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CMS Administrator Touts Red Tape Relief Efforts at Public Release of Proposed Regulatory Reforms

Posted on Monday, September 24, 2018 12:22 PM

Last week, Seema Verma detailed proposed changes to reduce regulatory burdens for providers and suppliers, including hospices and home health agencies. CMS is now accepting comments for the next 60 days on the proposed changes.
CMS estimates that these hospice specific provisions would produce a combined savings of $82 million annually.

Here is a breakdown of the hospice specific proposals:

1. Hospice Aide and Homemaker Services
CMS is proposing to revise § 418.76(a)(1)(iv) to remove the requirement that a State licensure program must meet the specific training and competency requirements set forth in § 418.76(b) and (c) to be deemed an appropriate qualification for employment. This change would defer issues related to hospice aide training and competency to State licensure requirements, except in states where no requirements exist, regardless of their content or format.

2. Drugs and Biologicals, Medical Supplies, and Durable Medical Equipment
CMS believes that most hospices now use pharmacy benefit management companies that directly employ pharmacy experts and that it is no longer necessary to include a regulatory requirement specifically related to the use of a pharmacology expert.

In lieu of existing requirements CMS is proposing to replace the requirement that hospices provide a physical paper copy of policies and procedures with a requirement that hospices provide information regarding the use, storage, and disposal of controlled drugs to the patient or patient representative, and family, which can be developed in a manner that speaks to the perspectives and information needs of patients and families. This information would be provided in a more user-friendly manner, as decided by each hospice.

3. Hospices That Provide Hospice Care to Residents of a SNF/NF or ICF/IID
While CMS believes that the intent of the requirement continues to be appropriate, the agency believes it may, as currently written, create duplication when multiple hospices provide care to residents of a single facility. Further, CMS notes that existing language assigns sole responsibility for this effort to hospice providers, which may impede joint hospice-facility collaboration and training innovations. In response to these concerns, CMS is proposing to remove §418.112(f) and add a new requirement at §418.112(c) (10), “Written agreement,” to address this issue. Under the proposed change, both hospices and facilities would be expected to negotiate the mechanism and schedule for assuring orientation of facility staff.

Emergency Preparedness

1. Annual Review of Emergency Preparedness Program
CMS is proposing that the annual review be changed to at least once every two years instead of annually.
2. Documentation of Cooperation Efforts
CMS is proposing to eliminate the requirement that facilities document efforts to contact local, tribal, regional, State, and Federal emergency preparedness officials and facilities’ participation in collaborative and cooperative planning efforts. Facilities will still be required to include a process for cooperation and collaboration with local, tribal, regional, State and Federal emergency preparedness officials’ efforts to maintain an integrated response during a disaster or emergency.
3.Annual Emergency Preparedness Training Program
Currently, facilities are required to train their employees annually on their emergency preparedness plans. They are now proposing that this training be done once every two years, or when their emergency plan is significantly changed.
4.Annual Emergency Preparedness Testing
Facilities are currently required to conduct exercises to test the emergency plan at least annually. The facility must conduct two emergency preparedness testing exercises every year.

Specifically, facilities must:
• Participate in a full-scale exercise that is community-based or when a community-based exercise is not accessible, an individual, facility-based. If the facility experiences an actual natural or-man made emergency that requires activation of the emergency plan (including their communication plan) and revision of the plan as needed), the facility is exempt from engaging in a community-based or individual, facility based full-scale exercise for one year following the onset of the actual event;

• Conduct an additional exercise that may include either a second full-scale exercise that is community-based or individual, facility-based or a tabletop exercise that includes a group discussion led by a facilitator.
Lastly, CMS is proposing to clarify the testing requirement exemption by noting that if a provider experiences an actual natural or man-made emergency that requires activation of their emergency plan, inpatient and outpatient providers will be exempt from their next required full-scale community-based exercise or individual, facility-based functional exercise following the onset of the actual event.

Source: NAHC Report

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