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CMS Revises Memo on Requirements to Reduce Risk of Legionella Infection

Be prepared for renewed interest in your water management program and especially how it is designed to prevent the spread of Legionella infection. CMS just updated its memo from last year on requirements to reduce the risk of Legionnaire’s disease, in part to clarify expectations for hospitals and nursing homes (NH).

While there are no new expectations for hospitals or critical access hospitals (CAH), be aware it does add a specific statement that “facilities must have water management plans” as well as a new note that testing for waterborne pathogens is left “to the discretion of the provider,” according to the letter to CMS’ Quality, Safety and Oversight (QSO) group, formerly the Survey & Certification (S&C) group.

“The terms ‘plans’ and ‘policies’ are sometimes confusing to hospitals,” warns Kurt Patton, the former director of accreditation services for The Joint Commission (TJC) and founder of Patton Healthcare Consulting, now in Naperville, Ill.

“TJC already requires a utilities management plan and water is a component of that. The unknown will be if CMS surveyors say they don’t want to look at a utilities plan, they want to look at a water management plan,” explains Patton. “At a minimum, I would suggest accredited hospitals have a table of contents and a subject header for ‘Water Management Plan’ inside their overall utilities plan.”

The memo, QSO 17-30-Hospitals/CAHs/NHs, was published July 6 and supersedes the former S&C 17-30-Hospitals/CAHs/NHs, issued in June 2017, and it adds more specific expectations for long-term care (LTC) facilities. [more]

New CMS guidance on ligature risk says Joint Commission recommendations set the bar

Expect CMS surveyors to be referring to recommendations set out by The Joint Commission last fall when looking for ligature risk and other environmental hazards in the push to make hospitals and psychiatric units safer for patients at-risk of self-harm.

For now, assess your hospital’s environmental compliance against those Joint Commission recommendations, regardless of what organization you might use for accreditation, and be prepared to provide one-to-one observation of at-risk patients if you cannot provide a ligature-resistant environment, says one safety consultant.

In a new memo to its state survey agencies, CMS said it would use those Joint Commission recommendations — drawn from a task force convened by the accreditor that included several CMS experts in suicide prevention — as the federal agency goes forward with clarifying and updating interpretive guidelines for its surveyors.

The memo QSO: 18-21-All Hospitals, “CMS clarification of Psychiatric Environmental Risks,” from the Quality, Safety & Oversight Group (QSO), formerly known as the Survey and Certification Group, is dated July 20, although it was not posted online until Aug. 1.

CMS says Joint Commission panel good enough

In earlier communications, CMS had indicated it would convene its own group of experts to update its guidance to increase focus on ligature as well as other physical risks covered under the Condition of Participation (CoP) for patient rights to care in a safe setting.

However, since participating in the The Joint Commission panel, CMS officials now think its own panel would be redundant. “CMS felt that to repeat the work of TJC Suicide Panel (in which CMS participated) would not provide any substantive additional gains and would not be a productive use of the time and expertise of the participants,” according to the newest memo.

CMS is still working to revise the interpretive guidelines for its surveyors but referred regional offices for now to expectations set out in its Dec. 8 memo on clarifying ligature risk, S&C 18-06-Hospitals (ECL 1/1/18). That memo carried extensive guidance, including an initial update to parts of the interpretive guidelines found in Medicare’s State Operations Manual, Appendix A (SOMA).

Expect more changes in the future, though. In the most recent memo, CMS said it would continue to work on updates to Appendix A as well as Appendix AA, guidelines for surveyors at Psychiatric Hospitals, “which will incorporate the standards that were recommended via the collaborative work of the The Joint Commission Suicide Panel Special Report: Suicide Prevention in Health Care Settings.” The memo provided an online link to the November The Joint Commission recommendations.

Written by A.J. Plunkett

CMS’ severe sepsis bundle ISN’T a Joint Commission requirement

The April 17 issue of Annals of Internal Medicine (AIM) incorrectly stated The Joint Commission was considering creating a requirement for hospitals to implement CMS’ Severe Sepsis and Septic Shock Early Management Bundle (SEP-1) to receive accreditation. This information is incorrect and AIM has published a correction.

CMS Inpatient-Only List: Preparing for Critical Changes in 2018

Each year CMS revises its inpatient-only list of approximately 1,700 procedures. The most notable changes to the list that went into effect January 1, 2018 include the addition of coronary revascularization during an acute myocardial infarction and the removal of total knee arthroplasty. Knee replacements, according to CMS, now may be performed on either an inpatient or an outpatient basis.

These list revisions are vital for hospitals to track and take into account. For example, “removing knee replacement surgery from the inpatient-only list is going to cause major changes for hospitals and physicians who do these procedures,” says Kurt Hopfensperger, MD, JD, vice president of compliance and physician education at Optum Executive Health Resources. Moving forward, they will have to apply utilization review processes more rigorously.

