What Is Medicare Conditions Of Participation?

Medicare Conditions of Participation

Medicare Conditions of Participation are a set of stringent health measures designed to regulate how hospitals and other medical establishments utilize Medicare aid. Every health-care facility which receives reimbursement for Medicare related costs must adhere to the guidelines specified by CMS, Center for Medicare & Medicaid Services. These rules are published in the Federal Register and regular inspections assures that all health-care facility follow guidelines, consistently. These rules also make sure that all patients receive a minimum standard of health service, which is the right of every beneficiary.

For example, the guidelines make sure that a hospital doing organ transplant has the necessary facilities, and that particular hospital only conducts business with a prescribed Organ Procurement Organization. Actually, the Medicare Conditions of Participation help streamline tasks, making it easier to keep the level of service consistent among all health-care facilities taking part in Medicare. According to the Code of Federal Regulations of October 2004, following are the Medicare Conditions of Participation for Hospitals:

Part A – General Provisions

Basis and scope
Provision of emergency services by nonparticipating hospitals

Part B – Administration

Compliance with Federal, State and local laws
Governing body
Patients’ rights

Part C – Basic Hospital Functions

Nursing services
Medical record services
Pharmaceutical services
Radiological services
Laboratory services
Food and dietetic services
Utilization review
Physical environment
Infection control
Discharge planning
Organ, tissue, and eye procurement

Part D – Optional Hospital Services

Surgical services
Anesthesia services
Nuclear medicine services
Outpatient services
Emergency services
Rehabilitation services
Respiratory care services

Special provisions applying to psychiatric hospitals
Special medical record requirements for psychiatric hospitals
Special staff requirements for psychiatric hospitals
Special requirements for hospital providers of long-term care services

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