CMS SOM App. W, Tag C-0340

furnished by doctors of medicine or osteopathy at the CAH are evaluated by--

(i) One hospital that is a member of the network, when applicable;

(ii) One QIO or equivalent entity;

(iii) One other appropriate and qualified entity identified in the State rural

health care plan;

(iv) In the case of distant-site physicians and practitioners providing

telemedicine services to the CAH’s patients under a written agreement between the

CAH and a distant-site hospital, the distant-site hospital; or

(v) In the case of distant-site physicians and practitioners providing

telemedicine services to the CAH’s patients under a written agreement between the

CAH and a distant-site telemedicine entity, one of the entities listed in paragraphs

(b)(4)(i) through (iii)of this section;

Interpretive Guidelines §485.641(b)(4)

All CAHs must, as a part of their quality assurance program, have an arrangement with

an outside entity to review the appropriateness of the diagnosis and treatment provided by

each MD/DO providing services to the CAH’s patients. This includes MDs and DOs

providing telemedicine services to the CAH’s patients from a distant-site hospital or

distant-site telemedicine entity. (See §485.616(c) for more information about

requirements for telemedicine services.

Some CAHs may prefer to conduct their own internal review in addition to the outside

review; this is neither prohibited nor required under the regulation. The regulation does

not specify the frequency of the outside review, since a quality assurance program is

ongoing in nature. The CAH and the outside entity must reach a mutual agreement on

the extent and frequency of the outside review.

Entities eligible to provide this outside review include, for MDs and DOs who provide

services on-site at the CAH, a hospital that is a member of the same rural health network

as the CAH; a Medicare Quality Improvement Organization, or its equivalent; or another

appropriate and qualified entity identified in the State’s Rural Health Plan to perform this

function.

In the case of MDs or DOs who provide telemedicine services to the CAH’s patients

under a written agreement between the CAH and a distant-site hospital, the distant-site

hospital is the outside entity responsible for reviewing the quality of care provided by

these physicians.

In the case of MDs or DOs who provide telemedicine services to the CAH’s patients

under a written agreement between the CAH and a distant-site telemedicine entity, the

outside entity responsible for reviewing the quality of care provided by these physicians

include a hospital that is a member of the same rural health network as the CAH; a

Medicare Quality Improvement Organization, or its equivalent; another appropriate and

qualified entity identified in the State’s Rural Health Plan to perform this function; or a

distant-site hospital with which the CAH has an agreement for provision of telemedicine

services.

Survey Procedures §485.641 (b)(4)

• Is there evidence that the CAH has an agreement for outside review of the quality

of care provided on-site (i.e., not including telemedicine services) by the CAH’s

MDs and DOs with at least one of the following: a hospital that is a member of

the same rural health network as the CAH; a Medicare Quality Improvement

Organization, or its equivalent; or another appropriate and qualified entity

identified in the State’s Rural Health Plan?

• If the CAH has one or more agreements for the provision of telemedicine services

to CAH patients by a distant-site hospital(s), does each such agreement include a

provision for the distant-site hospital to conduct the required outside review of the

quality of telemedicine services provided by the MDs and DOs covered by the

agreement?

• If the CAH has one or more agreements for the provision of telemedicine services

to CAH patients by a distant-site telemedicine entity, does the CAH have an

agreement for outside review of the quality of telemedicine services provided by

the MDs and DOs covered under the agreement? Is the outside review agreement

with at least one of the following: a hospital that is a member of the same rural

health network as the CAH; a Medicare Quality Improvement Organization, or its

equivalent; another appropriate and qualified entity identified in the State’s Rural

Health Plan; or a distant-site hospital with which the CAH has an agreement for

telemedicine services?

• Can the CAH provide examples of any reviews of the quality and appropriateness

of diagnosis and treatment of the CAHs MDs and DOs conducted by an eligible

outside entity in the prior 12 – 24 months?