Regulation of hospitals, granting rule-making authority, and requiring the exercise of rule-making authority. (FE)

These federal regulations are known as the federal conditions for Medicare participation for hospitals (COP). Certain hospitals designated as "critical access hospitals" pursuant to federal law operate under a different COP.

This bill generally provides that, effective July 1, 2016:

1. DHS must use and enforce the COPs as the minimum standards that apply to hospitals. DHS must interpret the COPs using guidelines adopted by CMS, unless DHS determines that a different interpretation is reasonably necessary to protect public health and safety.

2. DHS may not, except as described below, enforce certain administrative rules pertaining to hospitals that were promulgated by DHS that are currently in effect, including rules pertaining to management of hospitals, hospital medical staff, and required services in hospitals.

3. DHS must, within the scope of its rulemaking authority, promulgate rules to repeal and recreate its current rules pertaining to hospitals. Upon promulgation of a rule to repeal and recreate its current rules pertaining to hospitals, the prohibition against enforcement of DHS's rules no longer applies.

The bill also eliminates a restriction in current law providing that nothing in DHS's rules or standards for hospitals may pertain to a person licensed to practice medicine and surgery or dentistry.

Other changes to laws regulating hospitals The bill makes other changes to the laws regulating hospitals. Significant changes to current law in the bill include the following:

1. Current law provides that the building codes and construction standards of the Department of Safety and Professional Services (DSPS) apply to all hospitals.

Current law also allows DHS to promulgate and adopt rules and standards for the construction of hospitals, but provides that DHS may adopt additional construction codes and standards for hospitals only if they are not lower than the requirements of DSPS.

The bill retains the provision providing that the building codes and construction standards of DSPS apply to all hospitals, but provides that they apply only to the extent that they are not incompatible with any building codes or construction standards required by the COPs. The bill retains the authority for DHS to promulgate and adopt rules and standards for the construction of hospitals, but eliminates the specific restriction on that authority described above.

2. Under current law, DHS must conduct plan reviews of all capital construction and remodeling projects of hospitals to ensure that the plans comply with building code requirements in the laws administered by DSPS and with physical plant requirements for hospitals. Also under current law, DHS must promulgate rules that establish a fee schedule for its services in conducting the plan reviews described above. The schedule may not, however, set the fees at levels that are higher than certain specified amounts.

This bill retains the requirement that DHS conduct plan reviews of all capital construction and remodeling projects of hospitals and retains the authority of DHS to promulgate rules establishing a fee schedule for the plan reviews, but eliminates the restrictions on amounts in the fee schedule.

3. Current DHS rules require the governing body of a hospital to establish a policy that requires every patient to be under the care of a licensed physician, dentist, or podiatrist. The policy must, under those rules, provide that a person may be admitted to a hospital only on the recommendation of a physician, dentist, or podiatrist, with a physician designated to be responsible for the medical aspects of care.

Also, under current law, a hospital that admits patients for treatment of mental illness may grant to a psychologist who is listed or eligible to be listed in the National Register of Health Services Providers in Psychology or who is certified by the American Board of Professional Psychology an opportunity to obtain hospital staff privileges to admit, treat, and discharge patients. If a hospital grants a psychologist hospital staff privileges, the psychologist or the hospital must, prior to or at the time of hospital admission of a patient, identify an appropriate physician with admitting privileges at the hospital who shall be responsible for the medical evaluation and medical management of the patient for the duration of his or her hospitalization.

The bill provides that a hospital may afford any practitioner the opportunity to be a member of the hospital staff and obtain hospital staff privileges if the membership or privileges are not otherwise prohibited and the membership or privileges are consistent with the practitioner's scope of practice.

The bill repeals the provisions in current law that specifically address the granting of hospital staff privileges to psychologists.

4. Under current law, the secretary of health services or his or her designee (secretary) may grant a variance to a statute affecting hospitals or a rule of DHS affecting hospitals if all of the following apply: 1) the secretary determines that a disaster, as defined under the emergency management law, has occurred; 2) a hospital has requested the variance; and 3) the secretary determines that the variance is necessary to protect the public health, safety, or welfare. Such a variance must be for a stated term not to exceed 90 days, except that the secretary may extend the variance upon request by the hospital if the secretary determines that an extension is necessary to protect the public health, safety, or welfare.

This bill makes the following changes with respect to variances affecting hospitals: 1) eliminates the requirement that, in order to grant a variance, the secretary determine that a disaster has occurred; 2) eliminates the requirement that a variance be for a limited term unless extended; 3) also allows a variance to be granted for the purpose of supporting the efficient and economic operation of a hospital; 4) expands the scope of the secretary's authority to any other requirement for hospitals, such as the COP; and 5) allows the secretary to grant a waiver, in addition to granting a variance, from the requirements for hospitals.

5. The bill provides that a hospital accredited by an approved national accrediting organization is exempt from routine inspections and investigations to determine compliance with, and is considered to be in compliance with, the requirements for hospitals. The bill provides, however, that this exemption does not extend to plan reviews conducted by DHS of capital construction and remodeling projects of hospitals, and provides that DHS may inspect an accredited hospital to investigate a complaint or comply with a request by CMS, including a request to validate the findings of the accrediting organization.