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Monday 9:41 CST, April 21, 2014

State Recognition Details

State Recognition Contact Directory

Report a Complaint
800-994-6610

Jennifer Hoppe
Associate Director
630-792-5261

Karen Eberspacher
Government Relations Specialist
630- 792-5269


The Joint Commission actively monitors state legislative and regulatory activities for the purpose of identifying additional opportunities for state reliance on Joint Commission accreditation/certification.

The Joint Commission’s various accreditation/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, 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. 
 

STATE: PROGRAM:
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State: Florida
Program: Office-Based Surgery
Agency: Department of Health – Board of Medicine
State Reference: F.S.A. § 458.309
Setting/Service: Office-Based Surgery
Type of Recognition: Licensure

(3) All physicians who perform level 2 procedures lasting more than 5 minutes and all level 3 surgical procedures in an office setting must register the office with the department unless that office is licensed as a facility pursuant to chapter 395. The department shall inspect the physician's office annually unless the office is accredited by a nationally recognized accrediting agency or an accrediting organization subsequently approved by the Board of Medicine. The actual costs for registration and inspection or accreditation shall be paid by the person seeking to register and operate the office setting in which office surgery is performed.

State: Florida
Program: Office-Based Surgery
Agency: Department of Health – Board of Medicine
State Reference: 64 FL ADC 64B8-9.0091
Setting/Service: Office-Based Surgery
Type of Recognition: Licensure

(a) Unless the physician has previously provided written notification of current accreditation by a nationally recognized accrediting agency or an accrediting organization approved by the Board the physician shall submit to an annual inspection by the Department. Nationally recognized accrediting agencies are the American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF), Accreditation Association for Ambulatory Health Care (AAAHC) and Joint Commission on Accreditation of Healthcare Organizations (JCAHO). All nationally recognized and Board-approved accrediting organizations shall be held to the same Board-determined surgery and anesthesia standards for accrediting Florida office surgery sites.

State: Florida
Program: Office-Based Surgery
Agency: Department of Health – Board of Osteopathic Medicine
State Reference: 64 FL ADC 64B15-14.0076
Setting/Service: Office-Based Surgery
Type of Recognition: Licensure

(a) Unless the osteopathic physician has previously provided written notification of current accreditation by a nationally recognized accrediting agency or an accrediting organization approved by the Board the osteopathic physician shall submit to an annual inspection by the Department. Nationally recognized accrediting agencies are the American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF), Accreditation Association for Ambulatory Health Care (AAAHC), Joint Commission on Accreditation for Ambulatory Healthcare Organizations (JCAHO), American Osteopathic Association (AOA), and AOA Healthcare Facilities Accreditation Program (HFAP). All nationally recognized and Board-approved accrediting organizations shall be held to the same Board-determined surgery and anesthesia standards for accrediting Florida office surgery sites.

State: Florida
Program: Behavioral Health Care
Agency: Department of Public Health
State Reference: F.S.A. § 395.002
Setting/Service: Intensive Residential Treatment Programs
Type of Recognition: Licensure

(1) “Accrediting organizations” means the Joint Commission on Accreditation of Healthcare Organizations, the American Osteopathic Association, the Commission on Accreditation of Rehabilitation Facilities, and the Accreditation Association for Ambulatory Health Care, Inc.

(15) “Intensive residential treatment programs for children and adolescents” means a specialty hospital accredited by an accrediting organization as defined in subsection (1) which provides 24-hour care and which has the primary functions of diagnosis and treatment of patients under the age of 18 having psychiatric disorders in order to restore such patients to an optimal level of functioning.


State: Florida
Program: Nursing Care Center
Agency: Department of Social Welfare
State Reference: F.S.A. § 430.80
Setting/Service: Nursing Homes
Type of Recognition: Licensure

(3) To be designated as a teaching nursing home, a nursing home licensee must, at a minimum:

(a) Provide a comprehensive program of integrated senior services that include institutional services and community-based services;

(b) Participate in a nationally recognized accreditation program and hold a valid accreditation, such as the accreditation awarded by the Joint Commission on Accreditation of Healthcare Organizations;


State: Florida
Program: Behavioral Health Care
Agency: The Department of Public Health and The Agency for Health Ca
State Reference: F.S.A. § 394.90
Setting/Service: Community Substance Abuse and Mental Health Services
Type of Recognition: Licensure

(5) The agency shall accept, in lieu of its own inspections for licensure, the survey or inspection of an accrediting organization, if the provider is accredited according to the provisions of s. 394.741 and the agency receives the report of the accrediting organization.

State: Georgia
Program: Behavioral Health Care
Agency: Department of Community Health
State Reference: GA ADC 111-2-2-.26 
Setting/Service: Psychiatric and/or Substance Abuse Inpatient Programs
Type of Recognition: Licensure

(f) An applicant for a new psychiatric and/or substance abuse inpatient program(s) shall demonstrate the intent to meet the standards of the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) applicable to the type of program to be offered within 12 months of offering the new program. Extended care programs may demonstrate their intent to meet the standards of the Council on the Accreditation of Rehabilitation Facilities (CARF) or the Council on Accreditation (COA) in lieu of JCAHO.

(g) An applicant for an expanded psychiatric and/or substance abuse inpatient program(s) shall be accredited by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) for the type of program which the applicant seeks to expand prior to application. The applicant must provide proof of such accreditation. Extended care programs may be accredited by the Council on the Accreditation of Rehabilitation Facilities (CARF) or the Council on Accreditation (COA) in lieu of JCAHO.


State: Georgia
Program: Disease-Specific Care
Agency: Department of Community Health
State Reference: Ga. Code Ann., § 31-11-113  
Setting/Service: Primary Stroke Centers
Type of Recognition: Licensure/Designation

(a) A hospital identified as a primary stroke center shall be certified as such by the Joint Commission on Accreditation of Healthcare Organizations. Any hospital wishing to receive official identification under this Code section must submit a written application to the department, providing adequate documentation of the hospital's valid certification as a primary stroke center by the commission.

State: Georgia
Program: Home Care
Agency: Department of Community Health
State Reference: GA ADC 111-2-2-.32
Setting/Service: Home Health Agencies
Type of Recognition: Licensure

(i) An applicant for a new home health agency shall provide evidence of the intent to meet the appropriate accreditation requirements of the Joint Commission for Accreditation of Health Care Organizations (JCAHO), the Community Health Accreditation Program, Inc. (CHAP), and/or other appropriate accrediting agencies. (j) An applicant for an expanded home health agency shall provide documentation that they are fully accredited by the Joint Commission for Accreditation of Health Care Organizations (JCAHO), the Community Health Accreditation Program, Inc. (CHAP), and/or other appropriate accrediting agency.

