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Feb 8 -- Accrediting Organization Proposed Rule Fact Sheet

Each year, Accrediting Organizations (AOs) with a CMS-approved program survey over 9,000 accredited health care providers and suppliers participating in the Medicare/Medicaid program for compliance with health and safety requirements. These accredited facilities must meet all applicable federal participation requirements and are deemed to meet them through their CMS-approved AO accreditation. The AO’s approved program standards must meet or exceed CMS health and safety standards to ensure the quality of care provided to patients. When AOs request and receive CMS approval to determine compliance for facilities they accredit and are deemed by CMS to meet federal requirements, they take on a public trust responsibility in their oversight of providers and suppliers across the country.

In recent years, CMS has identified several concerns related to AO performance:

-- Providers and suppliers that have been terminated from the Medicare/Medicaid program but retain accreditation despite significant quality and safety concerns;
-- AOs provide fee-based consulting services to the providers and suppliers they accredit, potentially affecting the integrity of the onsite survey process and decreasing public trust by creating conflicts of interest;
-- Inconsistent survey results due to differing AO standards or practices (such as AOs notifying facilities of the date of their onsite surveys in advance contrary to CMS policies).

CMS’s annual AO oversight Reports to Congress (RTCs) highlight the agency’s significant concerns regarding AO performance that need to be addressed. CMS is committed to improving current deficiencies and strengthening oversight of AOs and establishing greater consistency in survey processes and standards to improve patient care.

CMS takes its responsibility to ensure the quality and safety of patient care very seriously. We recognize there are opportunities to improve our current AO performance review process, so we can better assess whether AOs are meeting their public-trust obligations.

To fulfill this public-trust mission, CMS released a Notice of Proposed Rulemaking (NPRM) on February 8, 2024 to bolster oversight of AOs and ensure providers meet health and safety standards so that patients can receive high-quality, safe care from our nation’s health care facilities. The most recent AO oversight RTC, the 2021 RTC, covers the 2020 oversight and validation activities for all AOs in fiscal year 2020, as well as those under the Clinical Laboratory Improvement Amendments of 1988 (CLIA).     

The changes proposed in the NPRM would strengthen oversight of AOs, reduce conflicts of interest, and strive for enhanced consistency of survey processes, all of which aim to improve patient safety and quality of care. These proposed changes, which align with CMS’s National Quality Strategy, are outlined below:

-- Holding AOs accountable to the same standards as State Survey Agencies (SAs), that also conduct surveys on behalf of CMS.
-- Ensuring that AOs remain independent reviewers by addressing conflicts of interest and placing certain limitations on the fee-based consulting services AOs provide to the health care facilities they accredit.
-- Preventing AO conflicts of interest by prohibiting AO owners, surveyors, and other employees, and as well as their immediate family members that have an interest in or relationship with a health care facility accredited by the AO from participating in surveys, having input into the survey results and involvement in pre- or post-survey  activities of that facility, or from having access to survey records related to that facility.
-- Addressing potential and actual conflicts of interest by requiring AOs to report specific information to CMS about how they will monitor, prevent, and handle conflicts of interest and fee-based consulting services they provide.
-- Improving AO performance by requiring AOs with poor performance to submit a publicly reported correction plan to CMS.
-- Improving consistency and standardization in surveys nationwide by more closely aligning AO survey activity requirements and staff training with those of SAs.
-- Additional changes proposed in the NPRM would reduce the burden on providers, strengthen survey policies, and increase the transparency of AO practices.

Currently, CMS has approved nine AOs to survey and accredit Medicare-certified facilities. The changes outlined in the NPRM affect all AOs except those that accredit clinical laboratories and noncertified suppliers, which include suppliers of advanced diagnostic imaging (ADI), home infusion therapy (HIT), and diabetes self-management training (DSMT), as well as durable medical equipment (DME) suppliers and suppliers of durable medical equipment prosthetics, orthotics, and supplies (DMEPOS).

Additional details on the proposed changes in this rule are described in the table below: . . .

Accreditation of Medicare Certified Providers & Suppliers: https://www.cms.gov/medicare/health-safety-standards/accreditation-programs
Proposed rule: https://www.federalregister.gov/d/2024-02137
Fact sheet: https://www.cms.gov/newsroom/fact-sheets/accrediting-organization-proposed-rule-fact-sheet

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