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CMS Issues New Rules for Hospitals

ON NOV. 27, 2006, the Centers for Medicaid and Medicare Services (CMS) released new “Hospital Conditions of Participation” (CoPs), five of which will impact the role of nurses in the evaluation of patients and their communication with other health care providers.
Hospitals accepting Medicare and Medicaid patients must follow these parameters in order to be reimbursed by the federal government for services they provide.
The five changes affecting nurses are:

  • The timeframe for the completion of patient history and physical examinations (H&P) has been expanded to 30 days before or 24 hours after admission to the hospital. Importantly, CMS eliminated the requirement that the H&P be performed by providers with medical staff privileges. The new CoP allows other qualified providers to conduct the H&P “to the extent consistent with state law.”
  • CMS has amended the rule governing the authentication of verbal orders by now requiring that verbal orders must be authenticated as mandated by federal or state law, or within 48 hours if state law is silent on the required timeframe. The previous rule was “as soon as possible.”
  • The CoP governing distribution and control of pharmaceuticals has been tightened. The new rule requires that all drugs and biologicals be kept in a secure area and locked “when appropriate,” which is not defined. The practice will likely vary from one hospital to the next.
  • Post-anesthesia evaluation may now be completed by any individual qualified to administer anesthesia. The old rule required the evaluation be completed by the practitioner who administered the anesthesia.
  • The training requirements for health care workers who use physical restraints and seclusion have been revamped to ensure that patients’ rights are protected and that the restraint or seclusion is appropriate. The list of practitioners who can conduct the required faceto- face evaluation when restraints are used has been expanded. It now includes RNs and physician assistants, but they must consult with a physician or other licensed independent practitioner (LIP) “as soon as possible.” Prior to this rule, only a physician or other LIP could conduct the evaluation.
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