CMS Advances ‘Patients over Paperwork’ Initiative Under Final Rule

October 2019 ~

On September 26, 2019, CMS issued The Omnibus Burden Reduction (Conditions of Participation) Final Rule, which advances the ‘Patients over Paperwork’ initiative aimed at reducing administrative costs in healthcare.

According to the press release from CMS, the final rule will strengthen patient safety by removing unnecessary, obsolete, or excessively burdensome health regulations on hospitals and other healthcare providers and could reduce inefficiencies to help providers deliver value, high-quality care and better outcomes for patients at the lowest cost.

The Omnibus Burden Reduction rule finalizes the provisions of three distinct proposed rules, each of which was originally published separately. CMS says that finalizing the three proposals in one final rule allows for administrative efficiency as well as promotes transparency. These rules are:

  • Regulatory Provisions to Promote Program Efficiency, Transparency, and Burden Reduction (“Omnibus Burden reduction”), published September 20, 2018;
  • Hospital and Critical Access Hospital (CAH) Changes to Promote Innovation, Flexibility, and Improvement in Patient Care, published June 16, 2016; and
  • Fire Safety Requirements for Certain Dialysis Facilities, published November 4, 2016.

As seen in the CMS fact sheet, each of the proposed rules includes reforms to Medicare regulations that are identified as unnecessary, obsolete, or excessively burdensome on health care providers and suppliers. The final rule would reduce the burden for participating providers and suppliers in the following ways:

Emergency Preparedness

  • Emergency program: Decreases the requirements for facilities to conduct an annual review of their emergency program to a biennial review.  NOTE: based on industry feedback, long term care (LTC) facilities will continue to review their emergency program annually.
  • Emergency plan: Eliminates the requirement that the emergency plan include documentation of efforts to contact local, tribal, regional, state, and federal emergency preparedness officials and a facility’s participation in collaborative and cooperative planning efforts;
  • Training: Decreases the training requirement from annually to every two years. NOTE: Nursing homes will still be required to provide annual training.
  • Testing (for inpatient providers/suppliers): Increases the flexibility for the testing requirement so that one of the two annually-required testing exercises may be an exercise of the facility’s choice; and
  • Testing (for outpatient providers/suppliers): Decreases the requirement for facilities to conduct two testing exercises to one testing exercise annually.


  • Allows multi-hospital systems to have unified and integrated Quality Assessment and Performance Improvement (QAPI) programs and unified and integrated infection control and antibiotic stewardship programs for all of their member hospitals;
  • Removes the requirement for a hospital’s medical staff to attempt to secure autopsies in all cases of unusual deaths and of medical-legal and educational interest.
  • Allows hospitals the flexibility to establish a medical staff policy describing the circumstances under which a pre-surgery/pre-procedure assessment for an outpatient could be utilized, instead of a comprehensive medical history and physical examination; and
  • Psychiatric hospitals: finalizes the clarification of the requirement to allow the use of non-physician practitioners and doctors of medicine/doctors of osteopathy (MD/DOs) to document progress notes of patients receiving services in psychiatric hospitals.

Hospital Swing-bed Providers, Critical Access Hospitals, Rural Health Centers, and Federally Qualified Health Centers

  • Hospital and CAH swing-bed providers:
    • Removes the requirement for a facility to request or allow swing-bed patients to perform services for the facility;
    • Removes the requirement for the facility to provide an ongoing activities program that is directed by a qualified professional because the patient’s activity needs are addressed in the nursing care plan;
    • Removes the requirement for facilities with more than 120 beds to employ a qualified social worker on a full-time basis because of the hospital swing-bed and CAH bed limit requirements; and
    • Removes the requirement for facilities to assist residents in obtaining routine and 24-hour emergency dental care because of the existing requirement for hospitals and CAHs to provide care in accordance with the needs of the patient (emergent and non-emergent).
  • CAHs:
    • Reduces the frequency that is currently required for CAHs to perform a review of all their policies and procedures; and
    • Removes the duplicative requirement for CAHs to disclose the names of people with a financial interest in the CAH.
  • RHCs and FQHCs:
    • Reduces the frequency of review of the patient care policies and facility evaluation from annually to every two years.

Ambulatory Surgical Centers

  • Reduces burden for ASCs by removing the provisions requiring ASCs to have a written transfer agreement with a hospital that meets certain Medicare requirements or ensuring that all physicians performing surgery in the ASC have admitting privileges in a hospital that meets certain Medicare requirements. Instead, ASCs will be required to periodically provide the local hospital with written notice that outlines the ASC operation and patient population served by the ASC facility.  All ASCs must continue to have an effective procedure for immediate transfers to a hospital for patients requiring emergency medical care beyond the capabilities of the ASC; and
  • Removes the current requirements that a physician or other qualified practitioner conducts a complete comprehensive medical history and physical assessment on each patient not more than 30 days before the date of the scheduled surgery. Additionally, CMS is finalizing the requirement that each ASC establishes and implements a policy that identifies patients who require an H&P prior to surgery.

