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Medicare: A Strategy for Quality Assurance - Volume I
Conditions of Participation
22. Special medical record requirements for psychiatric hospitals
(a) Development of assessment and diagnostic data
(b) Psychiatric evaluation
(c) Treatment plan
(d) Recording progress
(e) Discharge planning and discharge summary
23. Special staff requirements for psychiatric hospitals
(b) Director of inpatient psychiatric services; medical staff
(c) Availability of medical personnel
(d) Nursing services
(e) Psychological services
(f) Social services
(g) Therapeutic activities
24. Special requirements for hospital providers of long-term care services (“swing -beds”)
(b) Skilled nursing facility services
SOURCE: 42 CFR Part 482, effective September 15, 1986
tion control and surgical and anesthesia services. In addition, quality assurance was made a separate condition.
The new Conditions of Participation took effect September 15, 1986. They were accompanied by interpretive guidelines and detailed survey procedures developed by HCFA to increase consistency of interpretation and application by the state agency surveyors (HCFA, 1986).
Joint Commission standards are contained in its Accreditation Manual for Hospitals, parts of which are revised each year through an elaborate process of professional consensus. With the advent of the Conditions of Participation in 1966, which were based on Joint Commission standards of the time, the Joint Commission decided to develop “optimum” standards. An explicit quality-of-care standard first adopted in 1979 has undergone continuous evolution.
Shift from Capacity Standards to Performance Standards
In recent years, HCFA and the Joint Commission have tried to revise their standards in ways that would impel hospitals to examine and to im-