Hospital (Accrediting Organizations)
In order for a healthcare organization to participate in and receive payment from the Medicare or Medicaid programs, it must meet the eligibility requirements and must be certified as complying with the Conditions of Participation (CoP), or standards, set forth in federal regulations. This certification is based on a survey conducted by a state agency on behalf of the Centers for Medicare & Medicaid Services (CMS). However, if a national Accrediting Organization (AO) has and enforces standards that meet the federal Conditions of Participation, CMS may grant the AO "deeming" authority and "deem" each health care facility accredited by the AO as meeting the CoPs. Thus each accredited health care facility would have a "deemed status" and would not be subject to the Medicare survey and certification process.
Hospitals have the option of becoming Medicare-certified on the basis of accreditation by a CMS-approved AO instead of a survey by CMS or States. In such cases, the applicants have an alternate route to Medicare certification via CMS' acceptance of the AO's accreditation survey. While the applicant will pay a fee to the AO for the initial survey, applicants may conclude that the benefits outweigh the expense, particularly the expense of time waiting for a no cost CMS survey as a result of CMS's adherence to a prioritized work load.
Accreditation is voluntary and seeking "deemed status" through accreditation is an option, not a requirement. Organizations seeking Medicare approval may choose to be surveyed either by an AO or by a state agency on behalf of CMS. All surveys for Medicare certification are unannounced.
CMS conducts random validation surveys and complaint investigations of accredited hospitals. In addition, AOs are obliged to provide CMS with a listing of, and related documentation for, organizations receiving conditional accreditation, preliminary denial of accreditation, and accreditation denied. They also must provide CMS with accreditation decision reports for hospitals involved in CMS validation surveys and any other survey report requested by CMS.
Sections 1861(e) and 1865(a) of the Act allow institutions accredited as hospitals by a CMS approved AO to be deemed to meet the CoPs, with the exception of the following:
- The utilization review (UR) condition;
- A standard promulgated by the Secretary which is a higher-than-accreditation requirement;
- The two special CoPs for psychiatric hospitals; and at this time, the Joint Commission is the only AO approved by CMS to conduct the survey of the 2 special CoPs for psychiatric hospitals.
- Any higher-than-national standards approved by the Secretary.
The following accrediting organizations have been approved by CMS for hospital accreditation surveys:
- The Joint Commission
- American Osteopathic Association's Healthcare Facilities Accreditation Program
- DNV-GL Healthcare
- Center for Improvement in Healthcare Quality
- Phone numbers for accrediting organizations