Latest Updates in Credentialing and Accreditation Standards

CMS/HFAP Credentialing Updates CIHQ Overview Janet Wilson, BS, FMSP, CPCS, CPMSM JLWilson MedStaff Consulting

CMS Credentialing Update +December 1, 2020 CMS Update COVID-19 1135 Blanket Waivers still in effect (retroactive date March 1, 2020) +Medical Staff waiving 42 CFR 482.22(a)(1)-(4) to address workforce concerns related to COVID-19 +Allows physicians to continue to practice at hospitals after privileges expire +Allows new physicians to practice before full medical staff/governing body approval

CMS Credentialing Update +Telemedicine waiving 42 CFR 482.12(a)(8-9) for hospitals. Makes it easier for telemedicine services to be furnished to patients through an agreement with an off-site hospital. +Physician Services waiving 42 CFR 482.12(c)(1-2), (c)(4) which requires Medicare patients to be under care of physician. Allows hospitals to use other practitioners to the fullest extent possible during pandemic must be consistent with state emergency preparedness or pandemic plan

CMS Credentialing Update +Anesthesia Services waiving 42 CFR482.52(a)(5), 485.639(c)(2) and 416.42(b)(2) that requires a CRNA to be under supervision of physician. Supervision is at discretion of hospital and state law must be consistent with state emergency preparedness or pandemic plan +Other Telehealth eligibility, EMTALA, Verbal Orders, Medical Records, QAPI, etc.

HFAP Credentialing Update +2020 - HFAP joined ACHC (Accreditation Commission for Health Care) +ACHC has CMS deeming authority for home health, hospice, renal dialysis, DMEPOS, and home infusion therapy. +HFAP has CMS deeming authority for hospitals, ASC s, CAH and clinical laboratories. +HFAP will operate as a brand within ACHC and collectively the organization will be known as ACHC

HFAP Credentialing Update +2020 revision to HFAP hospital standards based on September 2019 CMS Final Rules which were effective May 2020 +Standard 03.01.15 Required App and Reap +(A) Licensure History added NP and PA s, a collaborative agreement or supervisory agreement is required +(G) revised - Healthcare History of Hospital Employment and Affiliations- +added to (1) Healthcare employment history of hospital-employed physicians and non-physician practitioners

HFAP Credentialing Update +Expanded (2) History of medical staff appointments and affilitations where privileges have been granted Required Elements: (A)PSV Evidence of current collaborative agreement for NP, or supervisory agreement for PA, with a physician that has the same privileges requested (G) Verification of employment history for hospital employed physicians and non-physician practitioners

HFAP Credentialing Update +(H) References from at least one but preferably three peers .. With initial apps, references should be obtained from Res Dir or Dept Chair +(I) Clinical Activity added fellowship program +Added (K) Meeting attendance is evaluated at time of reappointment against the requirements of the medical staff bylaws +Retired 3.10.06 Meeting frequency and attendance

HFAP Credentialing Update +Expanded 3.15.02 FPPE defined Indications (1. all initial privileges, (2) all new privileges, (3) unacceptable levels of performance or quality of care concerns) +Required Elements +Added The individual is provided written notification of the FPPE with a copy in the individuals credential file

CIQH Review +Center for Improvement in Healthcare Quality (CIQH) +Established in 1999 received CMS deeming authority in 2013 +Standards mirror COP s but CIQH has developed additional standards to address gaps in COP s and CMS Interpretive Guidelines +Accreditation designed to assure hospitals comply with COP s +Currently accredit 113 Hospitals ( TX, LA, AR, SD, DC, NC, NV, GA, IN, AZ, CA, KY, OK, PA, MA, IA, NE, ID, TN, MO, FL,PR,ND,OH,KS)

CIQH Review +Accredits Acute Care Hospitals, Free Standing Emergency Centers, Congregate Living Health Facilities, and Urgent Care Centers +Offer 7 Center of Excellence Programs +Partnered with Accreditation Resource Services (ARS) to offer web-based and on-site consulting services. Over 500 hospitals utilize their services +Offer 6 Disease Specific Certifications

CIQH Review +Offer Professional Certification Program +Healthcare Accreditation Certification Program (HACP) demonstrates you re an expert in accreditation and regulatory standards with a broad knowledge of the Medicare COP s for acute care hospitals. 1000+ have achieved HCAP certification.

QUESTIONS?? + Janet L Wilson, BS, FMSP, CPMSM, CPCS + JLWilson MedStaff Consulting + jlwilson2019@aol.com + 816-914-2029