Deemed status

Getting deemed status

Meeting Conditions for Coverage and Conditions of Participation

For any organization to receive funding from Centers for Medicare and Medicaid Services (CMS), that organization must meet either the "Conditions for Coverage" or the "Conditions of Participation". These are a set of minimal standards which must be met before CMS will ever issue any reimbursement for Medicare and Medicaid Services. Two kinds of organizations can review a health care provider to check for compliance with these conditions - either a state level agency acting on behalf of CMS, or a national accreditation agency like the Joint Commission.[1]

Examples of some of the areas of focus for these minimal guidelines are the End Stage Renal Disease Program,[2] ambulatory surgical centers,[3] and organ procurement organizations.[4]

The standards for care for nursing homes were distributed as a result of the Nursing Home Reform Act.[5]

Outpatient clinics cannot receive deemed status.[6] A consequence of this is that the CMS payment systems can be more complicated at small clinics than at large hospitals for the same procedures.[6]

Conditions for Coverage and Conditions of Participation apply to these kinds of organizations:

  • Ambulatory Surgical Centers (ASCs)[7]
  • Community Mental Health Centers (CMHCs)[7]
  • Comprehensive Outpatient Rehabilitation Facilities (CORFs)[7]
  • Critical Access Hospitals (CAHs)[7]
  • End-Stage Renal Disease Facilities[7]
  • Federally Qualified Health Centers[7]
  • Home Health Agencies[7]
  • Hospices[7]
  • Hospitals[7]
  • Hospital Swing Beds[7]
  • Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID)[7]
  • Organ Procurement Organizations (OPOs)[7]
  • Portable X-Ray Suppliers[7]
  • Programs for All-Inclusive Care for the Elderly Organizations (PACE)[7]
  • Clinics, Rehabilitation Agencies, and Public Health Agencies as Providers of Outpatient Physical Therapy and Speech-Language Pathology Services[7]
  • Psychiatric Hospitals[7]
  • Religious Nonmedical Health Care Institutions[7]
  • Rural Health Clinics[7]
  • Long Term Care Facilities[7]
  • Transplant Centers[7]

When any of these organizations are reviewed, the survey checks quality assurance and not "continuous quality improvement".[8] In other words, the process checks for minimal expectations, and not to see whether the facility is actually improving.[8]

History

In 1994 about 5000 hospitals were eligible to receive CMS funding as a result of being reviewed by the Joint Commission.[9]

The Medicare Improvements for Patients and Providers Act of 2008 removed the deemed status of the Joint Commission and directed it to re-apply to CMS to seek continued authority to review hospitals for CfC and CoP.[10]

References
  1. Joint Commission (August 1, 2014). "Facts about federal deemed status and state recognition". jointcommission.org. Retrieved 18 June 2015.
  2. Centers For Medicare & Medicaid Services (Cms), HHS (Apr 2008). "Medicare and Medicaid programs; conditions for coverage for end-stage renal disease facilities. Final rule". Fed Regist. 73 (73): 20369–484. PMID 18464351.
  3. Centers For Medicare & Medicaid Services (Cms), HHS (Oct 2011). "Medicare program; changes to the ambulatory surgical centers patient rights conditions for coverage. Final rule". Fed Regist. 76 (205): 65886–90. PMID 22022736.
  4. Centers For Medicare & Medicaid Services (Cms), HHS (May 2006). "Medicare and Medicaid programs; conditions for coverage for organ procurement organizations (OPOs). Final rule". Fed Regist. 71 (104): 30981–1054. PMID 16749219.
  5. The National Consumer Voice for Quality Long-Term Care (n.d.). "Deemed Status for Medicare and Medicaid Providers - Federal Requirements for Skilled Nursing Facilities". theconsumervoice.org. Retrieved 18 June 2015.
  6. Settles, JA (October 1995). "Deemed status accreditation of nonhospital-based ambulatory surgery centers". Seminars in Perioperative Nursing. 4 (4): 199–204. PMID 7581344.
  7. Centers for Medicare & Medicaid Services (6 November 2013). "Conditions for Coverage (CfCs) & Conditions of Participations (CoPs)". cms.gov. Retrieved 18 June 2015.
  8. Wish, JB (1998). "Role of external oversight in quality activities: Accreditation, credentialing, licensure, and deemed status". American Journal of Kidney Diseases. 32 (6): S177–S181. doi:10.1016/S0272-6386(98)70184-2. ISSN 0272-6386. PMID 9892388.
  9. Jost, Timothy Stoltzfus (1994). "Medicare and the Joint Commission on Accreditation of Healthcare Organizations: A Healthy Relationship?". Law and Contemporary Problems. 57 (4): 15–45. doi:10.2307/1192055. ISSN 0023-9186. JSTOR 1192055.
  10. Battard Menendez, Juliet (2010). "The Impetus for Legislation Revoking the Joint Commission's Deemed Status as a Medicare Accrediting Agency". JONA's Healthcare Law, Ethics, and Regulation. 12 (3): 69–76. doi:10.1097/NHL.0b013e3181ee276f. ISSN 1520-9229. PMID 20733410.
This article is issued from Wikipedia. The text is licensed under Creative Commons - Attribution - Sharealike. Additional terms may apply for the media files.