CMS Issues Proposed Rule Implementing Affordable Care Act Provisions

The Centers for Medicare and Medicaid Services (CMS) has issued a proposed rule that sets forth many of the payment parameters and oversight provisions related to federally facilitated health insurance exchanges and other requirements mandated by the Patient Protection and Affordable Care Act (PPACA). Importantly, for patient safety, quality, and risk managers the proposed rule also addresses requirements related to patient safety standards that qualified health plan issuers must meet. PPACA included requirements affecting hospitals with greater than 50 beds and health insurance marketplaces (also known as health insurance exchanges). PPACA required that, starting January 2015, a hospital with greater than 50 beds can participate in an exchange only if the hospital has a patient safety evaluation system (PSES) in place. This PSES must be as described in the Patient Safety and Quality Improvement Act and patient safety organization (PSO) rules and regulations. A PSES, as defined in PSO rules and regulations, is the collection, management, or analysis of information for reporting to or by a PSO.