CMS proposal would change Medicare, Medicaid eligibility

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Infection prevention, more protections against patient discrimination and readmission data are among the areas up for changes in a proposal the Center for Medicare & Medicaid Services has made for hospitals that want to be eligible for Medicare and Medicaid reimbursements.

Addressing concerns over current standards of practice and quality of care, a statement from CMS said the proposal would require all hospitals and critical access hospitals to:

  • Prevent and control infections throughout facilities, as well as have programs for healthcare-associated infections and appropriate use of antibiotics.

  • Develop and implement policies that prohibit discrimination against patients by healthcare providers.

  • Change the term “licensed independent practitioner” to “licensed practitioner” to allow physicians assistants to expand their roles.

  • Incorporate readmission data and hospital-acquired conditions to hospitals' Quality Assessment and Performance Improvement program

  • Require patients' medical records to include added information to justify admissions, diagnoses, and a variety of other hospital-related care. Discharge and transfer summaries would also need to be added.

  • Allow patients access to their records in a physical or electronic format, upon request.

The proposal also includes three additional changes, which would only be applied to critical access hospitals.

Patients' nutritional needs would be regulated under tighter constraints and a Quality Assurance Performance Improvement plan would be mandatory to improve overall care. Disclosure of ownership by the specialized facilities would no longer be required under the proposed changes.

A 60-day comment period for the proposal is now underway. To read the full CMS proposal for updating Medicare and Medicaid requirements for hospitals and critical access hospitals, click here.