Keeping pace with change

Hospitals that closely follow and interpret the CMS inpatient-only list benefit in several ways. The list follows evidence-based medicine and looks at the average length of stay, as well as typical risks and comorbidities, for each procedure. Thus, correctly placing a patient in inpatient status is a clinically good decision, and it helps organizations stay in compliance with Medicare rules.

Hospitals also protect revenue by making sure every patient undergoing a procedure on the inpatient-only list has a correct status determination, says Hopfensperger. As procedures drop off of the list, hospitals must do the same to avoid potential revenue integrity issues. “You want to make sure you are appropriately compensated for those patients who are high risk or who require a longer stay in the hospital,” he notes.

Continued at Health Leaders Media

CMS and Joint Commission change hospital eligibility requirements

Both organizations have changed their expectations on the defintion of a hospital. CMS’s new S&C Memo 17-44-Hospitals says that surveyors will use average daily census (ADC) and average length of stay (ALOS) data to determine if the hospital is primarily engaged in providing services to inpatients, and “a hospital must have inpatients at the time of survey in order for surveyors to directly observe the actual provision of care and services to patients, and the effects of that care” to determine if the facility is meeting the Conditions of Participation (CoP) in Medicare.

In addition, both CMS and The Joint Commission say that hospitals will need at least two active inpatients on site for an accreditation survey to be done. This change is effective immediately.

Main manual for CMS’ hospital Interpretive Guidelines updated

For the first time in two years, the online version of CMS’ State Operations Manual, Appendix A — also known as SOMA by some — is showing it has been revised!

The date on the appendix, which offers CMS surveyors Interpretive Guidelines to follow when implementing the hospital Conditions of Participation (CoP), is now Nov. 17, 2017. The last revision had been in November 2015.

The most recent update appears to mainly reflect changes to how CMS defines a hospital for survey. Those changes were announced in S&C memo 17-44-ALL-Hospitals.

And more changes should be on the way, especially in light of the recent publication of a new S&C memo on ligature risk. Among other things, S&C 18-06-Hospitals memo notes changes under Tag A-0701 that appear to delete references to emergency preparedness — now under their own set of CoP outlined in Appendix Z— and adds guidelines for checking out other physical safety concerns along with ligature risk within the environment of care.

CMS Emergency Prep rule is now enforceable by surveyors

It’s finally here.

CMS’ new Emergency Preparedness rule went into effect on Wednesday, November 15, which means surveyors can now cite facilities who aren’t compliant with the rule’s requirements.

The rule closes gaps in CMS’ previous regulations, such as requiring facilities to have contingency planning in place, emergency response training for staff, and communicate and coordinate their emergency plans with other hospitals and government agencies at the tribal, local, regional, state, and federal levels. Facilities have had over two years to prepare for this rule, and the agency has already said it won’t be accepting excuses for noncompliance.

While the rule itself is new, Steve MacArthur, a safety consultant at The Greeley Company in Danvers, Massachusetts, says that a lot of the new requirements are things that hospitals should have already been doing.

“I suppose I should stop and say that while this rule is new to the ‘marketplace,’ there are really no new concepts contained therein,” he says. “This may provide some guidance for CMS surveyors as they drill down on organizational preparedness activities. But none of this is groundbreaking or in any way representative of a change in how hospitals have done, and will continue to do, business. [It’s] just another set of official ‘eyes’ looking through the compliance microscope.”

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Thoughts about all that documentation the CoPs require? CMS wants to know

Have thoughts about the paperwork you have to generate because of Medicare’s Conditions of Participation (CoP)? Or rather, do you have thoughts you’d like to share with the public, as well as the Department of Health and Human Services (HHS)?

Now’s your chance. CMS has posted a call for comments on the paperwork required under the regulations that govern almost every aspect of operations at hospitals nationwide that also want the ability to bill Medicare for their services.

The call for public comment is periodic request, mandated in turn by the Paperwork Reduction Act of 1995. (So yes, it’s a regulatorily required chance to comment on extraneous regulations.)

And it’s one of many CMS puts out through the year. This particular request, according to the formal notice placed in the Federal Register Nov. 13, concerns the regular collection of information “needed to implement the Medicare and Medicaid Conditions of Participation (CoP) for 4,890 accredited and non-accredited hospitals and an additional 101 critical access hospitals (CAHs) that have distinct part psychiatric or rehabilitation units (DPUs). CAHs that have DPUs must comply with all of the hospital CoPs on these units. Thus, this package reflects the burden for a total of 4,991 hospitals (that is, 4,890 accredited/non-accredited hospitals and 101 CAHs which include 81 CAHs that have psychiatric DPUs and 20 CAHs that have rehabilitation DPUs).”

Translated, that’s most of the hospitals in the nation, minus the 1,183 CAHs without distinct part psychiatric or rehabilitation units. They operate under a separate set of CoP, according to the notice.

“The CoPs and accompanying regulatory requirements are used by our surveyors as a basis for determining whether a hospital qualifies for a provider agreement under Medicare and Medicaid. CMS and the health care industry believe that the availability to the facility of the type of records and general content of records is standard medical practice and is necessary to ensure the well-being and safety of patients and professional treatment accountability,” according to the notice.

