Key Takeaways:
- Centers for Medicare and Medicaid Services (“CMS”) has finalized significant new oversight requirements for accrediting organizations that accredit Medicare and Medicaid-participating providers and suppliers.
- Accrediting organizations (“AOs”) will face new conflict-of-interest restrictions, including limitations on certain consulting services provided to facilities they accredit.
- CMS is establishing a new direct-observation validation process to evaluate AO performance and will require publicly reported corrective action plans for AOs with unacceptable performance scores.
Recently, CMS issued a Final Rule aimed at improving healthcare quality by increasing oversight of accrediting organizations.[1]
The rule imposes new safeguards designed to preserve AO independence and target conflicts of interest. It limits certain fee-based consulting services and prohibits AO owners, surveyors, employees and certain family members with relationships to accredited facilities from participating in surveys or related accreditation activities involving those facilities.
AOs will no longer be able to alert facilities of an impending survey before it begins. Further, AOs will not be permitted to conduct mock surveys for providers they accredit before initial surveys and within 12 months of re-accreditation.
CMS will hold AOs to the same Medicare standards applied by state survey agencies and will implement a new direct-observation validation survey process to assess AO performance. Notably, officials from state agencies, such as health departments, will now accompany AOs on validation surveys. AOs receiving unacceptable performance scores will be required to submit publicly reported corrective action plans.
According to CMS, the rule is in response to long-held concerns regarding AO survey performance, including accreditation of providers with significant quality and safety issues, potential conflicts arising from AO consulting services, and inconsistencies between AO and state survey practices.
Healthcare providers and suppliers accredited by AOs should anticipate increased scrutiny of accreditation activities and greater consistency between AO and state survey expectations. Organizations should review their relationships with accrediting bodies, evaluate any consulting arrangements that could be affected by the new conflict-of-interest provisions, and ensure continuous compliance with Medicare Conditions of Participation and other applicable federal requirements.
If you have any questions about what the final rule could mean for you and your organization, please contact your Dinsmore health care attorney.
[1] https://www.cms.gov/newsroom/press-releases/cms-ensures-accrediting-organizations-uphold-trust-standards-oversight