Synergy - January/February 2015 - 12

industry feature

Weighing the
Options of Appointing
Non-Physician Practitioners
to the Medical Staff
By Jennifer A. Hansen and Katherine M. Dru
Quiz on page 15; Worksheet on page 32

This article is part of NAMSS' ongoing collaboration
with the American Health Lawyers Association and
its Medical Staff, Credentialing, and Peer Review
Practice Group. This article also is published in the
Practice Group's newsletter, MedStaff News.

T

he Centers for Medicare & Medicaid
Services (CMS) issued Final Rule
CMS-3267-F (Final Rule) on May 12,
implementing several changes (Revisions) to
the Medicare Conditions of Participation
(CoPs). Among these changes was a revision
to 42 C.F.R. § 482.22(a) (Revised CoP) to
clarify that while a hospital's medical staff
must be composed of doctors of medicine
or osteopathy (MDs or DOs), the medical
staff also may include other categories of
physicians and non-physician practitioners
eligible for appointment to the medical staff
under state law, including scope-of-practice
laws. The Revised CoP provides: "The
medical staff must be composed of doctors
of medicine or osteopathy. In accordance
with State law, including scope-of-practice
laws, the medical staff may also include
other categories of physicians (as listed at
§482.12(c)(1)) and non-physician practitioners
who are determined to be eligible for
appointment by the governing body."1
In light of this clarification, hospitals must
weigh the benefits and risks of appointing
non-physician practitioners to the medical
staff, including balancing the benefit of
increased flexibility with the potential

burdens of peer review and credentialing for
a wider range of practitioners.

Prior Rule and Need for
Clarification
Prior to the Revision, 42 C.F.R. § 482.22(a)
provided, "The medical staff must be
composed of doctors of medicine or
osteopathy and, in accordance with State law,
may also be composed of other practitioners
appointed by the governing body."2 The
language of this CoP left unclear whether
the term "other practitioners" was intended
to permit the appointment of physicians
who are neither MDs or DOs (Other
Physicians) to the medical staff, whether the
term instead was intended to permit the
appointment of non-physician practitioners
(Other Practitioners) to the medical staff, or
whether the term was intended to permit the
appointment of both Other Physicians and
Other Practitioners to the medical staff.
As CMS explained in its May 20 memorandum
on the Final Rule, the Revision to 42 C.F.R.
§ 482.22(a) was made "to indicate that the
medical staff must include MDs or DOs,
but may also include other categories of

physicians listed at § 482.12(c)(1), as well
non-physician practitioners. A prior rule
change inadvertently omitted the reference
to other categories of physicians."3

Categories of Practitioners:
Other Physicians and Other
Practitioners
The Revised CoP makes clear that a hospital's
medical staff may, in accordance with state
law, include three categories of practitioners:
MDs and DOs, Other Physicians (as listed
at 42 C.F.R. § 482.12(c)(1)), and Other
Practitioners.4 The Other Physicians
enumerated in Section 482.12 include:
* Doctors of dental surgery or dental
medicine;
* Doctors of podiatric medicine;
* Doctors of optometry;
* Chiropractors; and
* Clinical psychologists.5

42 C.F.R. § 482.22(a), effective July 11, 2014.

12

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SYNERGY JANUARY/FEBR UARY 2015

2

42 C.F.R. § 482.22(a), Rev. 78, effective Dec. 12, 2011.

Final Rule-Promoting Efficiency, Transparency, and Burden Reduction;
Part II-Informational Only, CMS, Center for Clinical Standards and
Quality/Survey & Certification Group, Memorandum of May 20, 2014
from Director of Survey and Certification Group to State Survey
Agency Directors, at p. 4, available at: www.cms.gov/Medicare/
Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/
Downloads/Survey-and-Cert-Letter-14-33.pdf.

4
1

3

42 C.F.R. § 482.22(a).

5

42 C.F.R. § 482.12(c)(1).

http://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Downloads/Survey-and-Cert-Letter-14-33.pdf http://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Downloads/Survey-and-Cert-Letter-14-33.pdf http://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Downloads/Survey-and-Cert-Letter-14-33.pdf

Synergy - January/February 2015

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