CMS Delays Implementation of New Joint Commission Telemed Requirements

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CMS has granted a reprieve to The Joint Commission (TJC), which would have required hospitals to implement cumbersome credentialing and privileging requirements for telemedicine services beginning July 15, 2010, when its ability to “privilege by proxy” expires. TJC now has until March 2011 to comply with CMS requirements, which are currently in flux and likely to change.

The delay means hospitals do not need to make changes to their credentialing and privileging policy for telemedicine providers by July 15, 2010, as previously communicated, according to Patricia Kurtz, director of Federal Relations, The Joint Commission.

CMS granted the extension to allow time for comments on a new proposed rulereleased May 26, intended to simplify the credentialing and privileging of telemedicine providers by hospitals and critical access hospitals. As currently proposed, however, imaging experts believe the rule could seriously limit access of hospitals to long-distance interpretations provided by radiology practices and teleradiology companies.

Meanwhile, Kurtz believes the CMS proposed rule does not apply to the ambulatory setting, where most practices and teleradiology companies are accredited: “We don’t read the CMS proposed rule as applying to ambulatory; they are pretty explicit in that it only applies to hospitals and critical access hospitals.

TJC currently enjoys statutory deeming authority to allow accredited organizations to recognize the credentials of each other’s privileged physicians, referred to as “privileging by proxy.” But TJC was scheduled to lose its authority to privilege by proxy on July 15, 2010, mandated by the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA), which required TJC to use CMS conditions of participation (CoPs) for credentialing and privileging in hospitals and critical access hospitals instead. Current Medicare CoPs require hospitals to make all privileging decisions based on recommendations of the medical staff after completing a review of the applicant practitioner’s credentials and assuring they meet Medicare criteria.

In the recently proposed rule, CMS recognized the administrative burden its CoPs present hospitals using telemedicine services, particularly for smaller hospitals with fewer administrative resources, by allowing hospitals to rely on the distant-site hospitals for credentialing and privileging. But because most hospitals rely on TJC-accredited teleradiology providers for credentialing and privileging, the proposal does not achieve the CMS intent to lessen the burden.

TJC intends to submit comments on the proposed rule, but Kurtz was not ready to go on record with their concerns. “I still need to get the team assembled and we haven’t fully flushed out what we are going to comment on,” Kurtz notes. “ There are some things we are concerned about.”

CMS will accept comments for 60 days from May 26, 2010, when the rule was published in the Federal Register. Reference file code CMS-3227-P. Comments can be made online at http://www.regulations.gov.