Regulatory

scales of justiceMHA’s staff interacts with federal and state officials to shape the regulatory activities of many federal and state agencies. This involves analyzing rules and regulations proposed by federal and state agencies and providing comments, where appropriate.

Medicaid

Health providers participating in Missouri’s Medicaid program, known as MO HealthNet, serve the health care needs of low-income children, their parents and caregivers, as well as the health care, nursing home and in-home care needs of the elderly and disabled.

Medicare

Hospitals that serve as Medicare providers must adhere to various rules and regulations for patient care and reimbursement. The following offer guidance to hospitals to ensure their compliance with Medicare.

  • Streamlining Government Initiative
  • Federal Regulations
  • State Regulations

To ensure Missourians receive quality and affordable health care, MHA is soliciting member input on actions to streamline existing regulatory requirements, and eliminate duplicative, obsolete or unnecessary state regulatory burdens.

Tell us about any requirements that you think can be performed in a more efficient manner by emailing Ted Wedel or Daniel Landon.

MACRA

MHA Issue Brief

HHS Finalizes MACRA MIPS, APM and Criteria for Physician-Focused Payment Models

The U.S. Department of Health and Human Services announced the release of the final rule which finalizes the new payment system for Medicare clinicians.  The rule finalizes the Medicare merit-based incentive payment system, the alternative payment model incentive under the physician fee schedule and criteria for physician-focused payment models.  HHS Secretary Sylvia Burwell stated “today, we’re proud to put into action Congress’s bipartisan vision of a Medicare program that rewards clinicians for delivering quality care to their patients.  Designed with input from thousands of clinicians and patients across the country, the new Quality Payment Program will strengthen our health care system for patients, clinicians and the American taxpayer”.  CMS is providing many documents, videos and webinars about the program, including:


MIPS


APM


Emergency Preparedness Final Rule

State Operations Manual Appendix Z (6/2/2017)

The audio recording and transcript of the October 5 MLN Connects® Call on Emergency Preparedness Requirements is now available. This call discussed the new requirements in the final rule, as well as how to plan for both natural and man-made disasters, while coordinating with other emergency preparedness systems.


Section 1557 Compliance

Nondiscrimination Notices


Engaging Your Community: A Guide for Nonprofit Hospitals

As recommended by MHA’s Hospital Tax Exemption Work Group and Board of Trustees, MHA staff has completed a guide to assist nonprofit hospitals in maximizing the provision and promotion of charitable programs and services. The guide describes numerous activities that enhance a nonprofit hospital’s tax exempt status and provides guidance on creating a community benefit report to publicize investments in the community.

Working Overtime: What HR Professionals and Managers Need to Know About the Department of Labor’s New Overtime Regulations

The U.S. Department of Labor has published its much-anticipated final rule updating the Fair Labor Standards Act overtime regulations. According to the DOL, changes in the overtime regulations likely will lead to more than 4.2 million workers being reclassified as non-exempt and, therefore, eligible for overtime compensation. The DOL further estimates that the rule may directly affect more than 500,000 workers in the health care industry. This program will discuss the FLSA’s existing overtime exemptions, the changes imposed by the DOL’s new rule, and provide participants with multiple strategies for complying with the new rule. Click here for more information provided by Vincent D. Reese, Esq. with Mickes O'Toole, LLC.

MHA Quality Assurance/Performance Improvement Guide

The MHA Acute Care and Critical Access Quality Assurance/Performance Improvement Guide is designed to help key hospital leaders recognize and understand the major components of the QAPI initiative. The 58-page guide will support your organization’s quality improvement efforts. The QAPI Guide is primarily designed for professionals who are new to their current position, organization or level of responsibility.

MHA Survey Manual

The MHA Survey Manual: A Guide to the Licensing and Certification Survey Process has been created to help hospital leaders prepare for and understand the federal and state hospital survey process. The 176-page manual provides tips on how to prepare for surveys, interact with surveyors, write plans of correction and avoid or appeal adverse actions.

