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Helpful MCN Healthcare Resources
CMS Updates State Operations Manual, Appendix W, Interpretive Guidance, for Critical Access Hospitals (CAHs)
The Centers for Medicare & Medicaid Services (CMS) has updated pertinent portions of the Critical Access Hospital (CAH) interpretive guidelines, found in SOM Appendix W, to reflect the following rule changes.
- CMS-3267-F, published on May 12, 2014; portions related to CAHs became effective July 11, 2014. Among other provisions, this final rule revised the CAH Conditions of Participation (CoP) requirements related to the responsibilities of doctors of medicine (MDs) and doctors of osteopathy (DOs).
- CMS-1599-F, published August 19, 2013; effective October 1, 2013. This final rule revised the CAH CoP requirements related to provision of inpatient acute care services.
- Revision of §485.631(b)(2), effective July 11, 2014, to remove the requirement that an MD or DO must be present in the CAH at least once every two weeks. CAH MDs/DOs are now required to be present for sufficient periods of time to provide medical direction.
- Revision of §485.635(a)(2), effective July 11, 2014, to remove the requirement for the CAH's patient care policies to be developed with the advice of at least one individual who is not a member of the CAH's professional healthcare staff.
- Revision of §485.635(a)(3)(vii), effective October 1, 2013, to remove the conditional language that could have been misunderstood as making it appear optional for a CAH to provide acute inpatient services.
In addition to modifications related to the above final rules, CMS has also updated interpretive guidance for the portions of 42 CFR 485.635 addressing the following topics, in order to bring them into alignment with current accepted standards of practice: pharmacy services; infection prevention and control; dietary services; services under arrangement; nursing services; and, rehabilitation services.
CDC Issues Health Advisory Regarding the U.S. Multi-State Measles Outbreak, December 2014-January 2015
The U.S. Centers for Disease Control and Prevention (CDC) has issued a Health Advisory regarding the multi-state outbreak of measles associated with travel to Disneyland Resort Theme Parks (which includes Disneyland and Disney California Adventure). The purpose of this HAN Advisory is to notify public health departments and healthcare facilities about this measles outbreak and to provide guidance to healthcare providers.
According to the CDC, the current multi-state outbreak underscores the ongoing risk of importation of measles, the need for high measles vaccine coverage, and the importance of a prompt and appropriate public health response to measles cases and outbreaks. Because of the success of the measles vaccine program, most young physicians have never seen a case of measles and may not take a detailed history of travel or potential exposure and initially may not consider the diagnosis in a clinically compatible case. Therefore the CDC is making the following recommendations for Health Care Providers:
- Ensure all patients are up to date on MMR vaccine and other vaccines.
o Note: Children 1 through 12 years of age may receive MMRV vaccine for protection against measles, mumps,
rubella, and varicella.
- For those who travel abroad, CDC recommends that all U.S. residents older than 6 months be protected from measles and receive MMR vaccine, if needed, prior to departure.
o Infants 6 through 11 months old should receive 1 dose of MMR vaccine before departure.
Note: Infants who receive a dose of MMR vaccine before their first birthday should receive 2 more doses of MMR vaccine, the first of which should be administered when the child is 12 through 15 months of age and the second at least 28 days later.
o Children 12 months of age or older should have documentation of 2 doses of MMR vaccine (separated by at least
o Teenagers and adults without evidence of measles immunity should have documentation of two (2) appropriately
spaced doses of MMR vaccine.
Note: One of the following is considered evidence of measles immunity for international travelers: 1) birth before 1957, 2) documented administration of 2 doses of live measles virus vaccine (MMR, MMRV, or measles vaccines), 3) laboratory (serologic) proof of immunity or laboratory confirmation of disease.
- Consider measles as a diagnosis in anyone with a febrile rash illness and clinically compatible symptoms (cough, coryza, and/or conjunctivitis) who has recently traveled abroad or who has had contact with someone with a febrile rash illness.
- Immunocompromised patients may not exhibit rash or may exhibit an atypical rash. The incubation period for measles from exposure to fever is usually about 10 days (range, 7 to 12 days) and from exposure to rash onset is usually 14 days (range, 7 to 21 days).
- Isolate suspect measles case-patients and immediately report cases to local health departments to ensure a prompt public health response.
- Obtain specimens for testing, including viral specimens for confirmation and genotyping. Contact the local health department for assistance with submitting specimens for testing.
The Health Advisory, link below, includes additional resources and information for health care professionals.
The US Centers for Disease Control and Prevention (CDC) is reporting that more than a third of reproductive-aged women enrolled in Medicaid, and more than a quarter of those with private insurance, filled a prescription for an opioid pain medication each year during 2008-2012. "These statistics are alarming because of the fact that taking opioid medications early in pregnancy can cause birth defects and serious problems for the infant and the mother, and many women of reproductive age are taking these medicines and may not know they are pregnant and therefore may be unknowingly exposing their unborn child. "
According to the CDC it is critical for health care professionals to take a thorough health assessment before prescribing these medicines to women of reproductive age.
The CDC researchers analyzed 2008-2012 data from two large health insurance claims data sets: one of women aged 15-44 years with private insurance and another of women in the same age group enrolled in Medicaid. They found that on average, 39 percent of Medicaid-enrolled women filled an opioid prescription from an outpatient pharmacy each year compared to 28 percent of women with private health insurance.
Previous studies of opioid use in pregnancy suggest these medications might increase the risk of neural tube defects, congenital heart defects and gastroschisis. There is also a risk of neonatal abstinence syndrome (NAS) from exposure to medications such as opioids in pregnancy. NAS is when a newborn experiences symptoms of withdrawal from medications or drugs taken by a mother during pregnancy.
The CDC's National Center on Birth Defects and Developmental Disabilities is working to provide better information to women and their health care providers about medication use during pregnancy through its Treating for Two: Safer Medication Use in Pregnancy initiative. Follow the link below for additional information.
Featured Policy Library Manuals
MCN’s Utilities and Equipment Management Policy and procedure Manual is a reference guide that is compliant with Joint Commission, NIAHO and CIHQ standards and CMS regulations. MCN provides easy-to-use policies and procedures that are field tested and proven - you need only to customize them to your healthcare organization. Policies and procedures include Utility Systems Management Plan, Alternative Equipment Maintenance Program, Clinical Alarms, Emergency Power and much more!Read more »
MCN Healthcare’s Administrative Manual for Critical Access Hospitals is specifically designed to assist critical access hospitals meet CMS, TJC and NIAHO standards for CAHs. This manual provides over 275 ready-to-implement policies, procedures and forms in an easy-to-customize Word format, and is designed to demonstrate compliance with CAH regulations. Transplant Safety polices are also included in this manual.Read more »
MCN's NEW Ambulatory Surgical Center/Outpatient Surgery Department Policy and Procedure Manual is cross referenced to TJC standards, AAAHC standards and CMS regulations. Policies and procedures meet AORN and CDC recommendations and guidelines. This comprehensive reference guide has over 290 policies and procedures that are ready to customize to your organization. See also the Administrative Manual for Ambulatory Care Facilities and the Ambulatory Services EOC Manual.Read more »