CMS sends new guidance following Ozarks appeal

CMS has issued a memorandum more than a year after the agency took away Springfield, Mo.-based Ozarks Community Hospital's Medicare provider agreement status because the facility did not satisfy the federal definition of a hospital.

Hospital officials said in a news release CMS amended the State Operations Manual to address the issues the hospital faced during a survey process and appeal related to the case. Now, they said, hospital surveyors must look at "whether the hospital is primarily engaged in providing inpatient services and there is a minimum standard and specific guidance on factors to consider."

Paul Taylor, CEO of Springfield-based OCH Health System, a safety-net organization comprised of the Springfield hospital and clinic locations across three states, explained further.

"The guidance in the amended manual which tells surveyors how to audit hospital operations is exactly what we were asking CMS to do. Give us a rule and we will satisfy it. Before this change, it was like being ticketed for speeding even though there was no established speed limit. CMS showed up and said our inpatient census was not high enough compared to the volume of outpatient care we were doing. We increased our inpatient volume and CMS accepted our plan of correction which stated we would maintain that increased inpatient census," he said.

"A few months later, for reasons known only to CMS, they showed up again and decided what we were doing — which they had approved — was not enough. In other words, they changed the speed limit. We asked CMS to tell us how much was enough and CMS said they could not."

Hospital officials said the new guidance also stipulates a hospital won't be surveyed if there are no inpatients on the day the survey begins, and the CMS regional office will instead investigate "to determine whether the hospital has maintained an average daily census of two for the prior 12-month period. If not, the hospital will be presumed to have failed to meet the standard. If the hospital had more than an ADC of two, the hospital will be surveyed and the new guidance provides a number of factors to be considered."

The case stems from summer 2016, when OCH closed the surgery and emergency departments at the Springfield hospital. The closure followed notification from CMS that it would take away the hospital's Medicare provider agreement status because it didn't satisfy the federal definition of a hospital. The hospital appealed the decision, although it decided to dismiss the appeal this week after CMS issued the memorandum.

Note: Becker's Hospital Review reached out to CMS for comment and will post additional details as they become available.


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