CMS Permits Unified and Integrated Medical Staff in Revised Conditions of Participation

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The Centers for Medicare & Medicaid Services (“CMS”) published a Final Rule on May 12, 2014, making modifications to the Medicare Conditions of Participation (“CoP”). Specifically, updates were published to revisit the CofP with respect to the medical staff of multiple hospital systems. Under the Final Rule, CMS will no longer prohibit a multi-hospital system from establishing a unified and integrated medical staff after receiving numerous comments and agreeing that a unified system may be best for standardization of practices in some hospital settings. CMS provided the following guidelines for such integration while recognizing the related parameters and limitations should be left to the hospitals.   
(1) Medical Staff Members Must Vote
All medical staff members practicing at each separately certified hospital must have voted by majority to either accept and incorporate a unified and integrated medical staff structure or to reject such structure and maintain a separate and distinct medical staff.
(2) Opt-Out Provisions Must be Included in Bylaws
Bylaws, rules, and requirements must exist to document several processes, including the ability for members of the medical staff to opt-out of the unified and integrated structure after a majority vote by the members and, conversely, to maintain a separate and distinct medical staff for the respective hospital.
(3) Medical Staff Must Acknowledge Unique Circumstances, Populations, and Services of Hospitals
The unified and integrated medical staff must be established to consider each hospital’s unique circumstances, including differences in patient populations or services offered in each hospital. Examples of patient population differences include, among others, low income or minority populations and rural populations. Furthermore, services offered include, among others, emergency, psychiatric, pediatric, long term acute care, organ transplant, and dialysis.
(4) Hospitals Must Give Due Consideration
Each hospital must give consideration to the needs and concerns of each medical staff member and mechanics must be created to ensure issues are considered and addressed.
Please note that hospitals may choose to exercise this flexibility only after determining such decision is in accordance with all applicable state and local laws. Additionally, please note that these modifications become effective on July 11, 2014.   
For additional information, or to obtain a complete summary of all modifications, please consult the Federal Registry at or contact Susan Ziel at