REGULATORY REVIEW


(a) Standard: Patient assess- ment and admission. (1) The ASC must develop and maintain a policy that identifies those patients who require a medical history and physi- cal examination prior to surgery. The policy must


(i) Include the timeframe for med- ical history and physical examination to be completed prior to surgery. (ii) Address, but is not limited to, the following factors: patient age, diagnosis, the type and number of procedures scheduled to be per- formed on the same surgery date, known comorbidities and the planned anesthesia level. (iii) Follow nationally recognized standards of practice and guidelines, and applicable State and local health and safety laws.


(2) Upon admission, each patient


must have a pre-surgical assessment completed by a physician who will be performing the surgery or other qualified practitioner in accordance with applicable State health and safety laws, standards of practice, and ASC policy. (3) The pre-surgical assessment must include documentation of any allergies to drugs and biologicals. (4) The patient’s medical history


and physical examination (if any) must be placed in the patient’s medical record prior to the surgical procedure. All pre-surgical assessments


would need to include documenta- tion regarding any allergies to drugs and biologicals. The proposal would also require that the medical history and physical examination (H&P), if completed, be placed in the patient’s medical record prior to the surgi- cal procedure. Many states may continue to require an H&P even if this proposal were to be finalized as drafted.


cate how the ASC plans to coordi- nate with them, but facilities would no longer need to document their efforts once they have reached out to officials.


■■


Training requirement changed from every year to every two years (or when EP is significantly updated). New employees still must receive training when they are onboarded.


■■


Outpatient providers would need only one testing exercise per year instead of two. ●■


Providers


CMS estimates that these proposed changes would collectively save health care providers an estimated $1.12 billion annually. If finalized, three of these proposals would bring significant changes to the Conditions for Coverage.”


— Kara Newbury, ASCA ●■


Emergency Preparedness CMS also proposed several changes to the emergency preparedness requirements that went into effect in November 2017. The following are proposals that apply to ASCs: ■■


must participate in


either a community-based full- scale exercise (if available) or conduct an individual facility- based functional exercise every other year, and


●■


In the opposite years may con- duct a testing exercise of their choice, which may include: a community-based full-scale exer- cise (if available), an individual facility-based functional exer- cise, a drill, or a tabletop exercise or workshop that includes a group discussion led by a facilitator.


Review and update of Emergency Plan (EP) and the policies and pro- cedures that are implemented by the facility in response to the EP every two years. This includes updates to the facility’s communi- cations plan. The current require- ment is for an annual review of all components.


■■


Elimination of the requirement that facilities document efforts to contact local, tribal, regional, state and federal EP officials. A facil- ity’s EP would still need to indi-


Providers are exempt from the next required exercise after an event requiring activation of EP plan (i.e., after a facility responds to an actual emergency) The comment period for this pro- posed rule closed on November 19, 2018. Unlike Medicare’s payment rules, this rule does not have to be finalized by any set date. ASCA will keep members updated throughout the process, and let you know what changes are finalized and when ASCs must implement changes. These proposals could be adopted one, two or three years from now, so stay tuned and check the email messages you get from ASCA and ASCA’s website regularly.


Kara Newbury is ASCA’s regulatory counsel. Write her at knewbury@ascassociation.org.


ASC FOCUS JANUARY 2019 | ascfocus.org 29


Page 1  |  Page 2  |  Page 3  |  Page 4  |  Page 5  |  Page 6  |  Page 7  |  Page 8  |  Page 9  |  Page 10  |  Page 11  |  Page 12  |  Page 13  |  Page 14  |  Page 15  |  Page 16  |  Page 17  |  Page 18  |  Page 19  |  Page 20  |  Page 21  |  Page 22  |  Page 23  |  Page 24  |  Page 25  |  Page 26  |  Page 27  |  Page 28  |  Page 29  |  Page 30  |  Page 31  |  Page 32  |  Page 33  |  Page 34  |  Page 35  |  Page 36  |  Page 37  |  Page 38