Email Alert
June 20, 2011
By Amanda Enyeart, Kimberly Kannensohn, R. Brent Rawlings, Anna Timmerman*
On June 17, 2011, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that would establish, for the first time, conditions of participation (CoPs) for Medicare-certified community mental health centers (CMHCs).1 The proposed CoPs would address client rights and care, establish requirements for staff and provider operations, and encourage client participation in care plans and treatment. The new CoPs would also provide a basis for CMS to survey CMHCs for compliance with health and safety requirements.
CMHCs provide partial hospitalization services that are reimbursable by Medicare pursuant to Sections 1832 (a)(2) (J) and 1861 (ff)(3) of the Social Security Act (the Act). Section 1861(ff)(3)(B) of the Act provides that a CMHC must meet the applicable licensing or certification requirements for the state in which it is located. However, the proposed rule notes that most states either do not have a certification or licensing program for CMHCs or have programs that only apply to facilities that receive state funding.
The proposed rule notes that CMS has received quality of care and service complaints regarding CMHCs. But in the absence of established CoPs, many participating CMHCs have not had an onsite survey visit after their initial certification. Once the CoPs are established, CMS will be able to survey CMHCs through state survey and certification agencies to ensure compliance with the standards established by the CoPs. To that end, the proposed rule solicits public comment on the issue of amending CMS regulations at 42 C.F.R. § 488.6 to grant deeming authority for CMHCs to accrediting organizations.
CMS proposes to establish a new subpart J under the regulations at
42 CFR part 485 to incorporate the proposed CoPs. The new subpart J would include six CoPs, which would: (1) establish qualifications for various CMHC personnel; (2) require a CMHC to notify clients of their rights and report violations of such rights; (3) provide requirements for admission, initial evaluation, comprehensive assessment, and discharge or transfer of the client; (4) require the establishment of an interdisciplinary treatment team, an active treatment plan, which would be developed with client input, and coordination of services; (5) require a CMHC to create a quality assessment and performance improvement program; and
(6) establish organization, governance, administration of services, and partial hospitalization services requirements. The CoPs would be effective twelve months after the publication of the final rule.
CMS has issued a press release regarding the new rule. The proposed rule is available for public comment until August 16, 2011.
*We would like to thank Amanda Enyeart, Esquire, Kimberly Kannensohn, Esquire, R. Brent Rawlings, Esquire, and Anna Timmerman, Esquire (McGuireWoods LLP, Chicago, IL , and Richmond, VA) for writing and reviewing this summary.