Nov. 19 MHA Survey Manual Webinar (Part 1) – Recording | Slides

Dec. 17 MHA Survey Manual Webinar (Part 2) – Recording | Slides

CMS Regulatory Provider Updates


MHA Self-Assessment Checklists

MHA has developed self-assessment checklists for

acute care hospitals and critical access hospitals that will aid them with their internal assessments of their compliance with state hospital licensure regulations, Medicare Conditions of Participation and the interpretative guidelines.

Medicare Conditions of Participation (CoPs)

Acute Care Hospitals

State Operations Manual Appendix A (11/20/15)

Recent Survey and Certification Memos

  • 16-21-All, CMS is clarifying requirements for providing services to justice involved individuals.  (5/3/16)
  • 16-01-Hospital, updates the interpretive guidance in Appendix A for pharmaceutical and nursing services’ conditions of participation. The revisions bring the COP guidance in alignment with current accepted standards of professional practice and updates guidance for compounded sterile operations outside of the pharmacy for medication administration. (10/9/15)

Compliance Resources


Critical Access Hospitals

State Operations Manual Appendix W (Rev 165, 12-16-16)

Recent Survey and Certification Memos
  • 17-21-All, Information to assist provider in meeting testing requirements for Emergency Preparedness regulations
  • 17-17-All, Recommendations to provider regarding cybersecurity
  • 17-10-CAHs, CAH Appendix W Revisions
  • 17-05-All, Information on implementation plans for Emergency Preparedness regulations

Compliance Resources


Life Safety Codes

State Operations Manual Appendix I (Rev 159, 09-09-16)

Recent Survey and Certification Memos
  • 17-15-LSC, Use of the Fire Safety Evaluation System
  • 17-14-LSC, Clarification of Automatic Fire Sprinkler System Installation Requirements

Psychiatric Hospitals and Units

  • Psychiatric Unit Criteria Worksheet Form CMS-437 (4/06)
  • State Operations Manual Appendix AA (10/9/15)
  • State Operations Manual Appendix N for Psychiatric Residential Treatment Facilities (12/19/14)

Outpatient Physical Therapy or Speech Pathology Services

State Operations Manual Appendix E (Rev 119, 07-25-14)

Swing Beds in Hospitals


Appendices for State Operations Manual



Quality/Regulatory Orientation Guide

MHA's Quality/Regulatory Orientation Guide is primarily designed for professionals who are new to quality improvement or regulatory compliance or new to their organization. (12/1/15)

Required Orientation and Education Crosswalk for Acute Care Hospitals — Synopsis includes requirements from state and federal agencies, as well as the Joint Commission. (3/16)

Required Orientation and Education Crosswalk for CAHs — Synopsis includes requirements from state and federal agencies, as well as the Joint Commission. (3/1/14)

State and Federal Hospital Signage Requirements Resource Guide (1/3/17)

UAP Toolkit — An overview of unlicensed assistive personnel training program requirements (2/08)

The Tobacco-Free Hospitals resource guide for creating tobacco-free hospitals is designed to assist hospitals in meeting the hospital regulations banning tobacco use.

Death Certificate Completion

March 27, 2017 Webinar – Recording | Slides

MHA Quality Assurance/Performance Improvement Guide

The MHA Acute Care and Critical Access Quality Assurance/Performance Improvement Guide is designed to help key hospital leaders recognize and understand the major components of the QAPI initiative. The 58-page guide will support your organization’s quality improvement efforts. The QAPI Guide is primarily designed for professionals who are new to their current position, organization or level of responsibility.

MHA Survey Manual

The MHA Survey Manual: A Guide to the Licensing and Certification Survey Process has been created to help hospital leaders prepare for and understand the federal and state hospital survey process. The 176-page manual provides tips on how to prepare for surveys, interact with surveyors, write plans of correction and avoid or appeal adverse actions. (2/16)

Nov. 19 MHA Survey Manual Webinar (Part 1) – Recording | Slides

Dec. 17 MHA Survey Manual Webinar (Part 2) – Recording | Slides

Missouri Hospital and Professional Licensure Rules

Hospitals Chapter 20 (7/31/14)

Rehabilitation Hospitals Chapter 22 (7/31/14)

Psychiatric Hospitals Chapter 24 (7/31/14)

Board of Pharmacy Statutes and Rules, Practice Guide