CMS estimates that the paperwork required to meet the CoPs of the combined 4,991 respondents generates 1,342,424 responses a year, requiring a total of 18,840,617 hours a year.

That’s about 3,775 hours per hospital. Or 72 hours a week. Or basically two full-time positions a year.

(You might not want to ask one of those people to generate the report to send to Medicare, if you do decide to submit a comment.

Or you might.)

Comments must be received by Jan. 12, 2018.

After the notice is published on Nov. 13, to comment electronically — no physical paperwork needs to be generated! — go to www.regulations.gov, search for “2017-24524,” hit the button that says “COMMENT NOW” and follow the instructions.

Note the warning that the comments will be made public.

Or you can send comments by regular mail: CMS, Office of Strategic Operations and Regulatory Affairs, Division of Regulations Development, Attention: Document Identifier/OMB Control Number 2017-24524, Room C4-26-05, 7500 Security Boulevard, Baltimore, Maryland 21244-1850.

To read the request of information first, go to https://www.gpo.gov/fdsys/pkg/FR-2017-11-07/pdf/2017-24134.pdf 

— Written by A.J. Plunkett (aplunkett@h3.group)

Joint Commission updates EM standards to match CMS

In response to CMS’ final emergency preparedness rule issued earlier this month, The Joint Commission announced revisions to its emergency management (EM) standards. CMS is expected to approve the updated standards before they go into effect on November 15.

Accredited organizations can access the proposed drafts on their Joint Commission Connect™ extranet site, with more information on the way.

The Joint Commission’s standards come with new Elements of Performance on the following topics:

•    Continuity of operations and succession plans
•    Documentation of collaboration with local, tribal, regional, state and federal emergency management officials
•    Contact information on volunteers and tribal groups
•    Annual training of all new or existing staff, contractors, and volunteers
•    Integrated healthcare systems
•    Transplant hospitals

Several of the new requirements merely provide more specifics on what The Joint Commission already expects. This includes including documentation for existing practices and annual training for staff.

CMS first announced the emergency preparedness CoPs in September 2016, compelling hospitals to communicate and coordinate their emergency plans with other hospitals and government agencies.

They also require regular emergency preparedness training with staff and disaster contingency planning. CMS published the final version of the new Appendix Z of Medicare’s State Operations Manual online, and state surveyors will use newly created E-tags to score deficiencies and expectations set in it.

 

CMS temporarily suspends some Medicare requirements for hurricane-stricken hospitals

Joint Commission also suspending surveys of hurricane affect hospitals temporarily

CMS Administrator Seema Verma announced the agency is temporarily suspending certain Medicare requirements for healthcare providers assisting with Hurricane Irma recovery efforts in Florida, Puerto Rico, and the U.S. Virgin Islands. The Joint Commission also announced that it would be suspending survey activities in the affected areas for the time being.

At the moment, CMS is waiving the following enrollment requirements:
•    Payment of the application fee
•    Fingerprint-based criminal background checks
•    Site visits
•    In-state licensure requirements

“CMS is dedicated to making it as easy as possible for the individuals and families impacted by Hurricane Irma to access medical care during this difficult time,” said Verma. “There are healthcare providers and suppliers in the aftermath of the hurricane that are ready and willing to help. CMS has established a hotline for providers and temporarily suspended certain Medicare requirements so that these healthcare professionals can provide services to those in need.”

The toll-free hotline she’s referring to is for non-certified Medicare Part B providers and other practitioners so they can enroll in federal health programs and receive temporary Medicare billing privileges. First Cost Service Option, a Medicare Administrative Contractor, will work to assist providers in these areas to temporarily enroll healthcare providers. The number is 855-247-8428, and it’s in service between 8 a.m. and 6 p.m. ET

Starting September 18, 2017, providers will be able to initiate temporary Medicare billing privileges over the phone and on the same day. In addition, CMS is:

•    Allowing providers not currently enrolled to initiate temporary billing privileges by providing limited information. This information includes (but isn’t limited), National Provider Identifier (NPI), Social Security Number (SSN) or a business Employer Identification Number taxpayer identification numbers (SSN/EIN/TIN), and valid in-state or out-of-state licensure.
•    Temporarily ceasing revalidation efforts for Medicare providers in areas directly impacted by Hurricane Irma.
•    Waiving the practice location reporting requirements
•    Not taking administrative actions on providers who fail to notify them about their temporary practice location. This temporary process will remain in effect from September 7 until the disaster designation is lifted. After that, it must be reported through appropriate channels.

“CMS will continue to work with all states and geographic areas in the path of hurricanes Irma and Harvey,” according to the press release. “The agency continues to update its emergency page (www.cms.gov/emergency) with important information for state and local officials, providers, healthcare facilities, suppliers and the public.”

To read previous updates regarding HHS activities related to Hurricane Irma and Hurricane Harvey, please visit https://www.hhs.gov/about/news/hurricane-response/index.html.