On October 19, CMS released two proposed rules and one final rule with the aim of implementing President Obama’s January 18, 2011, Executive Order to reduce regulatory burdens and expenses. The final rule changes the condition for coverage (CfC) regarding patient rights in ambulatory surgical centers (ASCs). The CfC previously had prohibited ASCs from scheduling patients for surgery on the same day they received required patient rights notifications except in emergency situations. The CfC now will permit ASCs to provide the written notice any time before the start of the surgical procedure. The final rule, which is expected to save ASCs $50 million in the first year, will become effective December 23, 2011.

The first of two proposed rules would simplify and eliminate some existing Medicare conditions of participation (CoPs) that CMS believes are unnecessarily burdensome for hospitals and critical access hospitals (CAHs). Notably, CMS proposes to eliminate the longstanding requirement that health systems maintain a separate governing board for each hospital facility. Other changes include allowing a hospital to appoint more than one director of outpatient services, clarifying that certain nonphysician practitioners may be granted privileges even if they are not members of the medical staff (within the bounds of state law) and allowing hospitals to integrate a patient’s nursing plan into his or her interdisciplinary care plan. The proposed rule also would allow CAHs to secure laboratory and radiology services under arrangement rather than requiring these services to be provided in house. CMS estimates that the changes to the CoPs could save hospitals $900 million in the first year and “many billions” in future years.

The second proposed rule would modify and delete a variety of existing regulations that CMS has determined are excessively burdensome and costly for providers. CMS proposes to eliminate the CfC for certain end stage renal disease providers that requires compliance with life safety code standards, including structural measures for fire safety. CMS reasons that low-risk dialysis centers are very unlikely to experience a fire, and the changes could save providers $108.7 million. The proposed rule also would allow ASCs to determine what emergency equipment is appropriate for its particular patient population, a change from the outdated list of equipment in the current CfCs that has not been modified since 1982. Also of note, the proposed rule would eliminate the regulation that automatically deactivates physician and nonphysician practitioners’ billing privileges after 12 months without a claim submission.