On Thursday, February 7, 2013, the U.S. Department of Health and Human Services Centers for Medicare and Medicaid Services (“CMS”) released a proposed rule that reforms a number of Medicare regulations. The proposed rule is in response to the President’s Executive Order instructing federal agencies to reduce outdated and unnecessary rules that divert resources and promote inefficiency.

The proposed rule aims to increase the ability of health care entities to devote resources to providing high quality patient care by modifying Conditions of Participation (“CoPs”) and Conditions for Coverage (“CfCs”) and redirecting these resources for patient care. The proposed rule affects many entity types. Some of the major provisions include:

• Reducing the requirements for Ambulatory Surgery Centers (“ASCs”) to provide radiological services. In the preamble, CMS notes “ASCs are currently subject to the full hospital requirements for radiology services even though they are only permitted to perform limited radiological services.” The proposed rule modifies supervision requirements for radiologic services and sets forth oversight responsibilities for ASC governing bodies for radiologic services;
• Critical Access Hospitals (“CAHs”) are no longer required to engage at least one person who is not a member of the CAH staff to develop patient care policies;
• CAHs, Rural Health Clinics (“RHCs”), and Federally Qualified Health Centers (“FQHCs”) are no longer required to staff a physician onsite at least once every 2 weeks;
• Redefining the meaning of “physician” for RHCs and FQHCs to the following:

1. A doctor of medicine or osteopathy legally authorized to practice medicine and surgery by the State in which the function is performed; and
2. Within limitations as to the specific services furnished, a doctor of dentistry or dental or oral surgery, a doctor of optometry, a doctor of podiatry or surgical chiropody or a chiropractor

• Hospitals providing swing-bed services are no longer required to undergo a separate survey to determine compliance with swing-bed requirements. Instead, accreditation organizations such as The Joint Commission, can determine compliance during routine surveys;
• Hospitals and CAHs are no longer required to have a medical staff member on the hospital’s governing body. Instead, the hospital’s governing body must “directly consult” with the head of the medical staff, or his or her designee;
• Clarifying that doctors, other than doctors of medicine or osteopathy, may be part of the medical staff and that non-physician practitioners, such as physician assistants and PharmDs, may be part of the medical staff;
• Practitioners, acting within the scope of his or her scope of practice under state law, may order outpatient hospital services even if the particular practitioner does not have privileges at that particular hospital. The hospital’s medical staff and governing body must determine which types of outpatient services these practitioners may order; and
• Revising requirements for food and dietetic services, nuclear medicine services, and transplant centers.

Interested parties may submit comments to CMS regarding the proposed rule until April 8, 2013.