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 (CoPs) (or Conditions for Coverage, CfCs, for health care suppliers), which are set forth in federal regulations. The certification is based on a survey conducted by a state agency on behalf of the Centers for Medicare & Medicaid Services (CMS) or a national accrediting organization, such as The Joint Commission, that has been approved by CMS as having standards and a survey process that meets or exceeds Medicare’s requirements. Health care organizations that achieve accreditation through a Joint Commission deemed status survey are determined to meet Medicare and Medicaid requirements.
Voluntary deemed status options are available for:
- Ambulatory surgical centers
- Clinical laboratories
- Critical access hospitals
- Home health
- Hospice agencies
- Psychiatric hospitals
Accreditation is required for:
- Advanced diagnostic imaging services
- Durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) providers
- Opioid treatment programs (deeming authority is through the Substance Abuse Mental Health Services Administration or SAMHSA, not CMS)
CMS oversight of accrediting organizations
CMS conducts complaint investigations and random validation surveys of Joint Commission accredited and deemed organizations. In addition, The Joint Commission provides CMS with a listing of, and related documentation for, deemed organizations receiving decisions of accreditation with follow-up survey, contingent accreditation, preliminary denial of accreditation, and denial of accreditation. The Joint Commission also provides accreditation decision reports for deemed organizations involved in CMS validation surveys and any other deemed status survey report requested by CMS.
Costs of deemed status survey allowable
CMS has determined that fees Joint Commission surveys 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
The Joint Commission’s accreditation and certification 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 and certification, in whole or in part, by one or more governmental agencies in exercising regulatory authority. This may include use of Joint Commission accreditation and certification 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 about state initiatives, call the Division of Business Development, Government and External Relations, at 630-792-5269.