State: Georgia
Program: Nursing Care Center
Agency: Department of Community Health
State Reference: Ga. Code Ann., § 31-7-1
Setting/Service: Nursing Home
Type of Recognition: Licensure

(4) “Institution” means:

(A) Any building, facility, or place in which are provided two or more beds and other facilities and services that are used for persons received for examination, diagnosis, treatment, surgery, maternity care, nursing care, or personal care for periods continuing for 24 hours or longer and which is classified by the department, as provided for in this chapter, as either a hospital, nursing home, or personal care home;

(b) The department may accept the certification or accreditation of an institution by the Joint Commission on the Accreditation of Hospitals, the American Osteopathy Association, or other accreditation body, in accordance with specific standards, as evidence of that institution's compliance with the substantially equivalent departmental requirements for issuance or renewal of a permit or provisional permit, provided that such certification or accreditation is established prior to the issuance or renewal of such permits. The department may not require an additional departmental inspection of any institution whose certification or accreditation has been accepted by the department, except to the extent that such specific standards are less rigorous or less comprehensive than departmental requirements. Nothing contained in this Code section shall prohibit departmental inspections for violations of such standards or requirements nor shall it prohibit the revocation of or refusal to issue or renew permits, as authorized by Code Section 31-7-4, or for violation of any other applicable law or regulation pursuant thereto.


State: Georgia
Program: Nursing Care Center
Agency: Department of Community Health
State Reference: GA ADC 111-2-2-.30
Setting/Service: New or Expanded Nursing Facilities
Type of Recognition: Licensure

(f) An applicant for a new or expanded nursing facility must provide evidence of the intent to meet all appropriate requirements regarding quality of care as follows:

6. In competing applications, favorable consideration will be given to an applicant that provides evidence of the ability to meet accreditation requirements of appropriate accreditation agencies within two years after the facility becomes operational.


State: Georgia
Program: Home Care
Agency: Department of Health
State Reference: GA ADC 290-5-38-.04
Setting/Service: Home Health Agencies
Type of Recognition: Licensure

These rules and regulations shall not apply to services which are provided under the following conditions:(a) Persons who provide personal or paraprofessional health services, either with or without compensation when there is no claim that the service is provided as a part of a licensed Home Health Agency; (b) Persons who provide professional services for which they are duly licensed under Georgia laws, when there is no claim that the service is provided as a part of a licensed Home Health Agency; (c) Services provided under the provisions of any other license issued by the State of Georgia when there is no claim that the service is provided as a part of a licensed or certified Home Health Agency; (d) Any Home Health Agency certified in a Federal program for reimbursement of Medicare or Medicaid services shall be exempt from an additional on-site licensure inspection upon presentation of evidence of such certification.

State: Georgia
Program: Laboratory Services
Agency: Department of Health
State Reference:
Setting/Service: Laboratory
Type of Recognition: Licensure

CLIA Certification

State: Georgia
Program: Hospitals
Agency: Department of Human Resources
State Reference: GA ADC 290-9-7
Setting/Service: Hospital
Type of Recognition: Licensure

(e) Accreditation in Place of Periodic Inspection. The Department may accept the accreditation of a hospital by the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO), the American Osteopathy Association (AOA), or other approved accrediting body, in accordance with specific standards determined by the Department to be substantially equivalent to state standards, as representation that the hospital is or remains in compliance with these rules.

1. Hospitals accredited by an approved accrediting body shall present to the Department a copy of the full certification or accreditation report each time there is an inspection by the accreditation body and a copy of any reports related to the hospital's accreditation status within thirty (30) days of re-ceipt of the final report of the inspection.

2. Hospitals accredited by an approved accrediting body are excused from pe-riodic inspections. However, these hospitals may be subjected to random in-spections by the Department


State: Georgia
Program: Ambulatory Health Care
Agency: Department of Human Resources
State Reference: Ga. Code Ann., § 31-7-3 
Setting/Service: Ambulatory Surgical Center
Type of Recognition: Licensure

b) The department may accept the certification or accreditation of an institution by the Joint Commission on the Accreditation of Hospitals, the American Osteopathy Association, or other accreditation body, in accordance with specific standards, as evidence of that institution's compliance with the substantially equivalent departmental requirements for issuance or renewal of a permit or provisional permit, provided that such certification or accreditation is established prior to the issuance or renewal of such permits. The department may not require an additional departmental inspection of any institution whose certification or accreditation has been accepted by the department, except to the extent that such specific standards are less rigorous or less comprehensive than departmental requirements.

State: Georgia
Program: Behavioral Health Care
Agency: Department of Human Resources
State Reference: 290-4-2-.06.
Setting/Service: Drug Abuse Treatment and Education Programs
Type of Recognition: Licensure

The department may issue a license to a program that provides proof of accreditation by an accreditation agency approved by the department, if the accreditation agency's requirements are substantially equivalent or more stringent than the requirements of these rules. The license may be issued without an on-site visit by the department, however, the department reserves the right to inspect accredited programs on a sample validation basis or whenever there is reason to believe that the requirements of these rules are not being met. Provided however, any denial, suspension, or revocation of such accreditation shall result in similar licensure actions, and the governing body shall be required to apply for a new license. For purpose of this rule, proof of accreditation shall require a copy of the program's most recent accreditation report together with any supplemental recommendations or reports. Such reports shall be submitted to the department whenever received by a program or whenever requested by the department.

 


State: Georgia
Program: Behavioral Health Care
Agency: Department of Social Services – Services for the Aging
State Reference: Ga. Code Ann., § 49-6-85
Setting/Service: Adult Day Care Centers
Type of Recognition: Licensure

An adult day center for which an application for a license has been submitted or to which a license has been issued shall be inspected by the department periodically and as determined necessary to monitor such center's compliance with applicable laws and regulations; provided, however, the department may exempt a center from inspection if such center has been certified or accredited by a certification or accreditation entity recognized and approved by the department if such entity uses standards that are substantially similar to those established by the department.  A center seeking exemption from inspection shall be required to submit to the department documentation of certification or accreditation, including a copy of its most recent certification or accreditation inspection report, which shall be maintained by the department as a public record.


State: Georgia
Program: Behavioral Health Care
Agency: GEORGIA DEPARTMENT OF BEHAVIORAL HEALTH AND
State Reference: User’s Guide Adult Application– Specialty Services
Setting/Service: BEHAVIORAL HEALTH PROVIDER - ADULT SPECIALTY SERVICES
Type of Recognition: Medicaid

 

Consideration will only be given to providers who are currently and appropriately accredited by one of the approved accrediting agencies and have been providing behavioral health services for a minimum of one year.

