CMS final rule reduces hospital administrative burdens


CMS issued a final rule to reduce unnecessary burden for health care providers, allowing them to focus on their priority—patients. Included in the rule is the removal of Medicare regulations identified as unnecessary, obsolete, or excessively burdensome. The rule removes the requirements for a facility to:


  • Request or allow swing-bed patients to perform services for the facility.
  • Provide an ongoing activities program that is directed by a qualified professional because the patient’s activity needs are addressed in the nursing care plan.
  • Employ a qualified social worker on a full-time basis because of the hospital swing-bed and Critical Access Hospital (CAH) bed limit requirements for those with more than 120 beds.
  • Assist residents in obtaining routine and 24-hour emergency dental care because of the existing requirement for hospitals and CAHs to provide care in accordance with the needs of the patient.
  • For CAHs, to perform a review of all their policies and procedures.
  • To disclose the names of people with a financial interest in the CAH.
  • For Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs), to review the patient care policies and facility evaluation annually, changing the frequency to every two years.
  • For a hospital’s medical staff, to attempt to secure autopsies in all cases of unusual deaths and of medical-legal and educational interest.


Hospitals, CAHs, and Home Health Agencies (HHAs) under the rule will be required to:


  • Have new discharge planning requirements—as mandated by the IMPACT act for hospitals, HHAs, and CAHs—which require facilities to assist patients, their families, or the patient’s representative in selecting a post-acute care (PAC) services provider or supplier by using and sharing PAC data on quality measures and resource use measures.
  • Have revised language that now requires a hospital (or CAH) to discharge the patient, and also transfer or refer the patient where applicable, along with his or her necessary medical information (current course of illness and treatment, post-discharge goals of care, and treatment preferences), at the time of discharge, to not only the appropriate post-acute care service providers and suppliers, facilities, agencies, but also to other outpatient service providers and practitioners responsible for the patient’s follow-up or ancillary care.
  • Have revised compliance language for HHAs that now requires these facilities to send all necessary medical information (current course of illness and treatment, post-discharge goals of care, and treatment preferences), to the receiving facility or health care practitioner to ensure the safe and effective transition of care, and that the HHA must comply with requests made by the receiving facility or health care practitioner for additional clinical information necessary for treatment of the patient.
  • Send necessary medical information to the receiving facility or appropriate PAC provider (including the practitioner responsible for the patient’s follow-up care) after a patient is discharged from the hospital or transferred to another PAC provider or, for HHAs, another HHA.
  • In the case of hospitals, ensure and support patients’ rights to access their medical records in the form and format requested by the patient, if it is readily producible in such form and format.
  • Allow multi-hospital systems to have unified and integrated Quality Assessment and Performance Improvement (QAPI) programs and unified and integrated infection control and antibiotic stewardship programs for all their member hospitals.
  • Allow hospitals the flexibility 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.
  • Additionally, CMS is moving to clarify the requirement to allow the use of non-physician practitioners and doctors of medicine/doctors of osteopathy (MD/DOs) to document progress notes of patients receiving services in psychiatric hospitals.


Richard P. Kusserow served as DHHS Inspector General for 11 years. He currently is CEO of Strategic Management Services, LLC (SM), a firm that has assisted more than 3,000 organizations and entities with compliance related matters. The SM sister company, CRC, provides a wide range of compliance tools including sanction-screening.

Connect with Richard Kusserow on LinkedIn.

Subscribe to the Kusserow on Compliance Newsletter

Copyright © 2019 Strategic Management Services, LLC. Published with permission.