CMS has issued revised conditions of participation standards and site review guidelines affecting physician supervision of nurse midwives, patient grievance procedures, availability of emergency laboratory services and responsibility for therapeutic diet orders.

Nurse midwives:

In states that allow nurse midwives to admit patients to hospitals, the new provisions clarify that the rules requiring physician supervision apply only to Medicare admissions by midwives.

Grievance procedures:

Defines grievances as a written or verbal complaint regarding patient care, abuse, neglect, or issues reference to CMS Conditions of Participation (CoP's) or a Medicare billing complaint under 42 CFR section 489 that is not resolved on the spot. A written complaint is always considered a grievance under this rule.

Patient satisfaction surveys do not consitute a grievance unless a written complaint is attached. Comments on the form do not have to be considered grievances, but may be treated as such by the hospital.

Data on grievances must be incorporated into the hospital's quality assessment and performance improvement program (QAPI).

The Board of the hospital is responsible for approving the grievance process and for effective operation of the process. The board must review and resolve grievances unless it delegates that function to a committee comprised of sufficient members to review, resolve, and respond to grievances consistent with the hospital's written plan.

Grievances must also address complaints of premature discharge and provide referral to the appropriate QIO.

Grievance response requirements are now stated as "average time frame of 7 days" rather than requiring EVERY grievance to be resolved within 7 days. (Data on average length of response will be needed to establish this average on a monthly basis.) If the resolution will take longer than 7 days, the hospital must inform the patient or patient's reprsentative of the delay and anticipated period for completion.

In responses, the hospital must provide adequate information to address each stated item of the complaint. The hospital does not have to provide the patient with exhaustive detail of every action taken to investigate or resolve the complaints, but CMS will require evidence of all compliance efforts. The response to the patient does not have to include statements that might be used in a legal action against the hospital. All grievances must receive a written response.

Lab Services:

Hospital lab services must be adequate to meet the needs of patients at each location of the hospital.

The hospital must provide onsite emergency laboratory services on each site or location and provide collection, processing, and reesults to meet the patient's emergency laboratory needs. In a hospital with multiple campuses, emergency laboratory services must be available onsite 24/7 at each campus, consistent with the scope and complexity of the hospital operation at each site and state and federal standards.

FULL TEXT: http://www.medlaw.com/cops82305.pdf