The DBHDD accepts accreditation from the following agencies:

TJC – The Joint Commission
CARF – Commission on Rehabilitation of Rehabilitative Facilities
CQL – The Council on Quality and Leadership
COA – Council on Accreditation

Note:  A copy of the agency’s accreditation certificate and most recent accreditation survey report must be submitted with Medicaid application


State: Georgia
Program: Home Care
Agency: Georgia Medicaid
State Reference: DME Provider Manual
Setting/Service: Durable Medical Equipment Providers
Type of Recognition: Medicaid Requirement

Accreditation: The deadline for all DME Provides/Suppliers to become accredited has been extended to September 2009. Effective September 1, 2009:

A. Complex Custom Rehab Suppliers must be accredited through one of the following approved Accreditation Companies for the service of Complex Custom Assistive Technology:

  1. The Joint Commission (JCAHO)
  2. Commission on Accreditation of Rehabilitation Facilities (CARF)
  3. Community Health Accreditation Program (CHAP)
  4. Healthcare Quality Association on Accreditation (HQAA)
  5. Accreditation Commission for Healthcare (ACHC)

B. Complex Respiratory Providers must be accredited through one of the following approved Accreditation Companies:

  1. The Joint Commission (JCAHO)
  2. Commission on Accreditation of Rehabilitation Facilities (CARF)
  3. Community Health Accreditation Program (CHAP)
  4. Healthcare Quality Association on Accreditation (HQAA)
  5. Accreditation Commission for Healthcare (ACHC), or
  6. The Compliance Team

C. All other Durable Medical Equipment Providers (excluding Complex Custom Rehab Suppliers and Custom Respiratory) must be or be in the process of being accredited by one of the following Medicare approved Accreditation Companies: JCAHO, CARF, CHAP, HQAA, ACHC, BOC, the Compliance Team/ Exemplary Provider and NAPB


 

 
 


State: Hawaii
Program: Hospitals
Agency: Department of Health
State Reference: HI ST § 321 -14.5
Setting/Service: Hospital
Type of Recognition: Licensure

SECTION 1. Section 321-14.5, Hawaii Revised Statutes, is amended by amending subsection (c) to read as follows:


 

"(c) The rules may provide that accreditation by the joint commission on accreditation of healthcare organizations demonstrates a hospital's compliance with all licensing inspections required by the State. The rules may exempt a hospital from a licensing inspection on a continuing basis throughout the term of the accreditation under the following conditions:

(1) The hospital provides a certified copy of the hospital's official joint commission on accreditation of healthcare organizations accreditation report to the department;

(2) The hospital continuously holds full accreditation by the joint commission on accreditation of healthcare organizations; and

(3) The hospital holds a current and valid state license."
 

State: Hawaii
Program: Laboratory Services
Agency: Department of Health
State Reference: HI ADC § 11-110.1-7
Setting/Service: Laboratory (Class I)
Type of Recognition: Licensure

(e) The department may inspect the laboratory for initial approval and renewal of its class I permit. A clinical laboratory with a class I permit shall allow the inspection of its premises, records, materials, equipment, and methodology by a representative of the department at any time during the laboratory's working hours. The department may accept the on-site inspections of the College of American Pathologists, Joint Commission on Accreditation of Healthcare Organizations, U.S. Department of Health and Human Services Centers for Medicare and Medicaid Services, and other agencies, provided that these agencies have standards that are substantially equal to or more stringent than the requirements of subparts 1 and 2 of this chapter.

State: Hawaii
Program: Laboratory Services
Agency: Department of Health
State Reference: HI ADC § 11-110.1-8
Setting/Service: Laboratory (Class II)
Type of Recognition: Licensure

(e) The department may inspect the laboratory for initial approval and renewal of a class II permit. A clinical laboratory with a class II permit shall allow the inspection of its premises, records, materials, equipment, and methodology, by a representative of the department at any time during the laboratory's working hours. The department may accept the on-site inspections of the College of American Pathologists, Joint Commission on Accreditation of Healthcare Organizations, U.S. Department of Health and Human Services Centers for Medicare and Medicaid Services, and other agencies, provided that these agencies have standards that are substantially equal to or more stringent than the requirements of this section.

State: Hawaii
Program: Laboratory Services
Agency: Department of Health
State Reference: HI ADC § 11-110.1-9
Setting/Service: Laboratory
Type of Recognition: Licensure

(c) The department may inspect the laboratory for initial approval and renewal of its clinical laboratory license. A licensed clinical laboratory shall allow the inspection of its premises, records, materials, equipment, and methodology, by a representative of the department at any time during the laboratory's working hours. The department may accept the on-site inspections of the College of American Pathologists, Joint Commission on Accreditation of Healthcare Organizations, U.S. Department of Health and Human Services Centers for Medicare and Medicaid Services, and other agencies, provided that these agencies have standards that are substantially equal to or more stringent than the requirements of this section.

State: Hawaii
Program: Behavioral Health Care
Agency: Department of Human Services
State Reference: HI ADC § 17-1737-44.1
Setting/Service: Crisis Management; Biopsychosocial Rehabilitative Program; Intensive Family Intervention; Intensive Outpatient Hospital Services; Assertive Community Treatment
Type of Recognition: Insurance

(a) Medical payments to eligible providers may be made for the following types of community mental health rehabilitative services:

(1) Crisis management: This service provides mobile assessment for individuals in active state of crisis (twenty-four hours per day, seven days a week). Immediate response is required. Crisis management services include referral to licensed psychiatrist, licensed psychologist, or to an inpatient acute care hospital. The presenting crisis situation may necessitate that the services be provided in the consumer's home or natural environment setting, such as the home, school, work environment, or other community setting as well as in a health care setting. These services are provided through agencies accredited by a national accreditation organization.

(3) Biopsychosocial Rehabilitative Programs: This is a therapeutic day rehabilitative social skill building service which allows individuals with serious mental illness to gain the necessary social and communication skills necessary to allow them to remain in or return to naturally occurring community programs. Provider qualifications to provide these services are ensured by provider compliance with requirements and standards of a national accreditation organization.

(4) Intensive Family Intervention: These are time limited intensive interventions intended to stabilize the living arrangement, promote reunification or prevent the utilization of out of home therapeutic resources (i.e. psychiatric hospital, therapeutic foster care, residential treatment facility) for children with serious emotional or behavioral disturbances or adults with serious mental illness. Additionally, provider qualifications must be in compliance with requirements and standards of a national accreditation organization.

