Medicare CMHC Conditions Of Participation Go Into Effect October 29, 2014

For the first time, community mental health centers offering partial hospitalization services under Medicare must meet specified Conditions of Participation, under guidance released by the Centers for Medicare and Medicaid Services (CMS) last week. The six Conditions of Participation (CoPs) establish requirements for client care, staff and provider operations, and quality measurement. The CoPs apply to community mental health centers (CMHCs) that participate in Medicare as partial hospitalization providers.

Prior to the new regulations, CMHCs were defined as providers that meet their state’s licensure and certification requirements and provide certain care services, such as outpatient care, 24-hour emergency services, day treatment, partial hospitalization or psychosocial rehabilitation services. In the wake of widespread reports of improper patient care and misuse of Medicare funds in states with little to no regulation of CMHCs, CMS began a rulemaking process to establish stricter standards of care and operation among the CMHCs participating in Medicare.

Previous Conditions of Participation Rulemaking

An earlier version of last week’s final rule had included a number of overly restrictive provisions that would have imposed millions of dollars in extra costs on CMHCs without achieving CMS’ stated goals of improved health and safety among CMHC clients. The National Council submitted comments to CMS encouraging modifications to these requirements, many of which are reflected in the final rule.

A Foothold in Federal Law

The establishment of the CMHC Conditions of Participation is notable because it is the first time federal law has delineated what it means to be a provider of community mental health services. Although the definition is limited in scope and applicable to only a narrow subset of community behavioral health providers, it is a major step forward for a provider group that has long been left out of the federal dictionary. Community mental health centers now have a foothold in the universe of federally recognized provider organizations – a status that will prove critical as other federal programs, states, and private payers examine their own delivery systems and implement changes to streamline services and improve patient care.

The New Conditions of Participation

The final rule covers six CoPs, which are effective as of October 29, 2014. The CoPs apply to the care provided to all clients of a participating CMHC, and not just those receiving partial hospitalization services.

 1.Personnel qualifications: establishes staff qualifications for the CMHC and requires staff providing direct patient care services to be appropriately licensed and certified and to act only within the scope of the applicable license or certification.

2.Client rights: emphasizes a CMHC’s responsibility to respect and promote the rights of each CMHC client by providing verbal and written notice of client rights. This CoP also addresses surrogate decision makers and standards for restraint and seclusion.

3.Admission, initial evaluation, comprehensive assessment, and discharge or transfer of the client: sets forth timelines for assessment, treatment, and discharge plans; in an expansion of the earlier proposed rule, allows mental health counselors and social workers to administer the initial comprehensive assessment.

4.Treatment team, active treatment plan, and coordination of services: requires that CMHCs provide a person-centered interdisciplinary team, allowing for flexibility in the types of professionals who serve on the team and work in consultation with the client’s primary healthcare provider.

5.Quality assessment and performance improvement: requires CMHCs to establish their own quality assessment and performance improvement systems so as to monitor and improve client care.

6.Organization, governance, administration of services: requires each CMHC to establish a governance structure that focuses on and enhances its coordination of services to better serve its clients.

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