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Conditions for Coverage (CfCs) & Conditions of Participations (CoPs)

Spotlight

CMS has several ongoing priority activities involving the Conditions of Participation (CoPs) and Conditions for Coverage (CfCs) for certain health care providers. Below you will find key information about our most important activities.

Sprinklers in Nursing Facilities (Life Safety Code)

On October 27, 2006 CMS published a proposed rule to require all long term care facilities to install automatic sprinkler systems throughout their buildings in accordance with the technical provisions of the 1999 edition of Standard for the Installation of Sprinkler Systems, published by the National Fire Protection Association (NFPA). CMS is also proposing to require all long term care facilities to test, inspect, and maintain their sprinkler systems in accordance with the technical requirements of the 1998 edition of Standard for the Inspection, Testing and Maintenance of Water-Based Fire Protection Systems, also published by the NFPA. This proposed rule is in response to a July 2004 General Accountability Office report that suggested all non-sprinklered nursing facilities install automatic sprinkler systems throughout their facilities. CMS is in the process of reviewing public comments and finalizing the rule. (See Related Links Outside of CMS at the bottom of page)

Alcohol Based Hand Sanitizers and Nursing Facility Smoke Alarms (Life Safety Code)

On September 22, 2006 CMS published a final rule, effective October 23, 2006, that allows certain health care facilities such as hospitals to place alcohol-based hand rub dispensers in exit corridors under specified conditions.  This rule also requires that nursing facilities install smoke alarms in resident rooms and common areas if their buildings are not fully sprinklered or they do not have system-based smoke detectors in those areas. (See the "Related Links Outside of CMS" section at the bottom of page)

Anesthesia Supervision

CMS established an exemption for Certified Registered Nurse Anesthetists (CRNAs) from the physician supervision requirement by recognizing a Governor's written request to CMS attesting that he or she is aware of the State's right to an exemption of the requirement and it is in the best interests of the State's citizens to exercise this exemption on November 13, 2001.

At this time, fourteen states have chosen to opt-out of the CRNA physician supervision regulation.  Those states are:  Iowa, Nebraska, Idaho, Minnesota, New Hampshire, New Mexico, Kansas, North Dakota, Washington, Alaska, Oregon, South Dakota, Wisconsin and Montana. 

 

Final Rule: Requirements for History and Physical Examinations; Authentication of Verbal Orders; Securing Medications; and Postanesthesia Evaluations

This final rule, published in the Federal Register November 27, 2006, revises the hospital requirements for completion of history and physical examinations; authentication of verbal orders; securing medications; and completion of postanesthesia evaluations.  These revisions are consistent with current standards of practice and reduce the regulatory burden of hospitals and practitioners.  These regulations are effective on January 26, 2007.  (See Related Links Outside of CMS at the bottom of page)

 

Restraint and Seclusion in Hospitals

On December 8, 2006, the Hospital CoP:  Patients' Rights, was published in the Federal Register as a Final Rule with an effective date of January 8, 2007.  The rule finalizes standards for the following:  notice of rights; exercise of rights; privacy and safety; confidentiality of patient records; and restraint and seclusion.  Standards regarding the use of restraint and seclusion have been revised and finalized based on public comments.  The rule modifies the 1-hour rule, limits the application of the restraint definition in medical/surgical care, clarifies monitoring and assessment requirements, specifies documentation requirements, and expands staff training and death reporting requirements.  (See Related Links Outside of CMS at the bottom of page)

 

Immunizations (flu & pneumococcal) of Nursing Facility residents

Despite the Federal government's unified efforts to increase the availability of safe and effective vaccines and despite substantial progress in reducing many vaccine‑preventable diseases, at‑risk individuals are not receiving influenza and pneumococcal vaccines. CMS published a final rule on October 7, 2005 which requires long term care (LTC) facilities to offer and provide immunizations for flu and pneumococcal disease to LTC residents unless the resident, or resident's legal representative, refuses or there is a medical contraindication.  The rule is effective immediately with in order to protect residents this upcoming flu season.  Increasing the utilization of cost-effective preventive services is the goal of both CMS and Centers for Disease Control (CDC), and this final rule will facilitate the delivery of appropriate vaccinations in a timely manner, increase the levels of vaccination rate, and decrease the morbidity and mortality rate of influenza and pneumococcal diseases.

