Hospitals can share facilities and services according to the final CMS guidelines

A hospital may be located on the same site or even in the same building as another hospital, as long as each organization can independently meet the Medicare and Medicaid eligibility requirements under management The Centers for Medicare and Medicaid Services released this information on Friday.

This policy document answers the questions hospitals have been asking for years and gives them more leeway than under the previous federal leadership. The policy also applies to housekeeping, security, laboratories and other services in co-located facilities.

“He offers a lot of clarification and does it in a way that I think will allow our members to be really flexible in their approach here, provided they can fit the bill,” said Mark Howell, American Hospital. Senior Deputy Director of the Association for Hospital Standards and Pharmaceutical Policy.

Hospitals need to consider whether facilities used by another hospital located on their premises could compromise their Medicare and Medicaid certifications, the CMS handbook says.

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The manual states that surveyors visiting a hospital that shares a campus or property with another hospital should identify common spaces. The hospital under investigation will be cited for not adhering to the program in the common areas, but these incidents can also lead to complaints being directed to a nearby hospital.

“Surveyors are not expected to evaluate co-location sites, but rather to determine whether a surveyed hospital qualifies for hospital participation, regardless of its co-located provider,” the guide says.

Ultimate guidance is less prescriptive than draft guidelines released in May 2019. The CMS released this earlier version in response to requests from the AHA and other organizations for the agency to be clearer about its expectations regarding the sharing of premises, services and personnel between hospitals. The lack of clear guidelines at the federal level in the past has led some hospitals to abandon sharing arrangements, raising concerns about access to health care. AHA wrote CMS in 2017.

The 2019 draft guidelines were still more liberal than previous CMS co-location policies, but nevertheless mandated hospitals to have “defined and separate spaces” under their control. Clinical areas should be separate, while public spaces and paths can be shared between separate facilities. The draft also includes additional requirements for interviews and staff sharing that are not included in the final guidance.

According to Lawrence Vernaglia, partner at Foley & Lardner, hospitals that share facilities, equipment, staff, or other resources with other agencies in the same location must be prepared to meet the Medicare and Medicaid eligibility requirements.

“They now say that co-location will not be a problem as long as the certified providers manage their requirements on their own according to their terms of participation, which has always seemed reasonable to me,” Vernaglia said.

The CMS should be lenient in its application, Vernaglia said, given that policy development is not yet complete.

Management leaves key questions unanswered, Vernaglia said. The CMS does not elaborate on whether this guideline applies, for example, to medical practices located near hospitals. In policy, it is unclear how the agency will distinguish between clinical and non-clinical premises in adjacent hospitals. In addition, the CMS needs to provide more information on how critical access hospitals can collaborate with doctors.

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