(6) Intensive outpatient hospital services: These are outpatient hospital services for the purpose of providing stabilization of psychiatric impairments as well as enabling the individual to reside in the community or to return to the community from a more restrictive setting. The services must be provided in the outpatient area or clinic of a licensed hospital certified by a national accreditation organization or other licensed facility that is Medicare certified for coverage of partial hospitalization/day treatment.

(7) Assertive Community Treatment (ACT): This is an intensive community rehabilitation service for individuals who are either children with serious emotional or behavioral disturbance or adults with a serious mental illness. Provider qualifications to provide these services are ensured by provider compliance with requirements and standards of a national accreditation organization.


State: Hawaii
Program: Behavioral Health Care
Agency: Department of Human Services
State Reference: HI ADC § 17-1737-18.1 
Setting/Service: Inpatient Psychiatric Services for Individuals Under 21
Type of Recognition: Insurance

(a) Inpatient psychiatric services for recipients under age twenty-one shall be provided:

(1) Under the direction of a physician;

(2) By:

(A) A psychiatric hospital or an inpatient psychiatric program that is accredited by the joint commission on accreditation of healthcare organizations;

or

(B) A psychiatric facility which is accredited by the joint commission on accreditation of healthcare organizations, the commission on accreditation of rehabilitation facilities, the council on accreditation of services for families and children, or by any other accrediting organization, with comparable standards that is recognized by the State;

and

(C) Is authorized to practice under the Medicaid program and meets the provisions of chapter 17-1736.


State: Hawaii
Program: Behavioral Health Care
Agency: Department of Insurance
State Reference: HRS § 431M-1
Setting/Service: Mental Health Outpatient Facility
Type of Recognition: Insurance

“Mental Health Outpatient Facility” means a health establishment, clinic, institution, center, or community mental health center, that provides for the diagnosis, treatment, care, or rehabilitation of mentally ill persons, that has been accredited by the Joint Commission on Accreditation of Health Care Organizations or the Commission on Accreditation of Rehabilitation Facilities or certified by the department of health.

State: Idaho
Program: Laboratory Services
Agency: Bureau of Laboratories
State Reference: ID ADC 16.02.06.012 
Setting/Service: Laboratory
Type of Recognition: Licensure

02. Other Certifying Agencies. Laboratories shall be excluded from compliance with these rules (except Sections 011 and 022) upon submission of annual evidence of certification from one (1) of the following agencies: (12-31-91) a. Center for Disease Control for testing of specimens in interstate commerce; (1-1-77) b. College of American Pathologists; (1-1-77) c. Medicare Title XVIII standards, providing they are also in compliance with Sections 022 and 023; (12-31-91) d. Laboratories located in hospitals approved by the Joint Commission on Accreditation of Hospitals; (1-1-87) e. Such other certification programs as may be approved by the Director. (12-31-91)

State: Idaho
Program: Behavioral Health Care
Agency: Department of Health and Welfare
State Reference: ID ADC 16.06.03.021
Setting/Service: Alcohol/Drug Abuse Prevention and Treatment Programs
Type of Recognition: Licensure

04. Acceptance Of JCAHO Accreditation. The Department may accept JCAHO accreditation as satisfaction of approval requirements. (4-5-00)

State: Idaho
Program: Home Care
Agency: Department of Health and Welfare
State Reference: I.C. § 39-2403 
Setting/Service: Home Health Agencies
Type of Recognition: Licensure

After January 1, 1993, no private or public agency or organization may advertise, operate, manage, conduct, open, maintain, or hold itself out to the public to be a home health agency unless licensed by the department of health and welfare. The department may grant licenses without conducting a licensure survey to Medicare certified agencies or agencies currently accredited by an accrediting body recognized by the health care financing administration pursuant to rules and regulations developed by the board prescribing the conditions under which these actions are made.

State: Idaho
Program: Hospitals
Agency: Department of Health and Welfare
State Reference: Memorandum of Understanding dated January 23, 1996.
Setting/Service: Hospital
Type of Recognition: Licensure

Hospital must file performance report and any monitoring reports in order to receive licensure in lieu of routine inspections.

State: Illinois
Program: Home Care
Agency: Department of Aging
State Reference: 89 IL ADC 240.1505
Setting/Service: In-Home Services
Type of Recognition: Licensure

B) The Department reserves the right to:

i) adjust the experience requirements specified in subsection (a)(5)(A) if the provider agency submits proof of current accreditation or certification by an appropriate national organization for the service for which Department certification is being requested. For in-home services, the following national accreditation organizations are acceptable:

Accreditation Commission for Health Care (2005, no later amendments or editions included), 4700 Falls of Neuse Rd., Suite 280, Raleigh NC 27609;

Community Health Accreditation Program (2004, no later amendments or editions included), 1300 19th St., Suite 150, Washington DC 20036;

The Joint Commission (2009, no later amendments or editions included), One Renaissance Blvd., Oakbrook Terrace IL 60181.


State: Illinois
Program: Behavioral Health Care
Agency: Department of Alcoholism and Substance Abuse
State Reference: 77 IL ADC 2090.50  and 77 IL ADC 2060.315
Setting/Service: Sub-acute Alcoholism and Substance Abuse Treatment Programs
Type of Recognition: Licensure

Each provider shall have and adhere to a quality improvement plan developed in compliance with the provisions in 77 Ill. Adm. Code 2060.315. i) All treatment and intervention licensees shall develop and maintain a written policy and procedures manual that describes the operation of the organization. At a minimum, the manual shall explain how the organization will comply with all federal and State regulatory and contractual requirements, any additional requirements from independent accrediting bodies, and any other organizational policies and procedures. The manual shall be approved by the board of directors of the organization or, if not applicable, the organization representative and annually reviewed and revised as necessary. The manual shall be submitted to the Department at the time of licensure and upon request from Department staff. The manual shall also be reviewed during the first year of employment by all staff. Annually thereafter, the organization shall ensure that all staff shall review updated sections pertinent to such staff.

