.

CMS said existing hospital-wide quality assessment and performance improvement (QAPI) requirements already provide an adequate foundation for monitoring OB care. Text in the proposed rule encourages hospitals to emphasize maternal health outcomes, disparities and maternal-mortality review findings in their QAPI programs. The Birthing-Friendly Hospital designation and state Perinatal Quality Collaboratives also are mechanisms for driving improved maternal care, the agency wrote.

In contrast to most of the proposed rule, a few provisions would add requirements for hospitals, including critical access hospitals (CAHs), that provide OB services.

Specifically, facilities would have to obtain informed consent before collecting, storing, donating, transferring, banking or releasing birth tissues, then document that consent in the patient’s medical record.

“Families giving birth at hospitals may reasonably wish to understand whether such tissues will be discarded, available for them to retain, used for research purposes, transferred to third parties, stored for future use or otherwise utilized in commercial activities,” the proposed rule states.

Other provisions would require written policies allowing patients to request retention or release of birth tissues and providing instructions for safe handling, transportation, storage and disposition by hospitals.

CMS seeks input on additional regulatory changes

In a request for information (RFI) within the proposed rule, CMS asks for feedback on how to reduce barriers for new organ transplant programs seeking Medicare certification.

The agency also asks about possibly alleviating the longstanding requirement for physicians to be immediately available to supervise a certified registered nurse anesthetist providing anesthesia.

Since an exemption to the supervision requirement became available in 2001, 26 states and one U.S. territory have requested and obtained exemptions, according to the proposed rule. CMS is inquiring whether the policy should be revised or perhaps eliminated.

Another topic in the RFI is about ways to reduce hospital reporting burdens with regard to respiratory illness and infectious disease by adopting automation and digital data collection through technology such as Fast Healthcare Interoperability Resources.

The comment period on the proposed regulations and the RFI runs for 60 days after the rule’s publication in the Federal Register, scheduled for Nov. 10.

Revised requirements for rural hospitals

Proposed provisions would clarify distance requirements for being classified as a critical access hospital (CAH), stating that determinations should be based on proximity to other providers of acute inpatient care.

Facilities that provide only specialty services (e.g., psychiatric hospitals, long-term care hospitals, rehabilitation hospitals, rural emergency hospitals) should not count as acute-care hospitals for the purpose of the distance requirement. This update essentially would codify current CMS guidance, according to the proposed rule.

For rural emergency hospitals (REHs), the rule would eliminate data-reporting requirements that apply during a public health emergency. REHs would be exempt from reporting patient-level information such as medical record identifiers, race, ethnicity, age, sex and ZIP code, along with pertinent comorbidities.

Changes to facility safety and construction standards

The rule would update facility safety standards to incorporate the 2024 editions of the National Fire Protection Association’s Life Safety Code and Health Care Facilities Code, both of which apply across multiple Medicare- and Medicaid-certified provider types. The proposals “would simplify and modernize the construction and renovation process for affected healthcare providers and suppliers, reduce compliance-related burdens and allow for more resources to be used for patient care,” CMS wrote.

Other flexibilities would apply to emergency and standby power requirements for hospitals, along with existing requirements for outside windows and doors in patient sleeping areas.

Reduced reporting requirements for long-term care facilities

Proposed provisions for long-term care facilities (i.e., skilled nursing facilities and nursing homes) are designed to lighten the burden around facility assessments, respiratory illness data reporting, COVID-19 vaccination requirements, and room occupancy and bathroom requirements.

CMS also proposes to rescind several of the reporting obligations for state Medicaid agencies with respect to payments made to long-term care facilities for distinct categories of workers.

Other provisions in the rule are geared toward intermediate care facilities for individuals with intellectual disabilities, hospices, ambulatory surgical centers and dialysis facilities, among other provider types.