CMS Credentialing Update December 1 2020 CMS Update

CMS Credentialing Update +December 1, 2020 CMS Update – COVID-19 – 1135 Blanket Waivers still in effect (retroactive date March 1, 2020) +Medical Staff – waiving 42 CFR 482. 22(a)(1)-(4) to address workforce concerns related to COVID-19 +Allows physicians to continue to practice at hospitals after privileges expire +Allows new physicians to practice before full medical staff/governing body approval

CMS Credentialing Update +Telemedicine – waiving 42 CFR 482. 12(a)(8 -9) for hospitals. Makes it easier for telemedicine services to be furnished to patients through an agreement with an off-site hospital. +Physician Services – waiving 42 CFR 482. 12(c)(1 -2), (c)(4) which requires Medicare patients to be under care of physician. Allows hospitals to use other practitioners to the fullest extent possible during pandemic – must be consistent with state emergency preparedness or pandemic plan

CMS Credentialing Update +Anesthesia Services – waiving 42 CFR 482. 52(a)(5), 485. 639(c)(2) and 416. 42(b)(2) that requires a CRNA to be under supervision of physician. Supervision is at discretion of hospital and state law – must be consistent with state emergency preparedness or pandemic plan +Other – Telehealth eligibility, EMTALA, Verbal Orders, Medical Records, QAPI, etc.

HFAP Credentialing Update +2020 - HFAP joined ACHC (Accreditation Commission for Health Care) +ACHC has CMS deeming authority for home health, hospice, renal dialysis, DMEPOS, and home infusion therapy. +HFAP has CMS deeming authority for hospitals, ASC’s, CAH and clinical laboratories. +HFAP will operate as a brand within ACHC and collectively the organization will be known as ACHC

HFAP Credentialing Update +2020 revision to HFAP hospital standards based on September 2019 CMS Final Rules which were effective May 2020 +Standard 03. 01. 15 – Required App and Reap – +(A) Licensure History – added NP and PA’s, a collaborative agreement or supervisory agreement is required +(G) revised - Healthcare History of Hospital Employment and Affiliations+added to (1) Healthcare employment “history of hospital-employed physicians and non-physician practitioners”

HFAP Credentialing Update +Expanded (2) “History of medical staff appointments and affilitations where privileges have been granted” Required Elements: (A) PSV – “Evidence of current collaborative agreement for NP, or supervisory agreement for PA, with a physician that has the same privileges requested” (G) “Verification of employment history for hospital employed physicians and non-physician practitioners”

HFAP Credentialing Update +(H) References from at least one “but preferably three peers”…. . ”With initial apps, references should be obtained from Res Dir or Dept Chair” +(I) Clinical Activity – added “fellowship program” +Added “(K) Meeting attendance is evaluated at time of reappointment against the requirements of the medical staff bylaws” +Retired 3. 10. 06 – Meeting frequency and attendance

HFAP Credentialing Update +Expanded 3. 15. 02 – FPPE – defined Indications (1. all initial privileges, (2) all new privileges, (3) unacceptable levels of performance or quality of care concerns) +Required Elements – +Added “The individual is provided written notification of the FPPE with a copy in the individuals credential file”

CIQH Review +Center for Improvement in Healthcare Quality (CIQH) +Established in 1999 received CMS deeming authority in 2013 +Standards mirror COP’s but CIQH has developed additional standards to address gaps in COP’s and CMS Interpretive Guidelines +Accreditation designed to assure hospitals comply with COP’s +Currently accredit 113 Hospitals ( TX, LA, AR, SD, DC, NV, GA, IN, AZ, CA, KY, OK, PA, MA, IA, NE, ID, TN, MO, FL, PR, ND, OH, KS)

CIQH Review +Accredits Acute Care Hospitals, Free Standing Emergency Centers, Congregate Living Health Facilities, and Urgent Care Centers +Offer 7 Center of Excellence Programs +Partnered with Accreditation Resource Services (ARS) to offer web-based and on-site consulting services. Over 500 hospitals utilize their services +Offer 6 Disease Specific Certifications

CIQH Review +Offer – Professional Certification Program +Healthcare Accreditation Certification Program (HACP) – demonstrates you’re an expert in accreditation and regulatory standards with a broad knowledge of the Medicare COP’s for acute care hospitals. 1000+ have achieved HCAP certification.

QUESTIONS? ? + Janet L Wilson, BS, FMSP, CPMSM, CPCS + JLWilson Med. Staff Consulting + jlwilson 2019@aol. com + 816 -914 -2029