State: Illinois
Program: Behavioral Health Care
Agency: Department of Children and Family Services
State Reference: 89 IL ADC 411.45 
Setting/Service: Secure Child Care Facility
Type of Recognition: Licensure

a) Upon request, the Department shall issue an application for a license to operate a secure child care facility to a qualified applicant, as defined in this Part. The application for license or the renewal of a license shall be completed and signed by the governing body of the facility or its authorized representatives on forms prescribed and furnished by the Department.

b) The application shall include the following:

1) Documentation of accreditation by one or more of the following nationally recognized accrediting organizations:

B) The Joint Commission on Accreditation of Healthcare Organizations (JCAHO), One Renaissance Boulevard, Oakbrook Terrace, Illinois 60181. Documentation of current accreditation status shall be achieved by submission by the secure child care facility to the Department of a certificate of accreditation and the most recent accreditation report, and a letter from the accrediting organization (see definition of “Qualified Applicant”), dated within 30 days prior to the date of the application for licensure, stating that the secure child care facility is in good standing with the organization.


State: Illinois
Program: Behavioral Health Care
Agency: Department of Children and Family Services
State Reference: 59 IL ADC 135.10
Setting/Service: Residential Treatment Facilities
Type of Recognition: Licensure

“Licensed private facilities.” Residential treatment facilities licensed by the Department of Children and Family Services (DCFS) in accordance with DCFS rules at 89 Ill. Adm. Code 404, Licensing Standards for Child Care Institutions and Maternity Centers, or, for out-of-state facilities, in accordance with Section 15.1 of the Mental Health and Developmental Disabilities Administrative Act [20 ILCS 1705/15.1], which have been accredited by the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) as a psychiatric facility serving children and adolescents or which have been surveyed and approved by the Department as meeting standards equivalent to standards for psychiatric facilities serving children and adolescents found in the 1997 Standards for Behavioral Health Care (the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), One Renaissance Boulevard, Oakbrook Terrace, Illinois 60181 (1996)).

State: Illinois
Program: Ambulatory Health Care
Agency: Department of Healthcare and Family Services
State Reference: 89 IL ADC 140.438 
Setting/Service: Imaging Centers
Type of Recognition: Medical Assistance Program

Participation Requirements for Imaging Centers To participate in the Illinois Medical Assistance program, an imaging center must, in addition to any other Department requirements, be licensed or certified:

A) for participation in the Medicare program; or
B) by the Joint Commission on Accreditation of Health Care Organizations (JCAHO); or
C) by a local or public health department; or
D) by any government agency having jurisdiction over the services provided and/or the equipment being used.


State: Illinois
Program: Behavioral Health Care
Agency: Department of Healthcare and Family Services
State Reference: 89 IL ADC 148.40
Setting/Service: Inpatient Psychiatric Treatment/Facilities for Individuals Under 21
Type of Recognition: Licensure

5) A psychiatric hospital must be accredited by the Joint Commission on the Accreditation of Health Care Organizations to provide services to program participants under 21 years of age or be Medicare certified to provide services to program participants 65 years of age and older. Distinct part psychiatric units and psychiatric hospitals located in the State of Illinois, or within a 100 mile radius of the State of Illinois, must execute an interagency agreement with a Department of Human Services (DHS) operated mental health center (State-operated facility) for coordination of services including, but not limited to, crisis screening and discharge planning to ensure linkage to aftercare services with private practitioners or community mental health services, as described in subsection (a)(6) of this Section.

State: Illinois
Program: Behavioral Health Care
Agency: Department of Human Services
State Reference: 89 IL ADC 590.60 
Setting/Service: Services for Individuals with Mental or Physical Disabilities
Type of Recognition: Licensure

To be qualified to provide the services specified in Section 590.40 of Part, the following shall apply:

b) Hospitals used to provide services to customers under this Part must be approved by the Joint Commission on Accreditation of Hospitals.


State: Illinois
Program: Behavioral Health Care
Agency: Department of Human Services
State Reference: 405 ILCS 30/3
Setting/Service: Mental Health and Substance Abuse Treatment Services
Type of Recognition: Licensure

(d-5) Accreditation requirements for providers of mental health and substance abuse treatment services. Except when the federal or State statutes authorizing a program, or the federal regulations implementing a program, are to the contrary, accreditation shall be accepted by the Department in lieu of the Department's facility or program certification or licensure onsite review requirements and shall be accepted as a substitute for the Department's administrative and program monitoring requirements, except as required by subsection (d-10), in the case of:

(1) Any organization from which the Department purchases mental health or substance abuse services and that is accredited under any of the following: the Comprehensive Accreditation Manual for Behavioral Health Care (Joint Commission on Accreditation of Healthcare Organizations (JCAHO)); the Comprehensive Accreditation Manual for Hospitals (JCAHO); the Standards Manual for the Council on Accreditation for Children and Family Services (Council on Accreditation for Children and Family Services (COA)); or the Standards Manual for Organizations Serving People with Disabilities (the Rehabilitation Accreditation Commission (CARF)).

(2) Any mental health facility or program licensed or certified by the Department, or any substance abuse service licensed by the Department, that is accredited under any of the following: the Comprehensive Accreditation Manual for Behavioral Health Care (JCAHO); the Comprehensive Accreditation Manual for Hospitals (JCAHO); the Standards Manual for the Council on Accreditation for Children and Family Services (COA); or the Standards Manual for Organizations Serving People with Disabilities (CARF).

(3) Any network of providers from which the Department purchases mental health or substance abuse services and that is accredited under any of the following: the Comprehensive Accreditation Manual for Behavioral Health Care (JCAHO); the Comprehensive Accreditation Manual for Hospitals (JCAHO); the Standards Manual for the Council on Accreditation for Children and Family Services (COA); the Standards Manual for Organizations Serving People with Disabilities (CARF); or the National Committee for Quality Assurance. A provider organization that is part of an accredited network shall be afforded the same rights under this subsection.


State: Illinois
Program: Behavioral Health Care
Agency: Department of Human Services
State Reference: 20 ILCS 1705/15.2
Setting/Service: Adult Developmental Training Day Services
Type of Recognition: Licensure

The Department shall annually certify that adult developmental training day services providers meet minimum standards. The Department may determine that providers accredited under nationally recognized accreditation programs are deemed to have met the standards established by the Department under this Section. The Department shall, at least quarterly, review the services being provided to assure compliance with the standards. The Department may suspend, refuse to renew or deny certification to any provider who fails to meet any or all such standards, as provided by rule.

State: Illinois
Program: Disease-Specific Care
Agency: Department of Public Health
State Reference: 210 ILCS 50/3.117
Setting/Service: Primary Stroke Centers
Type of Recognition: Licensure/Designation

(a) The Department shall attempt to designate Primary Stroke Centers in all areas of the State.

(1) The Department shall designate as many certified Primary Stroke Centers as apply for that designation provided they are certified by a nationally-recognized certifying body, approved by the Department, and certification criteria are consistent with the most current nationally-recognized, evidence-based stroke guidelines related to reducing the occurrence, disabilities, and death associated with stroke.