Transplant Centers

  • Updates the terminology used in the regulations to conform to the terminology that is widely used and understood within the transplant community, thereby reducing provider confusion; and
  • Removes the requirement for transplant centers to submit clinical experience, outcomes, and other data in order to obtain Medicare re-approval. NOTE: CMS will continue to monitor and assess outcomes and quality of care in transplant programs after initial Medicare approval.

Home Health

  • Removes the requirement that the Home Health Agency (HHA) conduct a full competency evaluation of a home health aide when deficiencies are identified in aide services, and replacing it with a requirement to retrain the aide regarding the identified deficient skill(s), and requiring the aide to complete a competency evaluation related only to those skills; and
  • Limits the requirements for verbal (meaning spoken) notification of all patient rights to those rights related to payments made by Medicare, Medicaid, and other federally funded programs, and for potential patient financial liabilities, as specified in the Social Security Act. NOTE: HHAs will still be required to provide written notice of all patient rights to all HHA patients.


  • Allows hospices to defer to State licensure requirements for qualification of their hospice aides, regardless of the State licensure content or format, thus allowing states to set forth training and competency requirements that meet the needs of their populations.
  • Removes the prescriptive requirement that hospices must consult with an individual with expertise in drug management in addition to the hospice’s own expert clinicians; and
  • Hospices providing care to residents of a Skilled Nursing Facility or Intermediate Care Facilities for Individuals with Intellectual Disabilities: requires hospices to work with their chosen Skilled Nursing Facility and intermediate care facility partners to educate facility staff about the hospice philosophy of care and specific hospice practices.

Comprehensive Outpatient Rehabilitation Facilities

  • Reduces the frequency of the implementation of a utilization review plan from four times per year to annually, which will allow an entire year to collect and analyze data to inform changes to the facility and the services provided.

Community Mental Health Centers

  • Removes the requirement for CMHCs to update the client comprehensive assessment every 30 days for all CMHC clients and instead only retain the minimum 30-day assessment update for those clients who receive partial hospitalization program services.

Portable X-Ray Services

  • Removes the four training and education requirements, which focus on the accreditation of the school where the technologist received training, and replacing it with a streamlined qualification that focuses on the skills and abilities of the technologist; and
  • Allows for portable x-ray services to be ordered in writing, by telephone, or by electronic methods, streamlining the ordering process.

Religious Non-medical Health Care Institutions (RNHCIs)

  • Allows a more condensed and flexible discharge process by requiring RNHCIs only to provide discharge instructions to the patient and/or the patient’s caregiver when the patient is discharged home.
    • Hospital and Critical Access Hospital (CAH) Changes to Promote Innovation, Flexibility, and Improvement in Patient Care
      • Changes the term “Licensed Independent Practitioner” in the hospital Patient’s Rights CoP to “Licensed Practitioner.” \
      • Updates the hospital CoPs to specify that hospital QAPI programs must incorporate existing quality indicator data, including patient care data submitted to, or received from, quality reporting and quality performance programs.
      • Clarifies requirements for nursing services that have been ambiguous or confusing due to unnecessary distinctions between hospital inpatient and outpatient services.
      • Updates hospital requirements for infection prevention and control programs, which do not fully conform to current standards of practice for the surveillance, prevention, and control of HAIs and other infectious diseases, and also requiring that hospital programs demonstrate adherence to nationally recognized infection prevention and control guidelines for reducing the transmission of infections within their hospitals;
      • Requires hospitals to establish and maintain antibiotic stewardship programs to help reduce inappropriate antibiotic use and antimicrobial resistance.
      • Additional flexibility to the hospital CoPs by specifying that a unified and integrated infection prevention and control program may also include a unified and integrated antibiotic stewardship program for a multi-hospital system;
      • Allows registered dietitians in CAHs to order therapeutic diets for patients in accordance with State scope-of-practice laws to allow for flexibility and to produce savings in this area;
      • Requires CAHs to have infection prevention and control and antibiotic stewardship programs similar to those being finalized for hospitals; and
      • Requires CAHs to develop, implement, and maintain proactive QAPI programs.
    • Fire Safety Requirements for Certain Dialysis Facilities
      • Requirements for certain higher-risk dialysis facilities from the 2000 edition of the fire safety code to the 2012 edition of the fire safety code have also been updated. It also removes an existing obsolete requirement for facilities to comply with the 2000 edition of the fire safety code. CMS is finalizing as proposed the adoption of the 2012 editions of the NFPA 101 and 99 for dialysis facilities that do not provide one or more exits to the outside at grade level from the treatment area level.

CMS expects that the Patients over Paperwork initiative to save providers an estimated 4.4 million hours previously spent on paperwork annually, with overall total provider savings projected to be approximately $8 billion over the next 10 years.

“In my trips across the country, I’ve heard time and again that unnecessary regulations are increasing costs on providers and they are losing time with patients as a result,” said Verma in a statement on the Omnibus Burden Reduction rule. “This final rule brings a common-sense approach to reducing regulations and gives providers more time to care for their patients while reducing administrative costs and improving health outcomes.”



Source(s): Modern Healthcare; HealthcareITNews;