On Monday, the Department of Health and Human Services ("HHS") issued a proposed rule which, ‎among other things, modifies the Affordable Care Act's ("ACA") provision that hospitals ‎with more than 50 beds must satisfy certain patient safety and quality improvement ‎requirements, including participation in a patient safety organization ("PSO"), in order to contract ‎with a qualified health plan ("QHP") through Cover Oregon or another health insurance ‎exchange. As originally written, the ACA mandated that QHPs could contract with hospitals with ‎more than 50 beds only if they meet certain patient safety requirements, including the use of a ‎patient safety evaluation system ("PSES"). The proposed rule clarifies the PSES provision and ‎defines it consistent with the Patient Safety & Quality Improvement Act, defining a PSES as "the ‎collection, management or analysis of information for reporting to or by a patient safety ‎organization (PSO)."

‎Under pressure from hospitals and systems already dealing with ACA compliance deadlines, the ‎Centers for Medicare & Medicaid Services ("CMS") proposes to delay and phase in the PSO ‎participation requirement through temporary alternatives. In phase one, CMS proposes that ‎hospitals could, in lieu of full PSO participation, qualify for QHP contracts by meeting the ‎Medicare Conditions of Participation (by being either Medicare-certified or being Medicaid-‎only). Phase one is intended to last two years or until further guidelines are issued. Most ‎commentators feel the delay is simply to give hospitals additional time to contract with a ‎certified PSO (or form their own), and does not signal an end to this patient safety and quality ‎improvement requirement.‎

The full text of the proposed rule (pertinent language begins at p. 72369) is here: http://www.gpo.gov/fdsys/pkg/FR-2013-12-02/pdf/2013-28610.pdf