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Wyatt Client Update:  Healthcare Legal Developments

CMS Revises Hospital CoPs and Supervision Levels; Federal Court Temporarily Enjoins Medicaid MCO

     CMS Developments.  The Centers for Medicare & Medicaid Services (CMS) recently published two final rulings that affect hospitals participating in Medicare and Medicaid.

     Hospital Governing Board Members.  Based on the first significant review in more than 25 years, the Conditions of Participation (CoPs) have been revised to allow a multi-hospital system to operate under a single governing board, in contrast to the previous requirement that each hospital have its own board.  This change reflects common current practice, and helps promote more cohesive and efficient management and oversight.  CMS has added a new requirement, however, that hospitals have at least one member of the medical staff on the governing board, in order to facilitate continuity and communication between the staff and the board, and to promote quality.  AHA has applauded the review of the CoPs and most of the final revisions, but has taken issue with the requirement for a medical staff member to be on the hospital board.  AHA argued that this membership requirement was not included in the proposed changes, so there was no opportunity for comment, and that some hospitals may find it difficult or impossible to comply.  CMS has responded that it will reconsider the rule.  The changes to the CoPs, excluding the hospital board member requirement, take effect July 16, 2012.  Click here to read the CMS issuance.

     Supervision of Outpatient Therapeutic Services.  In another final ruling, effective July 1, CMS revised the supervision levels for certain hospital outpatient therapeutic services, the majority of which are mental health services.  Under this rule, the supervision requirement for these services is reduced from direct supervision to general supervision.  CMS agreed with an independent advisory review panel commissioned to review these codes that the services as revised will ensure appropriate quality and safety for the patients who receive them. Click here to read the CMS guidance.  

     Federal Court Injunction in Favor of Kentucky Hospital.  Click here to read the federal court decision in the temporary injunction sought by Appalachian Regional Healthcare, Inc. (ARH) against Kentucky Medicaid MCO Coventry Cares.  Wyatt is pleased to have been a part of this victorious and courageous effort of ARH.