Changes to COPs Will Result in Savings for Hospitals and Other Providers

Hospitals could save $4.6 billion over five years as a result of changes made to the conditions of participation (COPs) announced by CMS in a Final rule published in the Federal Register on May 16th, 2012.  A second Final rule, issued on the same day, making changes to the COPs of other Medicare providers, could save those providers $630 million over five years according to CMS estimates. 

These changes remove primarily redundant and obsolete provisions from the COPs.  These two final rules making changes to the COPs were in response to Executive Order 13563 entitled “Improving Regulations and Regulatory Review.”  In this Executive Order, the President directed each executive agency to establish a plan for ongoing retrospective review of existing significant regulations to identify those rules that can be eliminated as obsolete, unnecessary, burdensome or counterproductive or that can be modified to be more effective, efficient, flexible, and streamlined. 


The most significant change for hospitals is that non-physician providers can be granted medical staff positions.  CMS estimates that this change alone will save hospitals $1.6 billion over five years.  Allowing non-physician providers medical staff positions will free up doctors to spend more time with patients and will give hospitals flexibility to administer care in the most cost-effective way. 

Hospitals will also no longer be required to have one person, an outpatient director, who is responsible for outpatient services. Under the Final rule, hospitals will be allowed to assign one or more individuals to be responsible for outpatient services. CMS estimates that this will save $1.5 billion over five years. 

The other changes affecting hospital would (1) allow one governing body for a multi-hospital system that must include at least one member from the medical staff; (2) allow hospitals to establish protocols for the self-administration of medication by patients in certain circumstances; (3) allow the use of standing orders, and the inclusion of nursing plans in interdisciplinary care plans; (4) allow non-physician practitioners to authenticate verbal orders and not require that these authentications occur within 48 hours; (5) eliminate the logging of incidents relating to infection and communicable disease; (6) remove the requirement that a transplant team verify the blood type before organ recovery; and (7) relax reporting requirements for patients who die as a result of the use of a two point soft restraint applied while the patient is not in seclusion. 

Other Providers

A number of changes applied to multiple types of providers and suppliers. The one to three year enrollment bar for suppliers who fail to timely respond for information requests in regards to a revalidation of enrollment is removed. In addition, Medicare billing privileges for a provider or supplier who fails to submit complete and accurate documentation within 90 days of a request to submit an enrollment application, resubmit an application, or verify their enrollment information will be deactivated as opposed to being revoked.  This will allow for easier reinstatement. 

The requirement that ambulatory surgical centers have specific types of emergency equipment in their operating room is removed, and the requirement that end stage renal disease facilities be in compliance with Chapters 20 and 21 of the Life Safety Code are also removed as those same requirements are in most state and local fire safety codes. 

Intermediate care facilities for individuals with intellectual disabilities (ICF/IID) (up until this regulation, known as intermediate care facilities for individuals with mental retardation ICF/MR) will no longer have an open-ended provider agreement and they will be surveyed at least once every 15 months and on average every 12 months. ICF/IID will now be on the same survey schedule as skilled nursing facilities. 

The phrase “mentally retarded” will be replaced with the phrase “individuals with intellectual disabilities” throughout the regulations. The term “recipient,” which is used to describe individuals who receive Medicaid, will be replaced by the word “beneficiary” throughout the regulations. 

CMS indicated in both Final rules that it will continue to look at removing other redundant, outdated and obsolete regulations and welcomes suggestions from providers and the general public.