CMS Eases Verbal Order and Nursing Care Plan Requirements for Hospitals
Good News! CMS has eased some of its longstanding requirements for hospitals, including psychiatric hospitals. The agency has released a Final Rule which revises some of the Medicare Conditions of Participation (CoPs) for Medical Record Services (42 CFR Section 482.24) and Nursing Services (42 CFR Section 482.23). The Final Rule implements President Obama's executive order to reduce regulatory burdens on hospitals. It was published in the May 16, 2012 Federal Register and will be effective on or about July 16, 2012. Here's a summary of the key changes related to authentication of verbal orders and nursing care plans:
48 Hour Timeframe
Current Requirement: Under the current CoP, verbal orders must be dated, timed and authenticated by the ordering practitioner within the timeframe specified by state law or, if state law is silent, within 48 hours. (The related Joint Commission standard in the Hospital Manual is RC.02.03.07 Element of Performance # 4.)
Revised Requirement: Under the Final Rule, CMS has eliminated the 48 hour requirement and, instead, defers to state law or hospital policy to define the timeframe for authentication of verbal orders.
Authentication by Another Practitioner
Current Requirement: Under the current CoP, a verbal order can be authenticated by "another practitioner responsible for the patient's care and authorized by hospital policy to write orders." However, this provision was temporary and expired on January 26, 2012.
Revised Requirement: Under the Final Rule, CMS has made permanent the provision for another practitioner to authenticate orders. Similar to the current CoP, the authenticating practitioner must be "another practitioner responsible for the patient's care and authorized by hospital policy to write orders."
Recommendation:In light of this change to the requirements for verbal orders, we recommend the following actions:
- Review your state regulations and current policies regarding authentication of verbal orders.
- Determine if (based on your state's regulations) you can take advantage of CMS's elimination of the 48 hour requirement and if you wish to do so.
- If so, revise your policies accordingly as well as any related medical record review processes.
Remember: TJC will survey you according to your own policy if it is stricter than the TJC standard.
Nursing Care Plans
Under the Final Rule, CMS has legitimized the use of an interdisciplinary plan of care that incorporates the nursing plan of care. Many psychiatric hospitals have been using this approach for several years and have not encountered any issues on CMS surveys. However, some hospitals had held onto the separate nursing care plan to meet the strict interpretation of the CMS CoP. With the Final Rule, CMS has made it clear that hospitals are free to incorporate the nursing care plan into the interdisciplinary treatment plan.