Healthcare News & Insights

CMS updates rules for Medicare, Medicaid participation: 3 highlights

There are several new changes coming from the feds that’ll affect your facility. A proposed rule from the Centers for Medicare & Medicaid Services (CMS) will update several requirements that hospitals must follow to participate in Medicare and Medicaid. 

178991922The new rule, published in the Federal Register, outlines changes to the current conditions of participation in federal healthcare programs. It covers several important areas, ranging from discrimination policies to infection control.

Here are some of the highlights, according to a news release from CMS.

New discrimination policies

Discrimination is a significant issue that can negatively affect a person’s access to health care. And many patients with different sexual orientations and ethnic backgrounds have reported they’ve experienced discriminatory behavior in certain healthcare settings.

Because of the impact that discriminatory behavior can have on healthcare delivery, CMS will now require all hospitals to establish and implement a written policy that bans discrimination based on race, color, national origin, sex, gender identity, age or disability.

As part of this change, hospitals must also inform patients of their right to be free from discrimination when seeking treatment, as well as how to get help if they do experience discrimination. This information must be given to the patient in the language the person is best able to understand.

Medical record documentation

Additionally, the feds are cracking down on what needs to be documented in a patients’ medical record for each hospital visit, whether it’s an inpatient or outpatient service.

According to the proposed rule, the medical record must contain all pertinent information that’s necessary to justify admissions and long-term hospitalizations. Documentation for both inpatient and outpatient visits needs to specifically list all services provided to the patient.

In addition, information listed in the medical record needs to support patient diagnoses, as well as describe the patient’s treatment progress and any responses to medications and services. Examples include any complications, hospital-acquired conditions or adverse drug reactions.

And as part of CMS’ new focus on discharge planning, the new rule requires hospitals to document discharge and transfer summaries in the medical record. This includes outcomes of all hospitalizations as well as providers’ recommended follow-up care for each patient.

Dealing with infections

CMS is continuing to focus on reducing hospital-acquired infections, which sicken thousands of patients each year.

In the past, the emphasis has been more on controlling these infections. But in its proposed rule, CMS will change the language of the existing regulations to make infection prevention more important. The agency will require that all hospitals follow all nationally recognized guidelines to prevent the transmission of infections.

To go along with the emphasis on prevention, CMS is also requiring all participating hospitals to develop and maintain antibiotic stewardship programs. Being more careful about prescribing antibiotics to patients is a big part of reducing the chances that they’ll develop deadly infections like C. diff. And it’ll also be helpful with preventing the spread of antibiotic-resistant infections.

Hospitals must monitor their infection control and prevention efforts using “surveillance.” Per the rule, this includes infection detection, along with using concrete data to analyze, monitor and evaluate the results of any preventive measures taken.

According to the new rule, these efforts must be led by a designated professional who has specialized expertise in the area of infection prevention and has been trained in a field such as nursing, epidemiology or microbiology. Each hospital’s antibiotic stewardship program must also have its own designated leader.

What’s next

CMS is taking comments on the proposed rule for 60 days before issuing a final rule. Feedback can be submitted in several ways, including online (at or via regular mail.

In the meantime, hospitals need to start preparing for these updates by reviewing their current protocols and policies to ensure they’ll meet the new standards.

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