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On January 26, 2023, the Centers for Medicare and Medicaid Services (CMS) issued guidance for Rural Emergency Hospitals (REHs), through which CMS outlined requirements on eligibility, the conversion process for eligible facilities, and other related information. The guidance clarifies the final rule CMS issued in November that established REHs as a new Medicare provider type, effective January 1, 2023.

This provider type was established to address the concern over closures of rural hospitals, which was particularly problematic during the COVID-19 pandemic. The final rule set forth the Conditions of Participation (CoPs) that REHs must meet in order to participate in the Medicare and Medicaid programs. The standards for REHs closely align with the current CoPs for Critical Access Hospitals (CAHs), available here.

This article provides a brief overview of CMS’s recent eligibility guidance.Continue Reading CMS issues guidance for rural emergency hospital eligibility requirements

The Centers for Medicare & Medicaid Services (CMS) has issued an “omnibus burden reduction” rule that finalizes a September 20, 2018 proposed rule intended to streamline various Medicare and Medicaid regulatory requirements, in alignment with the Administration’s “Patients over Paperwork” initiative.  The omnibus regulation also finalizes a November 4, 2016 proposed rule on…

The Centers for Medicare & Medicaid Services (CMS) has finalized changes to the discharge planning conditions of participation (CoPs) for hospitals (including long-term care hospitals (LTCHs) and inpatient rehabilitation hospitals (IRFs)), critical access hospitals (CAHs), and home health agencies (HHAs).  CMS believes the rule, which implements statutory requirements under the Improving Medicare Post-Acute Care Transformation…

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…

The Centers for Medicare & Medicaid Services (CMS) has released a long-awaited final rule establishing emergency preparedness requirements for Medicare- and Medicaid-participating providers and suppliers to ensure that they can meet the needs of patients and residents during emergency situations, both natural and man-made. According to CMS, the final requirements “establish a comprehensive, consistent, flexible, and dynamic regulatory approach to emergency preparedness and response that incorporates the lessons learned from the past, combined with the proven best practices of the present.”  CMS projects that compliance with the rule will cost $373 million in the first year, with subsequent annual costs of approximately $25 million.

The new requirements apply to 17 provider types (with certain variations): hospitals; critical access hospitals (CAHs); long-term care (LTC) facilities; psychiatric residential treatment facilities; intermediate care facilities for individuals with intellectual disabilities; religious nonmedical health care institutions; transplant centers; hospices; ambulatory surgical centers; Program for the All-inclusive Care for the Elderly (PACE) organizations; home health agencies; comprehensive outpatient rehabilitation facilities; community mental health centers; organ procurement organizations; clinics, rehabilitation, and therapy providers; rural health clinics/federally qualified health clinics; and end-stage renal disease providers.

The sweeping final rule (the advance version spans 651 pages) covers four aspects of emergency preparedness:
Continue Reading CMS Finalizes Emergency Preparedness Requirements for Medicare/Medicaid Providers

CMS has published a proposed rule on June 16, 2016 that would update the standards hospitals and critical access hospitals (CAHs) must meet to participate in Medicare and Medicaid. Specifically, CMS proposes to revise the conditions of participation (CoPs) for hospitals and CAHs to, among other things:
Continue Reading CMS Proposes Changes to Hospital CoPs to Promote Quality, Strengthen Discrimination Protections

On May 4, 2016, CMS is publishing a final rule amending fire safety standards applicable to the following types of Medicare- and Medicaid-participating health care facilities: hospitals, critical access hospitals, long-term care facilities, intermediate care facilities for individuals with intellectual disabilities (ICF-IIDs), ambulatory surgery centers (ASCs), hospices that provide inpatient services, religious nonmedical health care institutions, and programs of all-inclusive care for the elderly facilities.  As part of this significant update to the current standards, CMS is adopting the National Fire Protection Association’s (NFPA) 2012 edition of the Life Safety Code (LSC) and provisions of the 2012 edition of the NFPA Health Care Facilities Code.  In addition to promoting patient safety and health, CMS contends that “adopting the 2012 LSC would simplify and modernize the construction and renovation process for affected health care providers and suppliers, reduce compliance-related burdens, and allow for more resources to be used for patient care.”  Nevertheless, CMS estimates that the rule will cost $95 million over 12 years, with $18 million in costs during the first year of implementation, $12 million annually for years 2 and 3 of implementation, and $6 million annually for years 4-12.  The greatest costs are associated with a requirement that high-rise buildings containing health care occupancies to be protected by automatic sprinkler systems; facilities that are not already required to do so will have 12 years from publication to comply with this requirement.

The rule addresses numerous other fire/health safety requirements, including the following:Continue Reading CMS Finalizes Updated Fire Safety Standards for Health Care Facilities

The OIG has released the 2016 edition of its “Compendium of Unimplemented Recommendations,” which identifies what the OIG considers to be its top 25 unimplemented recommendations in terms of HHS program savings and/or quality improvements. About one-third of the priority recommendations involve Medicare Parts A and B policies, including recommendations to adjust payment…

On February 9, 2016, the Obama Administration released its proposed fiscal year (FY) 2017 budget, which contains significant Medicare and Medicaid reimbursement and program integrity legislative proposals – including $419 billion in Medicare savings over 10 years. These proposed policy changes would require action by Congress, and Republican Congressional leaders have already voiced general…

On December 21, 2015, CMS is hosting a “TeleTown Hall” on implementation of the Notice of Observation Treatment and Implication for Care Eligibility Act (NOTICE Act). The NOTICE Act, enacted in August 2015, requires hospitals and critical access hospitals to provide notification to Medicare beneficiaries receiving observation services as outpatients for more than 24…

On August 6, 2015, President Obama signed into law H.R. 876, the Notice of Observation Treatment and Implication for Care Eligibility Act.  The new law requires hospitals to provide written and oral notification to Medicare beneficiaries receiving observation status for more than 24 hours, rather than admitted as inpatients, beginning 12 months after the…

On July 27, 2015, the Senate approved H.R. 876, the Notice of Observation Treatment and Implication for Care Eligibility Act, clearing the measure for the President. H.R. 876 would require hospitals to provide written and oral notification to Medicare beneficiaries receiving observation status for more than 24 hours, rather than admitted as inpatients.
Continue Reading Senate Approves Hospital Outpatient Observation Status “Notice” Act

The OIG has issued a report on Medicare beneficiary copayment costs for outpatient services provided at critical access hospitals (CAH). Beneficiaries who receive services at CAHs pay Medicare coinsurance amounts based on CAH charges, in contrast to patients at acute care hospitals who are responsible for coinsurance amounts based on outpatient prospective payment system (OPPS)…

On April 16, 2014, the Centers for Medicare & Medicaid Services (CMS) published a proposed rule that would amend fire safety standards applicable to the following types of Medicare- and Medicaid-participating health care facilities: hospitals, critical access hospitals, long-term care facilities (skilled nursing facilities, nursing facilities, and distinct part skilled nursing facilities or nursing facilities),…

CMS has published a notice inviting applications for a new Frontier Community Health Integration Project Demonstration, which will test new models of integrated health care delivery in sparsely-populated rural counties with the goal of improving health outcomes and reducing Medicare expenditures. The demonstration is limited to critical access hospitals in Alaska, Montana, Nevada, North…

President Obama has signed into law the Consolidated Appropriations Act of 2014, which provides $1.012 trillion in discretionary funding for the operations of the federal government through September 30, 2014. In addition to setting overall funding levels for HHS agencies, the law specifies funding for numerous HHS policies and initiatives, such as additional funding…