The Medicare participation requirements that providers want cut

Modern Healthcare – Wednesday, June 18, 2025
By Bridget Early

Hospitals and other providers are urging federal regulators to ease Medicare conditions of participation that they contend are overly burdensome.

Since President Donald Trump returned to the White House in January, his administration has sought public input about regulations to eliminate or soften. In response to a request for information the Centers for Medicare and Medicaid Services issued in April, groups such as the Federation of American Hospitals and the American Medical Association suggest conditions of participation should be dialed back in areas including maternal health and staffing.

Healthcare organizations also recommend that CMS revisit policies related to the independent dispute resolution process, prior authorizations, telehealth and quality measurement.

Obstetric care

CMS should make significant changes to, or even eliminate, a set of obstetrics conditions for hospitals it announced in November, the AMA, the National Rural Health Association and the Association of American Medical Colleges wrote.

Under the new regulation, hospitals including critical access hospitals that participate in Medicare and Medicaid and offer obstetric care must improve staffing, training and service delivery.

Provider organizations warn that this rule could exacerbate maternity ward closures and worsen health disparities in underserved areas.

“If hospitals feel they are not adequately equipped to meet these standards or that additional investments must be made to meet these requirements, providers struggling to operate these services may ultimately make the decision to eliminate these services to avoid significant penalties for failure to meet [conditions of participation] requirements,” the AAMC wrote.

Respiratory illness reporting

Numerous groups recommend CMS eliminate a respiratory illness documentation requirement for hospitals that the agency finalized in August.

Hospitals must submit weekly data on COVID-19, influenza and respiratory syncytial virus infections to the Centers for Disease Control and Prevention for illnesses under the rule.

The AAMC and the Federation contend these policies are onerous, duplicative and don’t improve quality. The AHA and America’s Essential Hospitals made similar arguments in comments they recently submitted to CMS.

Nurse staffing

The Federation wants CMS to rescind an interim guidance it issued in March on nursing home inspections.

The guidance instructs surveyors to collect information on how many residents and staff each provider has in order to assess if the workforce is adequate, although it does not mandate staffing ratios. In addition, inspectors are expected to review payroll data to determine staffing hours per resident in general and specific to registered nurses.

These requirements go beyond the agency’s statutory authority and burden skilled nursing facilities and the hospitals that discharge patients to them, according to the Federation.

Home health

The Children’s Hospital Association wants CMS to revise home health conditions of participation to better account for pediatric patients.

Children’s hospitals sometimes partner with home health providers to care for children with chronic, complex conditions. But the home health conditions of participation are tailored to adults recovering from acute care, not children who are stable and require longer-term services, according to the CHA.

For instance, providers are required to document matters that are irrelevant to kids, such as whether they are able to shop for groceries or demonstrate independent living skills, the CHA wrote.

CMS should streamline documentation requirements for children, eliminate adult-specific criteria for pediatric cases and consider pediatric-specific guidance to clarify the rule, the CHA argues.

Other priorities

Providers raised a vast array of other policies CMS should change:

• The AMA wants CMS to eliminate the ”morass of complicated rules and requirements for compliance with the ineffective Merit-based Incentive Payment System.”
• The AMA, the Federation and the Medical Group Management Association ask CMS to fix the independent dispute resolution process used to settle out-of-network claims.
• A slew of groups want CMS to continue strengthening prior authorization oversight while transitioning to an electronic system.
• The AHA and the Federation want CMS to make the hospital Transforming Episode Accountability Model voluntary.

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