- Hospital Transfer Agreements/Admitting Privileges: This requirement has been removed from the ASC Conditions for Coverage (CfCs) effective November 29, 2019, and is replaced with a requirement that ASCs provide written notice to a local hospital as to their “operation and patient population served.” In the rule, CMS goes on to say, “For example, the notice would include details such as hours of operation and the procedures that are performed in the ASC.” ASCA staff has received questions as to whether a hospital agreement would “count” for this new written notice requirement. CMS staff had not contemplated this idea but agreed with ASCA that if the transfer agreement contains the information required in the written notice (hours of operation and population served in the ASC), it would count. ASCA told CMS there was confusion as to how much detail facilities would need to go into (such as, is a list of specialties sufficient or is a specific procedure list needed). ASCA supported keeping the requirement simple with just a list of specialties served. CMS acknowledged the concerns and further guidance is anticipated in the updated State Operations Manual Appendix L in the future.
- Medical History & Physical Assessment (H&P): Effective November 29, 2019, CMS has eliminated the requirement at § 416.52(a) for each patient to have a medical history and physical assessment completed by a physician not more than 30 days before the scheduled surgery and replaced it with the requirement for ASCs to develop and maintain a policy that identifies those patients who require a medical history and physical examination prior to surgery. This policy must be based on “nationally recognized standards of practice and guidelines, and applicable state and local health and safety laws.” ASCA staff raised concerns with the “nationally recognized standards” language and asked that CMS clarify what may meet this requirement. It is important to note that many states and accrediting organizations still require an H&P for all patients.
As a reminder, accrediting organizations and states can require more than CMS. ASCA’s Government Affairs team has crafted two one-page briefs detailing existing state requirements for both H&Ps and transfer agreements and admitting privileges. These briefs were created through a survey of state administrative rules and statutes across the country and represent the most complete and verifiable information ASCA could obtain on existing state requirements. The briefs include a categorization of state laws and regulations covering each issue, as well as a map graphic visualizing where the states stand on H&Ps and transfer agreements and admitting privileges. ASCA members may access these resources on ASCA’s website. Write Stephen Abresch with any questions regarding these resources, as well as questions regarding specific state requirements.
If you have questions, write Kara Newbury.