June 3, 2022
CMS Releases Long-Awaited Updates to ASC Guidance for Surveyors
The Centers for Medicare & Medicaid Services (CMS) released a surveyor memo today that provides updates to the State Operations Manual (SOM) Appendix L - Guidance for Surveyors: Ambulatory Surgical Centers. CMS published multiple final rules over the past several years that amended the ASC Conditions for Coverage (CfC). This Advanced Copy of Appendix L makes conforming revisions to the regulatory tags and interpretive guidelines, as well as clarifications and technical corrections to other guidance areas based on stakeholder feedback.
A few key updates are highlighted below.
Medical History and Physical (H&P) Assessment
The Medicare and Medicaid Programs; Regulatory Provisions to Promote Program Efficiency, Transparency, and Burden Reduction final rule (84 FR 51732), frequently referred to as the 2019 Burden Reduction Rule, changed the H&P requirements for facilities, and the CfC now states: “The ASC must develop and maintain a policy that identifies those patients who require a medical history and physical examination prior to surgery.” While much of Appendix L had been updated to indicate that H&Ps were no longer required by CMS in all cases, some language inadvertently left in place stated that surveyors should confirm that medical records include a “comprehensive medical history and physical assessment completed not more than 30 days before the date of the surgery.” Today’s surveyor memo, on page 20, changes that language to “A medical history and physical assessment, as applicable, if required by the ASC’s policy.”
Periodic Written Notice Requirement
This requirement, also finalized in the 2019 Burden Reduction Rule, states: “The ASC must periodically provide the local hospital with written notice of its operations and patient population served.” ASCA requested CMS provide facilities with more information on how to comply with this requirement, and today’s surveyor memo on pages 38–40 adds further guidance that the ASC provide the notice upon opening of the facility and at least every 24 months “to ensure the ASC keeps the local hospital informed and up-to-date on ASC information and any pertinent patient population changes.” The memo also provides guidance on what the notice must include and how it should be communicated (through the mail or electronically).
Today’s memo also adds language to the Interpretive Guidelines for 42 CFR §416.47(b) Standard: Form and Content of Record clarifying that the patient or the patient’s representative must sign informed patient consents. On page 59, the memo states: “Documentation of a properly executed informed patient consent that is signed by the patient or, if applicable, the patient’s representative.”
ASCA will provide more information and education in the coming weeks and months.
Please contact Kara Newbury with any questions.