CMS regulations support hospital medical staff membership for psychologists

The requirements are consistent with APAPO's comment letter

By Legal and Regulatory Affairs staff

June 7, 2012—The Centers for Medicare and Medicaid Services (CMS) recently released a final rule (PDF, 412KB) revising the requirements for hospitals and critical access hospitals that participate in Medicare and Medicaid. According to CMS, these revisions are primarily designed to increase flexibility and reduce regulatory burden by modifying, removing or streamlining current regulations. CMS estimates the overall savings from reductions in regulatory burdens resulting from this new rule could exceed $900 million in the first year.

Of particular relevance to psychologists, the new regulations modify the Medicare Condition of Participation (CoP) regarding hospital medical staff. Previously, CMS regulations stated that the medical staff must include doctors of medicine or osteopathy and, in accordance with state law, may also include “other practitioners” appointed by the governing body.

The updated rules, which go into effect on July 16, 2012, provide more specific guidance on medical staff eligibility and appointment procedures for non-physicians, including psychologists. The revised CoP (§ 482.22) includes the following: 

  • The medical staff must include doctors of medicine or osteopathy. In accordance with State law, including scope-of-practice laws, the medical staff may also include other categories of non-physician practitioners determined as eligible for appointment by the governing body. 

  • The medical staff must examine the credentials of all eligible candidates for medical staff membership and make recommendations to the governing body on the appointment of these candidates in accordance with State law, including scope-of-practice laws, and the medical staff bylaws, rules and regulations.

Although these new regulations do not appear to fundamentally change psychologists’ eligibility for hospital medical staff membership, CMS has clearly indicated its intent to broaden the participation of non-physicians. According to CMS, this change “is intended to encourage hospitals to be inclusive when they determine which categories of non-physician practitioners will be eligible for appointment to their medical staff.”

CMS further stated its belief that greater flexibility to maximize medical staff opportunities for all practitioners, within the bounds of their State licensing and scope of practice law, will improve the quality of patient care (77 Fed. Reg. 29047).

As discussed previously in PracticeUpdate, the APA Practice Organization (APAPO) submitted a comment letter in December 2011 supporting the general goals of the proposed revisions and recommending that all qualified non-physician professionals, including licensed psychologists, be given an opportunity to participate fully on the medical staff.

APAPO expressed concerns about language in the proposed rule that appeared to encourage hospitals to adopt different categories of medical staff membership that could put non-physician practitioners on a lower tier than physicians. The CMS final rule, however, does not include any provisions or commentary encouraging separate tiers of medical staff membership. Instead, the intent is to allow full medical staff privileges for eligible non-physician practitioners.

CMS guidance describes the final rule as “designed to reduce the regulatory burden on hospitals by…[r]equiring that all eligible candidates… be reviewed by the medical staff for potential appointment to the hospital medical staff and then allowing for the granting of all the privileges, rights, and responsibilities accorded to appointed medical staff members.” The final rule provisions and CMS guidance and commentary are consistent with APAPO’s comment letter and with the broader APA health care reform priority of integrating mental and behavioral health care into primary care and other health care services. It is hoped these regulatory changes will lead to increased opportunities for psychologists.

However, the practical effect of these changes will depend on state law and on each institution’s medical staff bylaws, rules and regulations. It may also depend on psychologists advocating for changes to relevant policies at the hospitals where they work.

In addition to advocating for any needed changes to medical staff bylaws or relevant hospital policies, psychologists are urged to seek and maintain the highest level of staff membership and broadest range of privileges consistent with their training and expertise. Inclusion of psychologists in a hospital’s medical staff promotes integrated care and assures that patients have access to the fullest possible benefits of psychologists’ expertise. This recommendation is consistent with the APA Guidelines for Psychological Practice in Health Care Delivery Systems (PDF, 245KB), which suggest that psychologists become involved in program, service and departmental leadership, as well as seek appointment to relevant medical staff committees.

For more information, contact the Legal and Regulatory Affairs department by email or at (202) 336-5889.