CMS Proposes to Reform Conditions of Participation

The Centers for Medicare & Medicaid Services (CMS) on Nov. 10 proposed the Cutting Administrative Requirements for Excellence (CARE) in Patient Care rule, which aims to reduce administrative burden without impeding quality of care. The rule reforms several regulations for hospitals, critical access hospitals, rural emergency hospitals, long-term care facilities, and intermediate care facilities for individuals with intellectual disabilities.

CMS proposes the following:

Hospitals

• Remove the staff training requirements for transfer protocols and emergency services readiness (both currently effective), and obstetric (OB) care (otherwise effective Jan. 1, 2027).
• Remove the OB care-specific Quality Assessment and Performance Improvement (QAPI) requirements (otherwise effective Jan. 1, 2027).
• Establish new patients' rights requirements related to birth tissue collection by hospitals that provide OB care, including standards for informed consent and policies and procedures to support families requesting birth tissue for cultural, religious, or personal reasons.
• Remove the requirement that patient care areas have access to natural light and ventilation through exterior windows and doors for hospitals, CAHs, and other providers with similar regulations.

Critical Access Hospitals (CAHs)

• Remove the staff training requirements related to emergency services readiness (currently effective) and OB care (otherwise effective Jan. 1, 2027).
• Remove the OB care-specific QAPI requirements (otherwise effective Jan. 1, 2027).
• Establish new patients' rights requirements related to birth tissue collection by CAHs that provide OB care services, including standards for informed consent and policies and procedures to support families requesting their birth tissues for cultural, religious, or personal reasons.
• Revise regulations to clarify current CMS policy that CAH distance eligibility determinations are based on proximity to hospitals that provide acute-care inpatient services or another CAH
• Implement new statutory requirements to allow CAHs that meet certain qualifying criteria, as defined by the statute, to be exempt from the distance eligibility requirements

Rural Emergency Hospitals (REHs)

• Remove expired COVID-19 and seasonal influenza reporting requirements related to ongoing data reporting and staff vaccination
• Remove REH data reporting requirements during a public health emergency

CMS also solicits comments on:

• Strategies to minimize burden for hospitals and CAHs to comply with ongoing respiratory illness and public health emergency infectious illness data reporting requirements.
• Approaches to allow flexibility for providers regarding the requirement for physician supervision of certified registered nurse anesthetists
• Revising criteria for transplant program initial certification to reduce barriers to entry for new transplant programs while maintaining patient safety and ensuring program competence

Comments are due Jan. 11, 2027.

Contact Director of Policy Rob Nelb, MPH, at [email protected] or 202.585.0127 with questions.