 

Proposed Revision to End Stage Renal Disease (ESRD) CfCs

On February 4, 2005, CMS published a proposed rule to revise the requirements that ESRD dialysis facilities must meet to be certified under the Medicare program. The proposed revisions to the Conditions for Coverage focus on the patient and the results of the care provided to the patient, establish performance expectations for facilities, encourage patients to participate in their care plan and treatment, eliminate some procedural requirements from the current conditions for coverage, and preserve strong process measures when necessary to promote patient well being and continuous quality improvement. We believe that these changes are necessary to reflect the advances in dialysis technology and standard care practices since the requirements were last revised in their entirety in 1976. CMS is in the process of reviewing public comments and finalizing the rule. (See Related Links Outside of CMS at the bottom of page)

 

Proposed CoPs for Transplant Hospitals

On February 4, 2005, CMS published a proposed rule to set forth the requirements that heart, heart-lung, intestine, kidney, lung, and pancreas transplant centers must meet to participate as Medicare-approved transplant centers.  These proposed Conditions of Participation focus on an organ transplant center's ability to perform successful transplants and deliver quality patient care as evidenced by good outcomes and sound policies and procedures. We are proposing that approval based on compliance with data submission, outcome measure, and process requirements will be granted for 3 years, and approval will be renewed every 3 years for centers that continued to meet the requirements. CMS is in the process of reviewing public comments and finalizing the rule. (See Related Links Outside of CMS at the bottom of page)

Critical Access Hospitals (CAHs)- Necessary Provider (NP) Relocations

As of January 1, 2006, the Medicare Modernization Act removes the ability of States to designate CAHs as "necessary providers (NPs)" -- a designation which denotes that the criterion that CAHs must be at least 35 miles from the nearest hospital has been waived.  Although no new CAHs will de deemed NPs as of January 1, 2206, the statute is silent about the issue of NP CAHs that might want to relocate and modernize their facilities.  Through rulemaking, CMS has issued criteria that the Regional Offices and State Agencies will utilize to evaluate if a NP CAH relocates appropriately. To appropriately relocate, the CAH must provide at least 75 percent of its current services to 75 percent of the same service area with 75 percent of it current staff in its new location. (See Related Links Outside of CMS at the bottom of page)

 

Proposed Revision to Hospice CoPs

On May 27, 2004 CMS published a proposed rule to revise the existing Conditions of Participation that hospices must meet to participate in the Medicare and Medicaid programs.  The proposed requirements reflect an interdisciplinary view of patient care that focuses on the care delivered to patients and their families by hospices and the outcomes of that care.  These changes are an integral part of the Administration's efforts to achieve broad-based improvements in the quality of health care furnished through the Medicare and Medicaid programs. CMS is in the process of reviewing public comments and finalizing the rule. (See Related Links Outside of CMS at the bottom of page)

Final Organ Procurement Organization CfCs

On May 31, 2006, CMS published a final rule to establish the Conditions for Coverage for Organ Procurement Organizations (OPOs).  This rule finalizes the February 4, 2005, proposed rule on Conditions for Coverage for OPOs, CMS-3064-P, and re-certifies all of the existing 58 OPOs from August 1, 2006 through July 31, 2010.  It also provides that the OPOs' agreements with the Secretary for this certification cycle will end on January 31, 2011.  In addition, this final rule establishes new conditions for coverage, including new outcome and process performance measures, a new appeals process, and a new competition process.    

 

Downloads
Final Patient Rights Rule [PDF, 332 KB]

Restraint Reduction Assessment and Alternatives Help Guide for Skilled Nursing Facilities [PDF, 530KB]
Related Links Inside CMS
State Operations Manual for hospitals
Related Links Outside CMSExternal Linking Policy

Final CfCs for OPOs 

Hospital CoPs

Proposed CfCs for ESRD

Proposed CoPs for Hospice

Final CoPs / CfCs for Life Safety Code

Sprinklers in Nursing Facilities Proposed Rule

Final Rule: Requirements for History and Physical Examinations; Authentication of Verbal Orders; Securing Medications; and Postanesthesia Evaluations


Page Last Modified: 12/14/2005 12:00:00 AM
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