WHA Seeking Comment on Draft CMS Memo on Hospital Co-location Arrangements

May 14, 2019

The Centers for Medicare & Medicaid Services (CMS) has issued long-awaited draft guidance on application of exclusive use requirements in the Medicare Conditions of Participation (CoPs) for PPS and CAH hospitals that implicates hospital co-location and shared services arrangements. Despite increased enforcement in recent years by CMS regarding co-location issues, prior to the draft memo, there was no formal guidance from CMS on such arrangements.

CMS is seeking comments on the draft memo, which are due by July 2. WHA will provide a comment letter to CMS and is requesting feedback from hospitals on impacts and recommended changes to the draft guidance.

In July 2016, WHA spearheaded a letter together with the Rural Wisconsin Health Cooperative that was sent from Wisconsin’s Congressional Delegation to CMS, expressing significant concerns with enforcement actions by CMS regarding co-location and shared services arrangements and the negative impact they could have on rural health care access. That letter called for CMS to review its increasingly restrictive review and approval of shared space/mixed-use sites.

Specifically, the draft memo provides guidance regarding application of the CoPs in some key areas:

Shared spaces. The draft memo clarifies that it is acceptable for hospitals and a co-located health care entity to have shared public areas such as entrances and waiting rooms, but clinical spaces should not be shared due to infection control, patient management, confidentiality, and other quality and safety concerns.
Shared staffing. The draft memo addresses shared staffing, saying that while it is acceptable for privileged and credentialed medical staff to “float” between the hospital and another health care entity during the same time, nurses and other staff may not do the same, but must be assigned to only one entity at a time.
Time share arrangements. The draft memo does not address issues of time-sharing, such as when a facility would enter into an agreement with a visiting provider authorizing the provider to use waiting room or other space in the hospital. Previously, CMS indicated it would be providing guidance regarding such timeshare arrangements.

If you have questions about the draft memo or have comments or recommendations that you would like to see addressed in WHA’s comment letter to CMS, contact WHA General Counsel Matthew Stanford or WHA Director of Federal Relations Jon Hoelter.

This story originally appeared in the May 14, 2019 edition of WHA Newsletter