What is federal deemed status?
In order for a health care organization to participate in and receive payment from the Medicare or Medicaid programs, it must meet the eligibility requirements for program participation, including a certification of compliance with the Conditions of Participation, 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. However, if a national accrediting organization, such as The Joint Commission, has and enforces standards that meet or exceed the federal Conditions of Participation, CMS may grant the accrediting organization “deeming” authority and deem each accredited health care organization as meeting Medicare and Medicaid certification requirements. The health care organization would have deemed status and would not be subject to Medicare’s survey and certification process.
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 accrediting body, such as The Joint Commission, or by state surveyors on behalf of CMS. All deemed status surveys are unannounced. Deemed status options are available for:
Ambulatory Surgical Centers. Effective December 1996, Joint Commission accredited centers are deemed to meet the Medicare Conditions for Coverage for Ambulatory Surgical Services. The deemed status survey is unannounced.
Clinical Laboratories. Laboratories that receive accreditation through a biennial survey are deemed to meet the requirements of the federal Clinical Laboratory Improvement Amendments (CLIA) of 1988. The Joint Commission began conducting surveys for CLIA certification in January 1995.
Critical Access Hospitals. Effective November 2002, Critical Access Hospitals accredited by The Joint Commission are deemed to meet Medicare certification requirements. The deemed status survey is unannounced.
Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS). Effective November 2006, The Joint Commission is deemed to accredit suppliers of DMEPOS as meeting new quality standards under Medicare Part B. In 2007, bidding will occur in 10 selected metropolitan areas for the equipment that is most frequently billed to Medicare. A supplier must have at least applied for accreditation to submit a bid, and must achieve full accreditation prior to being awarded a competitively bid contract.
Home Health. Effective June 1993, surveys to be used for deemed status must be unannounced. Survey intervals, which may be one, two or three years, will be determined using CMS criteria. More frequent surveys may be necessary for an accredited home health agency that, for example, has had a change of ownership.
Hospices. Effective June 1999, hospice deemed status surveys must be unannounced. This deemed status option is open to organizations seeking Medicare funding for hospice services as well as those already Medicare certified. Organizations choosing this option will be evaluated against both Joint Commission standards and Hospice Medicare Conditions of Participation. Accreditation remains voluntary and seeking deemed status through accreditation is not a requirement for Medicare certification.
Hospitals. Since the enactment of the Social Security Amendments of 1965, hospitals with Joint Commission accreditation have been deemed as meeting the federal Conditions of Participation for the Medicare and Medicaid programs. The deemed status survey is unannounced.
CMS conducts random validation surveys and complaint investigations of organizations with deemed status through Joint Commission accreditation. In addition, The Joint Commission is obliged to provide CMS with a listing of, and related documentation for, organizations receiving conditional accreditation, preliminary denial of accreditation, and accreditation denied. The Joint Commission also provides CMS with accreditation decision reports for hospitals involved in CMS validation surveys and any other survey report CMS requests.
Costs of deemed status survey allowable
CMS has determined that fees for surveys by The Joint Commission are allowable costs and may be included in a health care organization’s costs on its annual cost report for those organizations required to file cost reports.
Recognition for state licensure and certification
While federal deemed status does not typically provide an exemption from current state requirements for state licensure, The Joint Commission’s various accreditation programs are recognized and relied on by many states in the states’ quality oversight activities. Recognition and reliance refers to the acceptance of, requirement for, or other reference to the use of Joint Commission accreditation, in whole or in part, by one or more governmental agencies in exercising regulatory authority. Recognition and reliance may include use of accreditation for licensing certification or contracting purposes by various state agencies.
For more information
For information about deemed status, call The Joint Commission’s Washington, D.C., office at (202) 783-6655. For information on state initiatives, call The Joint Commission’s Division of Business Development, Government and External Relations, (630) 792-5269.
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