CMS Enhances Oversight of Accrediting Organizations for Medicare and Medicaid
The Centers for Medicare & Medicaid Services (CMS) has released an overview emphasizing the roles of accrediting organizations (AOs) responsible for surveying Medicare and Medicaid providers and suppliers. This document, dated June 12, underscores that AO accreditation standards must meet or surpass those of Medicare and Medicaid, ensuring quality and safety in patient care.
CMS-approved AOs conduct annual surveys of over 9,000 healthcare providers to verify compliance with health and safety standards. Once approved by CMS, these organizations assume a "public trust" role, conducting surveys as an alternative to state survey agencies, overseeing healthcare provider compliance.
CMS has highlighted several concerns regarding AO performance, including maintaining accreditation for providers terminated from Medicare or Medicaid due to safety issues, potential conflicts of interest from AOs providing consulting services to entities they accredit, and discrepancies in survey results stemming from differences in AO and state survey agency standards, including advanced notifications of onsite survey dates.
Regulatory Enhancements and the Role of AOs
To improve AO survey performance, CMS is committed to enhancing oversight, minimizing conflicts of interest, and ensuring consistency in survey practices. This effort aims to strengthen patient care and safety in participating facilities. The new "Strengthening Oversight of AO and Preventing AO Conflicts of Interest" rule aims to harmonize state and AO survey processes and promote transparency in provider accreditation.
CMS Administrator Mehmet Oz, M.D., emphasized the importance of accrediting organizations, stating, “The work accrediting organizations do is vital... With this new rule, CMS is advancing its commitment to upholding rigorous standards for accrediting organizations and ensuring the health and safety of American patients.”
The rule introduces new protocols for monitoring AO performance, standardizing survey processes, and updating validation systems. It mandates CMS training for AO surveyors equivalent to that of state counterparts and prohibits AOs from conducting pre-survey mock evaluations, ensuring the independence of the accreditation process.
"By applying Medicare conditions and requirements as the baseline standards, CMS ensures the application of consistent safety requirements across facilities," CMS stated. These regulatory enhancements aim to alleviate provider burdens, enhance survey procedures, and minimize regulatory compliance challenges while promoting robust patient safety measures.