Hospital medical staff bylaws consulting helps hospitals draft bylaws and credentialing procedures under 42 CFR 482.22. Integral Healthcare Solutions (IHS) drafts these documents for new, merged or converting hospitals; the medical staff adopts and enforces the bylaws, and the governing body approves them.
IHS is a consulting firm, not a law firm.
Last updated: November 5, 2026
What does 42 CFR 482.22 require of medical staff bylaws and credentialing?
The hospital must have an organized medical staff that operates under bylaws approved by the governing body, and that staff is responsible for the quality of medical care provided to patients by the hospital. Source: 42 CFR 482.22, Condition of participation: Medical staff, current eCFR; page opened November 5, 2026.
The section has three working parts: paragraph (a) on eligibility and appointment, paragraph (b) on organization and accountability, and paragraph (c) on the bylaws themselves. Under (c), the medical staff must “adopt and enforce bylaws to carry out its responsibilities.”
What the bylaws must contain
| Paragraph | What the bylaws must do | What IHS drafts for it |
|---|---|---|
| (c)(1) | Be approved by the governing body. | Governing body approval resolution. |
| (c)(2) | Include a statement of the duties and privileges of each category of medical staff, such as active or courtesy. | Staff category article. |
| (c)(3) | Describe the organization of the medical staff. | Organization article and committee structure. |
| (c)(4) | Describe the qualifications a candidate must meet for the medical staff to recommend appointment by the governing body. | Qualifications and appointment procedure. |
| (c)(5) | Specify completion and documentation of the history and physical, any required update, and any permitted outpatient assessment under (c)(5)(i)–(v). The history and physical FAQ below explains timing, examiner qualifications and the conditional exception. | History and physical article and, if the staff chooses, the outpatient assessment policy. |
| (c)(6) | Include criteria for determining the privileges granted to individual practitioners and a procedure for applying them to people who request privileges. | Privileging criteria and procedure, request and evaluation forms. |
Under (a)(2), the staff examines all eligible candidates’ credentials and recommends appointments under State law, including scope-of-practice laws, and its bylaws, rules and regulations. Recommended and appointed candidates are subject to those documents and this section.
Organization and accountability
Paragraph (b) says the staff must be organized in a manner the governing body approves, and that if there is an executive committee, a majority of its members must be doctors of medicine or osteopathy. Responsibility for staff organization and conduct belongs to an individual doctor of medicine or osteopathy or, when the hospital’s State law permits, a doctor of dental surgery, dental medicine or podiatric medicine. Under paragraph (a)(1), the medical staff must periodically conduct appraisals of its members.
What the section does not spell out
The section sets no hearing procedure for individual practitioners. The only mention of peer review and due process rights guarantees is in paragraph (b)(4)(ii), for the bylaws of a unified and integrated staff. Any other hearing or peer review process comes from sources outside this section, so counsel reviews the draft against State law, including scope-of-practice law, which paragraph (a) names.
Who needs it and what triggers it?
IHS offers this work for new hospitals, mergers, conversions, outdated bylaws and systems considering unified staffs. These are project situations, not automatic federal deadlines: 42 CFR 482.22 requires an organized medical staff and approved bylaws; paragraph (b)(4) governs a unified staff.
How IHS helps
IHS assesses gaps against 42 CFR 482.22, maps documents and evidence to requirements, drafts program and clinical content for client clinicians to approve, reviews sample credentials files, and supports readiness for hospital review and adoption. Thomas G. Goddard, JD, PhD, IHS founder and former URAC Chief Operating Officer and General Counsel, leads the work. IHS runs three practice lines, Accreditation Consulting, Compliance Services and Program Development, and this build sits in Program Development, next to compliance program development and Compliance Services.
What IHS drafts
- The medical staff bylaws, for review and adoption.
- Rules and regulations.
- Appointment and privileging procedures and the request and evaluation forms.
- A periodic appraisal calendar for paragraph (a)(1).
What you supply
You supply the medical staff leadership's decisions on categories and criteria, governing body approval, counsel's review against State law, and, for a unified staff, the votes and records.
The real limit
Drafting is document work. Adoption by the medical staff and approval by the governing body are the hospital's acts. IHS does not decide clinical content, does not credential anyone, does not serve on a committee and does not guarantee a survey outcome.
What to have ready
Gather applicable records under 42 CFR 482.22 (current eCFR; page opened November 5, 2026):
- Current bylaws and governing-body approval ((c)(1)).
- Staff-category duties and privileges ((c)(2)).
- Organization chart and, if an executive committee exists, its roster showing a majority of doctors of medicine or osteopathy ((b)(2)).
- Person responsible for staff organization and conduct ((b)(3)).
- Credentials examination and appointment recommendation process ((a)(2)).
- Privileging criteria and procedures ((c)(6)).
- History-and-physical policy and any optional outpatient assessment policy ((c)(5)).
- Periodic appraisal process ((a)(1)).
- Telemedicine agreements, if applicable ((a)(3)–(4)).
- Unified-staff election records and evidence addressing all conditions, if this structure is contemplated or used ((b)(4)).
With the list in hand, the free introductory call is where IHS walks through it with you.