(2) A hospital certified as a Primary Stroke Center by a nationally-recognized certifying body approved by the Department, shall send a copy of the Certificate to the Department and shall be deemed, within 30 days of its receipt by the Department, to be a State-designated Primary Stroke Center.


State: Illinois
Program: Hospitals
Agency: Department of Public Health
State Reference: 77 IL ADC 250.130 
Setting/Service: Hospital
Type of Recognition: Licensure

c) Inspections

1) All hospitals to which these requirements apply shall be subject to inspection by personnel of the Department, or by such other persons, including full-time local health officers, as the Department may designate. The licensee or person representing the licensee in the hospital shall provide the representative of the Department with any requested hospital records, assist in inspecting the premises, and secure information required by the Act or Requirements.

2) The Department shall make or cause to be made such inspections and investigations as it deems necessary.

3) Hospitals are authorized to submit a copy of the Joint Commission's survey report, certification and accreditation, interim self-evaluation report and Plan of Correction to the Department.

4) Information contained in reports of surveys made by the Joint Commission on Accreditation of Hospitals and information gained from reports of surveys or transmittals of information from the various Divisions of the Department or State Agencies may be used in determining the need for inspections for compliance with licensing requirements. All such reports provided to the Department for this purpose shall be considered confidential information as provided in Section 9 of the Act.


State: Illinois
Program: Laboratory Services
Agency: Department of Public Health
State Reference: 77 IL ADC 450.30 
Setting/Service: Laboratory
Type of Recognition: Licensure

c) The following are not required to obtain a permit or be licensed under the Clinical Laboratory Act: 1) Clinical laboratories operated by the United States Government. 2) Clinical laboratories located in hospitals licensed under the Hospital Licensing Act that are under the control of the governing board of such hospitals owned by the exact same entity identified as owner/operator of the hospital as indicated on the last hospital license application filed with the Department; located at the same site and contiguous with the hospital; subject to the regulations and hospital by-laws; and where the entity which receives payment for the laboratory services is the same entity that owns the hospital.

State: Illinois
Program: Nursing Care Center
Agency: Department of Public Health
State Reference: 210 ILCS 45/3-805
Setting/Service: Long-Term Care Facilities
Type of Recognition: Licensure

(a) The Department shall conduct a pilot project to examine, study and contrast the Joint Commission on the Accreditation of Health Care Organizations (“Commission”) accreditation review process with the current regulations and licensure surveys process conducted by the Department for long-term care facilities. This pilot project will enable qualified facilities to apply for participation in the project, in which surveys completed by the Commission are accepted by the Department in lieu of inspections required by this Act, as provided in subsection (b) of this Section. It is intended that this pilot project shall commence on January 1, 1990, and shall conclude on December 31, 2000, with a final report to be submitted to the Governor and the General Assembly by June 30, 2001.

(b)(1) In lieu of conducting an inspection for license renewal under this Act, the Department may accept from a facility that is accredited by the Commission under the Commission's long-term care standards the facility's most recent annual accreditation review by the Commission. In addition to such review, the facility shall submit any fee or other license renewal report or information required by law. The Department may accept such review for so long as the Commission maintains an annual inspection or review program. If the Commission does not conduct an on-site annual inspection or review, the Department shall conduct an inspection as otherwise required by this Act. If the Department determines that an annual on-site inspection or review conducted by the Commission does not meet minimum standards set by the Department, the Department shall not accept the Commission's accreditation review and shall conduct an inspection as otherwise required by this Act.


State: Illinois
Program: Ambulatory Health Care
Agency: Department of Public Health
State Reference: 210 ILCS 3/1
Setting/Service: Birthing Center
Type of Recognition: Licensure/Certification

In adopting rules for birth centers, the Department shall consider: the American Association of Birth Centers' Standards for Freestanding Birth Centers; the American Academy of Pediatrics/American College of Obstetricians and Gynecologists Guidelines for Perinatal Care; and the Regionalized Perinatal Health Care Code. The Department's rules shall stipulate the eligibility criteria for birth center admission. The Department's rules shall stipulate the necessary equipment for emergency care according to the American Association of Birth Centers' standards and any additional equipment deemed necessary by the Department. The Department's rules shall provide for a time period within which each birth center not part of a hospital must become accredited by either the Commission for the Accreditation of Freestanding Birth Centers or The Joint Commission.


State: Indiana
Program: Behavioral Health Care
Agency: Advisory Board of the Division of Professional Standards
State Reference: 515 IN ADC 2-1-3
Setting/Service: Rehabilitation Centers
Type of Recognition: Insurance

(2) “Rehabilitation center” means:

(A) a state or privately owned and accredited institution, hospital, or facility offering diagnostic, rehabilitative, or habilitative services to children or adults who are cognitively impaired, developmentally delayed, head injured, or learning disabled that is located in Indiana or supported by a hospital located in Indiana and accredited by the joint commission on accreditation of healthcare organizations (JCAHO);

(B) a penal or correctional facility operated by the department of corrections;

(C) an institution operated by the department of health under IC 16-19-6;

or

(D) a private facility offering vocational or diagnostic services to the mentally retarded, developmentally delayed, brain injured, or physically handicapped that is accredited by the council on accreditation of rehabilitation facilities (CARF), JCAHO, or certified by the state.


State: Indiana
Program: Laboratory Services
Agency: Department of Health
State Reference:
Setting/Service: Laboratory
Type of Recognition: Licensure

CLIA Certification

State: Indiana
Program: Home Care
Agency: Department of Health
State Reference: 410 IN ADC 17-10-1
Setting/Service: Home Health Agencies
Type of Recognition: Licensure

(r) In the years that a home health agency has an accreditation survey by a body recognized as a home health accrediting agency, the home health agency may submit the accreditation survey report to the department for review and action as follows:

(1) If the department determines that the agency was found to substantially comply with the accreditation standards, the department will accept the report instead of a licensing survey.

(2) If the department determines that the agency failed to significantly comply with the accreditation standards, the department may conduct a licensing survey.


State: Indiana
Program: Hospitals
Agency: Department of Health
State Reference: Not Codified
Setting/Service: Hospital
Type of Recognition: Licensure

Department accepts accreditation in lieu of conducting an inspection provided that the hospital provides state with accreditation report and follow-up correspondence.

