CMS has issued a proposed rule intended streamline the Medicare and Medicaid regulatory burden on numerous types of providers and suppliers.  CMS generally classifies the proposals as falling into the following categories:  (1) those that simplify and streamline processes, (2) those that reduce the frequency of activities and revise timelines, and (3) those that address obsolete, duplicative, or unnecessary requirements.  CMS estimates that its proposal would result in total annual savings of about $1.1 billion, with a one-time implementation cost of $64 million.

Major provisions of the proposed rule include the following:

• Emergency Preparedness Requirements. CMS proposes to:  allow facilities to review their emergency programs every two years, rather than annually; reduce testing frequency for outpatient providers and suppliers and allow all providers to use innovative emergency preparedness testing methods; and eliminate certain documentation requirements.
• Hospitals. The rule would allow multi-hospital systems to have unified and integrated Quality Assessment and Performance Improvement programs and infection control programs for all member hospitals.  CMS also proposes to allow hospitals to establish a medical staff policy describing the circumstances under which a pre-surgery/pre-procedure assessment for an outpatient could be utilized, instead of a comprehensive medical history and physical examination.  In addition, the rule would provide discretion regarding when an autopsy is indicated in certain instances.
• Ambulatory Surgical Centers (ASCs). CMS proposes to remove the requirements that ASCs have a written transfer agreement with a hospital that meets certain Medicare requirements or ensure that all physicians performing surgery in the ASC have admitting privileges in a hospital meeting certain standards.  The rule also would remove the requirement that a physician or other qualified practitioner conduct a complete comprehensive medical history and physical (H&P) assessment on each patient not more than 30 days before the date of the scheduled surgery; instead, each ASC would be required to establish and implement a policy that identifies patients who require an H&P assessment prior to surgery.
• CAH, RHC, and FQHCs. The proposed rule would reduce the frequency with which Critical Access Hospitals (CAHs), Rural Health Centers (RHCs) and Federally Qualified Health Centers (FQHCs) must perform reviews of certain policies and procedures.  It also would remove the conditions of participation requirement for CAHs to disclose the names of people with a financial interest in the CAH, in light of duplicative program integrity requirements.
• Hospices. The proposed rule would remove federal qualification standards for hospice aides and defer to state licensure requirements; remove the requirement related to having on the hospice staff an individual with education and training in drug management; allow hospices to provide to the patient or patient representative, and family information regarding the use, storage, and disposal of controlled drugs (rather than requiring hospices to provide them with a copy of medication policies and procedures); and provide hospices and long term care (LTC) facilities with additional flexibility to negotiate the format and schedule for orienting LTC facility staff on certain hospice-specific information.
• Other Provisions. Other proposed policies address, among other things:  home health agency requirements for providing patients with copies of clinical records and verbal notification of patient rights; frequency of comprehensive outpatient rehabilitation facility utilization reviews; requirements for portable x-ray orders and conditions for coverage for portable x-ray technologists; organ transplant program re-approval requirements; community mental health center client assessment requirements; and discharge planning in religious nonmedical health care institutions.

CMS will accept comments on the proposed rule through November 19, 2018.  CMS also invites comments on additional regulatory reforms for consideration in future rulemaking, consistent with CMS’s ‘‘Patients Over Paperwork’’ Initiative.”