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September 2018


The Centers for Medicare & Medicaid Services (CMS) issued a proposed rule to revise the applicable conditions of participation (CoPs) for providers and conditions for coverage (CfCs) as a continuation of our efforts to reduce regulatory burden in accordance with the January 30, 2017 Executive Order “Reducing Regulation and Controlling Regulatory Costs” (Executive Order 13771).

In a continued effort to balance patient safety and quality of care while limiting unnecessary procedural burdens on providers, and in accordance with the aforementioned Executive Order, we have conducted a comprehensive review of the Medicare conditions of participation for all provider types. In developing these proposals, we reviewed recently released regulations as well as long-standing requirements for opportunities to produce burden reduction and cost savings for providers. We also reviewed letters from a variety of stakeholders and over 2,800 public comments we received in response to requests for information included in the payment regulations published in 2017.

Proposed Requirements

We propose changes to the current regulatory requirements that would simplify and streamline the current regulations and thereby increase provider flexibility and reduce excessively burdensome regulations, while also allowing providers to focus on providing high-quality healthcare to their patients, all while maintaining health and safety standards for patients.

This proposed rule would also reduce the frequency of certain required activities and, where appropriate, revise timelines for certain requirements for providers and suppliers and remove obsolete, duplicative or unnecessary requirements. These proposals would balance patient safety and quality, while also providing broad regulatory relief for providers and suppliers. The proposed rule would reduce burden for participating providers and suppliers in the following ways:

Emergency Preparedness

We continually assess our Emergency Preparedness policies to ensure that facilities maintain access to services during emergencies, provide safety for patients, safeguard human resources, maintain business continuity and protect physical resources. This proposed rule will continue to ensure that these expectations are met. At the same time, we are proposing to reduce the complexity of the requirements to ensure that providers are spending more time and resources on actual patient care.

  • Emergency program: Give facilities the flexibility to review their emergency program every two years, or more often at their own discretion, in order to best address their individual needs. A comprehensive review of the program can involve an extensive process that may not yield significant change over the course of one year. Facilities may review the plan more frequently should significant changes become necessary as determined by the individual needs of the facility. The combination of all Emergency Preparedness requirements (policies and procedures, testing, communication plan) will continue to hold facilities accountable for their outcomes while allowing them more time to focus on their unique needs and specific circumstances
  • Emergency plan: Eliminating the duplicative requirement that the emergency plan include documentation of efforts to contact local, tribal, regional, State and federal emergency preparedness officials and a facility’s participation in collaborative and cooperative planning efforts. This information is already contained in other regulations requiring that these activities occur.
  • Training: Give facilities greater discretion in revising training requirements to allow training to occur annually or more often at their own discretion. Overly restrictive training requirements can have unintended consequences in preventing facilities from focusing their training efforts on what makes sense in unique circumstances.
  • Testing (for inpatient providers/suppliers): Increasing the flexibility for the testing requirement so that one of the two annually-required testing exercises may be an exercise of the facility’s choice. While two annual tests are still required, flexibility is provided so that one of those training sessions can be done through various innovative methods such as simulations, desk top exercises, workshops or other methods that may best meet the needs of the facility and the patients that they serve. The second training must continue to be a full scale community exercise.
  • Testing (for outpatient providers/suppliers): Revising the requirement for facilities to conduct two testing exercises to one testing exercise annually. Additional testing will be at the facilities’ discretion based on unique needs. This will allow facilities to modernize their testing to use innovative methods such as desktop drills and simulations.
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