State: Indiana
Program: Ambulatory Health Care
Agency: Department of Health
State Reference: Information found on Indiana State Department of Health Website
Setting/Service: Ambulatory Surgical Center
Type of Recognition: Licensure

Many ASCs voluntarily submit themselves for accreditation by an ASC accreditation association. If an ASC is accredited, the ASC may substitute the accreditation survey for the state licensure on-site survey. In years when an accreditation survey is performed, there may not be a state licensure survey conducted by the ISDH

Section 1865 (b)(2) of the U.S. Social Security Act allows institutions accredited as ASCs by the AAAHC, JCAHO, AAAASF, and AOA to be deemed to meet the Conditions of Coverage for ASCs. The ISDH also accepts the AAAHC, AAAASF, JCAHO, or AOA inspection report in lieu of a state licensure on-site survey. In years when an accreditation survey is performed, there may not be a state licensure survey conducted by the ISDH.


State: Indiana
Program: Behavioral Health Care
Agency: Department of Human Services
State Reference: IC 12-7-2-39
Setting/Service: Community Mental Retardation and Other Developmental Disabilities Centers
Type of Recognition: Insurance

Sec. 39. “Community mental retardation and other developmental disabilities centers”, for purposes of IC 12-29 (except as provided in IC 12-29-3-6), means a program of services that meets the following conditions:

(4) Is accredited for the services provided by one (1) of the following organizations:

(A) The Commission on Accreditation of Rehabilitation Facilities (CARF), or its successor.

(B) The Council on Quality and Leadership in Supports for People with Disabilities, or its successor.

(C) The Joint Commission on Accreditation of Healthcare Organizations (JCAHO), or its successor.

(D) The National Commission on Quality Assurance, or its successor.

(E) An independent national accreditation organization approved by the secretary.


State: Indiana
Program: Behavioral Health Care
Agency: Department of Mental Health
State Reference: IC 12-12-1-4.1
Setting/Service: Vocational and Community Rehabilitation Centers
Type of Recognition: Licensure

(b) When entering into contracts for job development, placement, or retention services, the bureau shall contract with governmental units and other public or private organizations or individuals that are accredited by one (1) of the following organizations:

(1) The Commission on Accreditation of Rehabilitation Facilities (CARF), or its successor.

(2) The Council on Quality and Leadership in Supports for People with Disabilities, or its successor.

(3) The Joint Commission on Accreditation of Healthcare Organizations (JCAHO), or its successor.

(4) The National Commission on Quality Assurance, or its successor.

(5) An independent national accreditation organization approved by the secretary.

(c) To the extent that the accreditation requirements of an accrediting organization listed in subsection


State: Indiana
Program: Behavioral Health Care
Agency: Division of Disability and Rehabilitative Services
State Reference: 460 IN ADC 6-5-6
Setting/Service: Community-Based Sheltered Employment Services
Type of Recognition: Licensure

Sec. 6. To be approved to provide community-based sheltered employment services, an applicant shall meet the following requirements:

(1) Be an entity.

(2) Be accredited by one of following organizations:

(A) The Commission on Accreditation of Rehabilitation Facilities (CARF) or its successor.

(B) The Council on Quality and Leadership in Supports for People with Disabilities or its successor.

(C) The Joint Commission on Accreditation of Healthcare Organizations (JACHO [sic., JCAHO]) or its successor.

(D) The National Commission on Quality Assurance or its successor.

(E) An independent national accreditation organization approved by the secretary.


State: Indiana
Program: Behavioral Health Care
Agency: Division of Mental Health and Addiction
State Reference: 440 IN ADC 10-3-2
Setting/Service: Opioid Treatment Programs
Type of Recognition: Licensure

(4) Documentation showing that the applicant is accredited by an accreditation body approved by the division and by the United States Department of Health and Human Services, Substance Abuse and Mental Health Services Administration (SAMHSA), including a copy of the following:

(A) The accreditation report.

(B) Any response to the report required by the accreditation body.

(C) The final disposition issued by the accreditation body.


State: Indiana
Program: Behavioral Health Care
Agency: Division of Mental Health and Addiction
State Reference: 440 IN ADC 1.5-2-3
Setting/Service: Private Mental Health Facility
Type of Recognition: Licensure

Sec. 3. (a) An entity seeking a license as a private mental health institution shall file an application with the division.

(c) An applicant that is accredited shall submit the following to the division:

(1) Proof of accreditation in all services provided by the applicant.

(2) Site survey recommendations from the accrediting agency.

(3) The applicant's responses to the site survey recommendations.

(d) The division may require the applicant to correct any deficiencies described in the site survey.

(e) If an applicant is not yet accredited in all services provided by the applicant, but provides proof of application to an accrediting agency approved by the division, the division may issue a temporary license for a period of six months.

(f) At the end of the six month period of a temporary license granted under subsection (e), the division may extend the temporary license for not longer than six additional months, if the nonaccredited applicant continues to meet all other requirements for a license except for accreditation.

(g) Prior to the expiration of an extended temporary license under subsection (f), the applicant shall provide the division with the following:

(1) Proof of accreditation.

(2) Site survey recommendations from the accrediting agency.

(3) The applicant's responses to the site survey recommendations.

(4) If required by the division, proof of the correction of any deficiency described in the site survey.

(5) Any other materials requested by the division as a part of the application process.

(h) If an applicant fails to achieve accreditation within a period of twelve months from the date of application, the applicant may not reapply for a license until twelve months after an extended temporary license expires.


State: Indiana
Program: Behavioral Health Care
Agency: Division of Mental Health and Addiction
State Reference: 440 IN ADC 4.1-2-4
Setting/Service: Community Mental Health Centers
Type of Recognition: Licensure

(f) At the time of application, the applicant shall be providing and have accreditation for all of the services that are required to be provided directly for each of the following populations:

(1) seriously emotionally disturbed children and adolescents;

(2) seriously mentally ill adults;

and

(3) individuals who abuse alcohol and other drugs; and all other services in the continuum of care that the center is providing directly.

(g) The applicant's accreditation must be by an accrediting agency approved by the division.

(h) The applicant must forward to the division proof of accreditation in all services provided by the applicant, site survey recommendations from the accrediting agency, and the applicant's responses to the site survey recommendations.

(i) The division may require the applicant to correct any deficiencies described in the site survey.

(j) The division shall issue regular certification as a community mental health center to the applicant after the division has determined that the applicant meets all criteria for a community mental health center set forth in federal and state law and in this article, (440 IAC 4.1) including the assignment of an exclusive geographic primary service area under 440 IAC 4.1-3.

(k) The certification shall expire ninety (90) days after the expiration of the center's accreditation from the accrediting agency designated by the center as its official accrediting agency.