How it compares
| Structure | Federal framework |
|---|---|
| Separate hospital staff | Staff bylaws require governing-body approval under 482.22. |
| Unified system staff | Available subject to all conditions in 482.22(b)(4), summarized in the unified-staff FAQ below. |
| Opt-out | Each hospital’s privileged medical staff members may vote by majority, in accordance with medical staff bylaws, to maintain a separate staff. |
For individual distant-site telemedicine practitioners, the governing body may choose reliance on distant-site credentialing and privileging decisions when its staff recommends privileges, in lieu of (a)(1)–(2), only when the written agreement satisfies every applicable condition in (a)(3) or (a)(4). For a telemedicine entity, the agreement must also ensure services permit compliance with all applicable contracted-service conditions of participation under 482.12(e). Paragraph (c)(6) additionally applies 482.12(a)(8)–(9) (current eCFR; page opened November 5, 2026). See credentialing program design.
What it costs
42 CFR 482.22 is a federal condition of participation, and the text states no application fee or other authority fee.
The cost of a bylaws and credentialing build depends on how many hospitals and staff categories are involved, whether bylaws already exist, whether a system is weighing a unified staff, and whether the hospital uses telemedicine privileging.
IHS scopes each engagement after a free introductory call.
What this is not
- IHS is a consulting firm, not a law firm; this is not legal advice. Counsel reviews State law, and this page does not cover accreditor standards or state peer review law.
- IHS does not guarantee survey or licensing outcomes or credential practitioners.
- IHS does not contact, submit to or correspond with regulators or accreditors for the hospital; the hospital handles submissions.
Frequently asked questions
What do hospital medical staff bylaws have to include under 42 CFR 482.22?
Paragraph (c) requires governing-body approval, staff-category duties and privileges, staff organization, appointment qualifications, history-and-physical provisions including any permitted outpatient assessment policy, and privileging criteria and procedures. IHS drafts these provisions for hospital review.
Who approves the bylaws, the medical staff or the governing body?
The staff adopts and enforces the bylaws; the governing body approves them under (c)(1). This section does not specify that both actions require votes.
Who can be on the medical staff?
The staff must be composed of doctors of medicine or osteopathy. In accordance with State law, including scope-of-practice laws, it may also include other categories of physicians listed in 482.12(c)(1) and non-physician practitioners whom the governing body determines to be eligible for appointment.
What must the bylaws say about history and physical examinations?
Under (c)(5)(i)–(ii), the bylaws must require a medical history and physical examination completed and documented no more than 30 days before or 24 hours after admission or registration, before surgery or a procedure requiring anesthesia services; if completed within the preceding 30 days, an update including changes in condition must be completed and documented within 24 hours after admission or registration and before that surgery or procedure, except under (iii). Under (iii)–(v), the staff may instead maintain a policy identifying specific outpatient surgical or procedural patients for an assessment completed and documented after registration and before surgery or a procedure requiring anesthesia services. The staff must demonstrate that this policy applies only to those patients and is based on age, diagnoses, the type and number of scheduled surgeries and procedures, comorbidities, anesthesia level, nationally recognized assessment guidelines and practice standards, and applicable state and local health and safety laws; these optional-policy provisions do not apply if the staff retains the full history-and-physical and update requirements for all patients. Each examination, update or assessment must be completed and documented by a physician as defined in section 1861(r) of the Act, an oral and maxillofacial surgeon, or another qualified licensed individual, in accordance with State law and hospital policy.
Who is responsible for the organization and conduct of the medical staff?
Paragraph (b)(3) says that responsibility must be assigned only to a doctor of medicine or osteopathy or, when the law of the hospital's State permits, to a doctor of dental surgery or dental medicine or a doctor of podiatric medicine. The hospital names the person.
Can a hospital system have a unified and integrated medical staff?
Yes, for a system of multiple separately certified hospitals that elects this structure after determining compliance with all applicable State and local laws. Each hospital must demonstrate that all its medical staff members holding specific privileges voted by majority, in accordance with medical staff bylaws, to accept the structure or maintain a separate staff. The unified staff must have bylaws, rules and requirements addressing self-governance, appointment, credentialing, privileging, oversight, peer review policies, due process guarantees and a process advising each hospital’s privileged staff members of their opt-out rights after a majority vote to maintain a separate staff. It must account for each hospital’s unique circumstances and significant differences in patient populations and services, implement policies giving due consideration to staff needs and concerns regardless of practice or location, and have mechanisms to consider and address hospital-specific issues.
How do privileging criteria and the credentials examination fit together?
Under (a)(2), the staff examines all eligible candidates’ credentials and recommends appointments in accordance with State law, including scope-of-practice laws, and its bylaws, rules and regulations. The bylaws specify appointment qualifications under (c)(4) and privileging criteria and procedures under (c)(6), including the telemedicine conditions described above.
What does IHS draft and what do the medical staff and board do?
IHS drafts the bylaws, rules and regulations, appointment and privileging procedures, evaluation forms and an appraisal calendar. The medical staff leadership decides categories and criteria, the staff adopts the bylaws, and the governing body approves them.
Does counsel need to review the bylaws?
IHS includes hospital counsel’s review in the drafting process. Paragraph (a) ties eligibility and appointment to State law, including scope-of-practice laws; this section does not itself require counsel review or set an individual hearing procedure. IHS gives no legal advice.
Does the consultant contact CMS?
No. IHS does not contact, submit to or correspond with CMS or any state agency for the hospital.