Omnibus Burden Reduction (Conditions of Participation) Final Rule CMS-3346-F Part 2

The removal of these regulations has been approved as an effort to reduce inefficiencies and improve the delivery of lower cost, high quality care with better patient outcomes. This new rule complies with President Trump’s Executive order directing  healthcare providers to focus on the patient as the priority. The Final rule would reduce burden for participating providers and suppliers.

A summary of the reduction measures is provided for rural health centers, federally qualified health centers, transplant centers, home health, hospices, comprehensive outpatient rehabilitation centers, community mental health centers, portable x-ray services, religious nonmedical health care institutions-(RNHCIs) and certain dialysis facilities.

Rural Health Centers and Federally Qualified Health Centers:
· “Reducing the frequency of review of the patient care policies and facility evaluation from annually to every two years”.

Transplant Centers
· “Updating the terminology used in the regulations to conform to the terminology that is widely used and understood within the transplant community, thereby reducing provider confusion; and
· Removing the requirement for transplant centers to submit clinical experience, outcomes, and other data in order to obtain Medicare re-approval.  Although we are finalizing the removal of this requirement, CMS will continue to monitor and assess outcomes and quality of care in transplant programs after initial Medicare approval”.

Home Health
· “Removing the requirement that the Home Health Agency (HHA) conduct a full competency evaluation of a home health aide when deficiencies are identified in aide services, and replacing it with a requirement to retrain the aide regarding the identified deficient skill(s), and requiring the aide to complete a competency evaluation related only to those skills; and
· Limiting the requirements for verbal (meaning spoken) notification of all patient rights to those rights related to payments made by Medicare, Medicaid, and other federally funded programs, and for potential patient financial liabilities, as specified in the Social Security Act. HHAs will still be required to provide written notice of all patient rights to all HHA patients”.

· “Allowing hospices to defer to State licensure requirements for qualification of their hospice aides, regardless of the State licensure content or format, thus allowing states to set forth training and competency requirements that meet the needs of their populations.
· Removing the prescriptive requirement that hospices must consult with an individual with expertise in drug management in addition to the hospice’s own expert clinicians; and
· For hospices that provide hospice care to residents of a Skilled Nursing Facility or Intermediate Care Facilities for Individuals with Intellectual Disabilities, CMS is requiring hospices to work with their chosen Skilled Nursing Facility and intermediate care facility partners to educate facility staff about the hospice philosophy of care and specific hospice practices”.

Comprehensive Outpatient Rehabilitation Facilities
· “Reducing the frequency of the implementation of a utilization review plan from four times per year to annually, which will allow an entire year to collect and analyze data to inform changes to the facility and the services provided”.

Community Mental Health Centers-CMHC
· “Removing the requirement for CMHCs to update the client comprehensive assessment every 30 days for all CMHC clients and instead only retain the minimum 30-day assessment update for those clients who receive partial hospitalization program services”.

Portable X-Ray Services
· “Removing the four training and education requirements, which focus on the accreditation of the school where the technologist received training, and replacing it with a streamlined qualification that focuses on the skills and abilities of the technologist; and
· Allowing for portable x-ray services to be ordered in writing, by telephone, or by electronic methods, streamlining the ordering process”.

Religious Nonmedical Health Care Institutions (RNHCIs)
RNHCIs provide health care furnished under religious tenets that prohibit medical care, we have:
· “Reduced burden by not requiring them to prepare discharge instructions to a medical facility”.

Fire Safety Requirements for Certain Dialysis Facilities, published November 4, 2016.
· “Updated requirements for certain higher-risk dialysis facilities from the 2000 edition of the fire safety code to the 2012 edition of the fire safety code. This change aligns with state requirements and with the requirements for all other facility types.
· Removes an existing obsolete requirement for facilities to comply with the 2000 edition of the fire safety code.
· No additional burden exists for these facilities as all states have adopted the 2012 edition of the NFPA 101 and 99. CMS is finalizing this rule as proposed. CMS is finalizing as proposed the adoption of the 2012 editions of the NFPA 101 and 99 for dialysis facilities that do not provide one or more exits to the outside at grade level from the treatment area level”.

The final rule [CMS-3346-F] can be viewed at:

CMS Patients over Paperwork
Regulatory Provisions to Promote Program Efficiency, Transparency, and Burden Reduction (“Omnibus Burden Reduction”), published September 20, 2018.
January 30, 2017 Executive Order “Reducing Regulation and Controlling Regulatory Costs” (Executive Order 13771)
Regulatory Provisions to Promote Program Efficiency, Transparency, and Burden Reduction (“Omnibus Burden reduction”), published September 20, 2018;
Hospital and Critical Access Hospital (CAH) Changes to Promote Innovation, Flexibility, and Improvement in Patient Care, published June 16, 2016; and
Fire Safety Requirements for Certain Dialysis Facilities, published November 4, 2016.

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