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CMS Home > Regulations and Guidance > Conditions for Coverage (CfCs) & Conditions of Participations (CoPs) > Spotlight


CMS has several ongoing priority activities involving the Conditions of Participation (CoPs) and Conditions for Coverage (CfCs) for certain health care providers. Below you will find key information about our most important activities.

Anesthesia Supervision

CMS established an exemption for Certified Registered Nurse Anesthetists (CRNAs) from the physician supervision requirement by recognizing a Governor's written request to CMS attesting that he or she is aware of the State's right to an exemption of the requirement and it is in the best interests of the State's citizens to exercise this exemption on November 13, 2001.

At this time, fifteen states have chosen to opt-out of the CRNA physician supervision regulation. Those states are: California, Iowa, Nebraska, Idaho, Minnesota, New Hampshire, New Mexico, Kansas, North Dakota, Washington, Alaska, Oregon, South Dakota, Wisconsin and Montana. (updated 7/2009)

Final Hospice CoPs

On June 5, 2008, the Centers for Medicare & Medicaid Services (CMS) published a new rule that will improve the quality of care provided to more than 940,000 Medicare beneficiaries receiving hospice care each year. The final conditions of participation (CoPs) ease the regulatory burden for hospice providers and improves the quality of care for all hospice patients.

The provisions of this new rule include issues relating to:

  • Patient assessment;
  • Quality assessment and performance improvement (QAPI);
  • Contracting for core services;
  • Drug management;
  • Respite care requirements;
  • Guidance for hospices that care for residents of nursing facilities; and
  • Qualifications for hospice social workers.

The rule adopts contemporary standards of practice in the hospice community, and incorporates recommendations made by the Secretary's Advisory Committee on Regulatory Reform, the Office of the Inspector General, the Office of Disability, Aging and Long-Term Care Policy, and Operation Restore Trust. The final rule also responds to and incorporates suggestions from the public that were submitted in response to the proposed rule, published on May 27, 2005.

Proposed Revision to Rural Health Clinic CoPs

On June 27, 2008, CMS published a proposed rule, "Changes in Conditions of Participation Requirements and Payment Provisions for Rural Health Clinics and Federally Qualified Health Centers." This proposed rule revised certification and payment requirements for RHCs and FQHCs as required by the Balanced Budget Act of 1997 (BBA).

The proposed rule would establish location requirements and exception criteria for RHCs; revise the RHC and FQHC payment methodology; require RHCs to establish a quality assessment and performance improvement (QAPI) program; allow RHCs to contract with RHC non-physician providers under certain circumstances; and other changes to update several health and safety requirements to reflect advancements in technology and treatment.

Final End Stage Renal Disease CfCs

On April 15, 2008, the Centers for Medicare and Medicaid Services issued a final rule that establishes new conditions for coverage that dialysis facilities must meet to be certified under the Medicare program. It focuses on the patient and the results of care provided to the patient, establishes performance expectations for facilities, encourages patients to participate in their plan of care and treatment, eliminates many procedural requirements from the previous conditions for coverage, preserves strong process measures when necessary to promote meaningful patient safety, well-being, and continuous quality improvement. This final rule reflects the advances in dialysis technology and standard care practices since the requirements were last revised in their entirety in 1976.

Final Ambulatory Surgical Centers CfCs

On November 18, 2008, the Centers for Medicare and Medicaid Services (CMS) published an ASC final rule updating the existing Conditions for Coverage (CfC) to reflect contemporary standards of practice in the ASC community, as well as recommendations from the HHS Inspector General. The new requirements will promote and protect patient access to quality services in ASCs. The changes include updates to the following issues:

  • Quality assessment and performance improvement (QAP1);
  • Governing body responsibility of oversight and accountability for the QAPI program;
  • Disaster preparedness;
  • Comprehensive radiologic requirements;
  • Patient rights;
  • Infection control; and
  • Patient assessment

Final CORF CoPs

In a November 25, 2009 final rule, CMS revised the definition of "respiratory therapist" in reference to personnel qualifications that must be met by a CORF. This regulatory revision corrected a previous change to the definition of "respiratory therapist" made in a 2008 final rule, which inadvertently excluded a category of respiratory professional, "certified respiratory therapists (CRTs)." The 2008 change to the definition prevented CMS from paying CORFs for services provided by CRTs. Restoration of the proper regulatory language in the November 25, 2009 rule ensured that CORFs would be paid for services provided by CRTs and ensured Medicare beneficiaries' access to care provided by CRTs in the approximately 400 Medicare- & Medicaid-participating CORFs.

The proposed rule was published in the Federal Register, Volume 74, No. 132, July 13, 2009. The final rule was published in the Federal Register, Volume 74, No. 226, November 25, 2009.

Diabetes Self-Management Training - Approval of the American Association of Diabetes Educators as a National Accreditation Organization

On February 27, 2009, CMS published a final notice announcing the approval of an application from the American Association of Diabetes Educators (AADE) for recognition as a National Accreditation Organization (NAO)to accredit entities that furnish outpatient diabetes self-management training (DSMT) to Medicare beneficiaries. The effective date of this approval was March 29, 2009 and extends for a period of 3 years. The AADE is the third of three NAOs that have been granted status as an NAO. The other two organizations, American Diabetes Association and the Indian Health Services, have been approved by Medicare as NAOs for DSMTs for approximately 9 years.

Final Portable X-Ray CoPs

On November 19, 2008, the Centers for Medicare and Medicaid Services (CMS) issued a final rule that revised the requirements that portable x-ray suppliers must meet. This final rule updated the Portable X-ray Conditions for Coverage (CfCs) to reflect the existing professional standards of practice and training requirements for x-ray personnel.


ESRD Conditions Final Rule [PDF, 1MB]
Related Links Inside CMS

There are no Related Links Inside CMS
Related Links Outside CMSExternal Linking Policy

Hospice Final Rule [PDF, 695KB]

Rural Health Proposed Rule [PDF, 270KB]

Ambulatory Surgical Centers Final Rule [PDF, 57MB]

CORF Proposed Rule [PDF, 14 MB]

CORF Final Rule [PDF, 32MB]

Application by the American Association of Diabetes Educators (AADE) for Recognition as a National Accreditation Organization (NAO) for Accrediting Entities To Furnish Outpatient Diabetes Self-Management Training (DSMT)[PDF, 55KB]


Page Last Modified: 09/14/2010 7:37:37 AM
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