CMS Publishes Discharge Planning Final Rule

CMS released a final rule that gives patients the ability to make informed decisions about their care received in a post-acute care environment. The rule requires the discharge planning process to focus on the patient’s goals of care and treatment preferences. The rule also “supports CMS’ interoperability efforts by promoting the seamless exchange of patient information between health care settings, and ensuring that a patient’s health care information follows them after discharge from a hospital or PAC provider.”

The rule was published in the Federal Register on Sept. 27, 2019, and went into effect on Nov. 26, 2019. The CoPs were updated on Feb. 21, 2020; however, the detail of the Interpretive Guidance still is pending publication.

MHA published an issue brief with additional details.

CMS Publishes Final Rule on Interoperability and Patient Access

On CMS’ website on March 9, 2020, it stated these CoPs would be effective six months after the publication of the final rule in the Federal Register. The final rule has been changed to state that the new CoPs at 42 CFR Parts 482 and 485 now will be effective 12 months after the final rule was published in the Federal Register on May 1.

CMS also finalized the Patient Access API and Provider Directory API policies for Medicare Advantage, Medicaid and the Children’s Health Insurance Program effective Jan. 1, 2021. CMS will exercise enforcement discretion for a period of six months in connection with these two API provisions. Therefore, as a result of COVID-19 and to provide additional flexibility to payers, CMS will not enforce the new requirements under 42 CFR Parts 422, 431, 438, and 457 until July 1, 2021.

CMS finalized the Patient Access API for Qualified Health Plan issuers on the individual market Federally Facilitated Exchanges beginning with plan years beginning on or after Jan. 1, 2021.  CMS will not enforce the new requirements under 45 CFR Part 156 until July 1, 2021.

Webinars

ADT Notification CoPs — Final Rule CMS Guidance and FAQs

HIDI and MHA offered members and partners a complimentary regulatory webinar to hear from well-known health care and HIPAA attorney, Helen Oscislawski, on the impact of the final rule on hospitals. Discussions included an overview of the final rule, new CoPs requirement guidelines and compliance tools available through HIDI.

CMS Listening Session: Promoting Interoperability

An audio recording (ZIP), transcript (PDF) and clarification (PDF) are available for the Dec. 16 Medicare Learning Network listening session on the Improving Prior Authorization Processes and Promoting Patients’ Electronic Access to Health Information Proposed Rule. Learn about the proposed requirements.

CMS Releases Omnibus Burden Reduction (CoPs) Final Rule

In an effort to “cut red tape,” CMS released an omnibus burden reduction final rule. The rule finalizes the provisions of three proposed rules. The rule was published in the Federal Register on Sept. 27, 2019, and went into effect on Nov. 26, 2019. The CoPs were updated on Feb. 21, 2020; however, the detail of the Interpretive Guidance still is pending publication.

• regulatory provisions to promote program efficiency, transparency and burden reduction (omnibus burden reduction)
• hospital and critical access hospital changes to promote innovation, flexibility and improvement in patient care
• fire safety requirements for certain dialysis facilities

The rule removes Medicare regulations identified as unnecessary, obsolete or excessively burdensome to hospitals.

MHA published an issue brief with additional details.

Sepsis

MHA has been communicating withCMS, commercial payers and state agencies about our concerns with the application of the Sepsis-3 definition for reimbursement. Currently, CMS pays claims based on the Sepsis-2 definition. Increasingly, we are seeing commercial payers deny claims citing the patient did not meet the criteria of Sepsis-3, which is end organ failure. MHA has been instrumental in pushing this issue forward gaining the attention and support of national groups and other state hospital associations.

MHA submitted the following communication and continues to engage on the issue. MHA staff facilitating these discussions are Andrew Wheeler and Sarah Willson.

• Letter to CMS Administrator Seema Verma on Sepsis-3 Definition (July 2020)
• Comment on ICD-10 Sepsis Coding Changes (November 2019)
• Letter to Commercial Payers on Sepsis Denials (October 2019)

United States Pharmacopeia Updates

USP is postponing the official date of Pharmaceutical Compounding — Sterile Preparations <797>. After publication of the revised <797> on June 1, 2019, USP received appeals on certain provisions of the chapter. USP is postponing the official date of <797> until further notice. In the interim, the current official version of <797> (last revised in 2008), including the section Radiopharmaceuticals as CSPs, will remain official. The decisions on the appeals to <797> do not foreclose the possibility of future revisions to this chapter.

• USP <797>: Understanding Changes with Sterile Compounding in Hospitals — Recording | PowerPoint

USP General Chapter <800> provides standards for safe handling of hazardous drugs to minimize the risk of exposure to health care personnel, patients and the environment. On Dec. 1, 2019, USP <800> became official, and is informational only and not compendially applicable. “Informational” means that it is not required and does not contain any mandatory tests and assays unless otherwise specified by regulators and enforcement bodies

• USP <800>: Understanding the Organizational Impact of Safe Handling of Hazardous Drugs — Recording | PowerPoint

Understanding 988 Implementation in Missouri

Date: June 21, 2022

As of July 2022, 988 is the national three-digit phone number for all mental health, substance use and suicide crises. While 988 is available nationally, it is up to each state to ensure crisis services are adequately funded and available. Missouri’s 988 Task Force is developing a 988 plan and exploring long-term funding options. The webinar provides information on current and future implementation plans, including how hospitals can support implementation efforts.

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Resources

The QR code above links directly to the Missouri Department of Mental Health’s website for information related to the rollout of 988 in Missouri.

SAMHSA Partner Toolkit: Hospitals may use this resource to communicate about 988 with their communities and staff.

Sexual Assault Forensic Examination

In 2020, Senate Bill 569 was passed by the General Assembly and signed by Gov. Parson. The newly enacted legislation contains several provisions impacting Missouri hospitals.

• 192.2520 and 197.135: Justice for Crime Survivors
• 595.201: Sexual Assault Survivors Bill of Rights
• 595.202: Missouri Rights of Victims of Sexual Assault Task Force
• 595.220: Electronic Tracking of Sexual Assault Kits

MHA is monitoring the implementation by state agencies and providing feedback when requested. MHA is hosting an upcoming webinar on the newly enacted legislation to provide hospitals with an understanding of the language. The state will need to develop regulations to implement the new laws.

Sexual Assault Survivors Bill of Rights

The Sexual Assault Survivors’ Bill of Rights requires the Missouri Department of Public Safety to develop documents to be provided by law enforcement officers and medical providers to survivors upon their initial interaction. 595.201.2(12), RSMo. These documents are available on the DPS website.

Webinars

Victims of Sexual Assault Legislative and Regulatory Webinars

Dates: Sept. 2 & 16, 2020

MHA’s complementary legislative webinars on Senate Bill 569 Victims of Sexual Offenses covers the provisions of the language, identifies hospital requirements and provides a timeline for compliance with the provisions.

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How ‘White Bagging’ Impacts Patients, Hospitals and Providers

Date: June 17, 2021

Hospitals are increasingly facing an issue commonly known as ‘white bagging.’ White bagging occurs when a prescription is filled by a payer-mandated third-party specialty pharmacy and delivered directly to the provider for administration. The seemingly minor change of using a third-party pharmacy can raise patient copays and plan sponsor bills, interrupt scheduling and treatment, increase costs, disrupt pharmacy receiving and storage systems, and introduce safety concerns. There are limited situations where white bagging should occur; however, the increased incidence of payer-mandated occurrences is concerning.

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Hospital Visitation Webinar

Date: Aug. 25, 2022

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