State: Indiana
Program: Hospitals
Agency: Division of Mental Health and Addiction
State Reference: 440 IN ADC 1 through 1.5-2-8
Setting/Service: Private Mental Health Institutions
Type of Recognition: Licensure

440 IAC 1.5-2-2 (b) A private mental health institution shall be accredited by an accrediting agency approved by the division…. 440 IAC 1.5-2-3 (3)(h) If an applicant fails to achieve accreditation within a period of twelve (12) months from the date of application, the applicant may not reapply for a license until twelve (12) months after an extended temporary license expires. Private mental health institution defined: an inpatient hospital setting, including inpatient and outpatient services provided in that setting, for the treatment and care of individuals with psychiatric disorders or chronic addictive disorders, or both, that is physically, organizationally, and programmatically independent of any hospital or health facility licensed by the Indiana state department of health under IC 16

State: Indiana
Program: Behavioral Health Care
Agency: Division of Mental Health and Addictions
State Reference: 440 IN ADC 7.5-2-1
Setting/Service: Residential Treatment Facilities for Individuals With Psychiatric Disorders or Addictions
Type of Recognition: Licensure

Sec. 1. The following is a general overview of the requirements for residential facilities under this article:

Should be accredited.


State: Indiana
Program: Office-Based Surgery
Agency: Medical Licensing Board
State Reference: 844 IN ADC 5-5-20Economic Impact Statement: LSA Document #07-842
Setting/Service: Office-Based Surgery
Type of Recognition: Requirement for Anesthesia Use

Sec. 20. After January 1, 2010, a practitioner may not perform or supervise a procedure that requires anesthesia in an office-based setting unless the office-based setting is accredited by an accreditation agency approved by the board under this rule. Statement Concerning Rules Affecting Small Businesses: This proposed new rule adds 844 IAC 5-5 to establish standards for procedures performed in office-based settings that require moderate sedation/analgesia, deep sedation/analgesia, general anesthesia, or regional anesthesia. Beginning January 1, 2010, a practitioner may not perform or supervise a procedure that requires anesthesia in an office-based setting unless the office-based setting is accredited by an accreditation agency approved by the Board under this rule. Offices will have the ability to choose from one of the four Board recognized accreditation organizations that are also nationally recognized and follow the standards for accreditation of facilities: American Association for Accreditation of Ambulatory surgery Facilities, Inc. (AAAASF); Accreditation Association for Ambulatory Health Care, Inc. (AAAHC); Joint Commission on Healthcare Accreditation Organizations (JCHAO); Healthcare Facilities Accreditation Program.


State: Iowa
Program: Laboratory Services
Agency: Department of Health
State Reference:
Setting/Service: Laboratory
Type of Recognition: Licensure

CLIA Certification

State: Iowa
Program: Nursing Care Center
Agency: Department of Inspections and Appeals: Health Facilities Div
State Reference: I.C.A. § 135C.2
Setting/Service: Nursing Facilities
Type of Recognition: Licensure

7. The rules adopted by the department regarding nursing facilities shall provide that a nursing facility may choose to be inspected either by the department or by the joint commission on accreditation of health care organizations. The rules regarding acceptance of inspection by the joint commission on accreditation of health care organizations shall include recognition, in lieu of inspection by the department, of comparable inspections and inspection findings of the joint commission on accreditation of health care organizations, if the department is provided with copies of all requested materials relating to the inspection process.

State: Iowa
Program: Home Care
Agency: Department of Public Health
State Reference: I.C.A. § 135J.2
Setting/Service: Hospice
Type of Recognition: Licensure

The hospice program shall meet the criteria pursuant to section 135J.3 before a license is issued. The department of inspections and appeals is responsible to provide the necessary personnel to inspect the hospice program, the home care and inpatient care provided and the hospital or facility used by the hospice to determine if the hospice complies with necessary standards before a license is issued. Hospices that are certified as Medicare hospice providers by the department of inspections and appeals or are accredited as hospices by the joint commission on the accreditation of health care organizations, shall be licensed without inspection by the department of inspections and appeals.

State: Iowa
Program: Behavioral Health Care
Agency: Human Services Department
State Reference: IA ADC 441-77.33(249A)
Setting/Service: Case Management Providers
Type of Recognition: Medicaid

77.33(21) Case management providers. A case management provider organization is eligible to participate in the Medicaid HCBS elderly waiver program if the organization meets the following standards:

a. The case management provider organization shall be an agency or individual that:

(1) Is accredited by the mental health, mental retardation, developmental disabilities, and brain injury commission as meeting the standards for case management services in 441--Chapter 24;

or

(2) Is accredited through the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) to provide case management;

or

(3) Is accredited through the Council on Accreditation of Rehabilitation Facilities (CARF) to provide case management;

or

(4) Is accredited through the Council on Quality and Leadership in Supports for People with Disabilities (The Council) to provide case management;

or

(5) Is approved by the department of elder affairs as meeting the standards for case management services in 321--Chapter 21;

or

(6) Is approved by the department of public health as meeting the standards for case management services in 641--Chapter 80.


State: Iowa
Program: Behavioral Health Care
Agency: Human Services Department
State Reference: IA ADC 441-78.31(249A)
Setting/Service: Alcoholism and Substance Abuse Treatment Programs
Type of Recognition: Insurance

78.31(4) Requirements for specific types of service.

a. Alcoholism and substance abuse.

(1) Approval by the joint commission or substance abuse commission. In addition to certification by the department, alcoholism and substance abuse programs must also be approved by either the joint commission on the accreditation of hospitals or the Iowa substance abuse commission.


State: Iowa
Program: Behavioral Health Care
Agency: Human Services Department
State Reference: IA ADC 441 -202.16
Setting/Service: Psychiatric Medical Institutions for Children
Type of Recognition: Licensure

202.16(1) Applicants for departmental approval of need shall submit the following to the division of child and family services:

a. A description of the population to be served, including age, sex, and types of disorders, and an estimate of the number of these youth in need of psychiatric care in the area of the state in which the applicant is located.

b. A statement of the number of beds requested and a description of the treatment program to be provided, the outcomes to be achieved and the techniques for measuring outcomes.

c. A proposed date of operation as a psychiatric medical institution for children.

d. A description of the applicant's experience with providing similar services to youth, especially the target population.

e. A description of the applicant's plan, including the timeline for achieving accreditation to provide psychiatric services from a federally recognized accrediting organization under the organization's standards for residential settings and licensure as a psychiatric medical institution for children, or a copy of the organization's report if already accredited.

f. References from the service area manager for the department service area in which the proposed psychiatric medical institution for children would be located, the chief juvenile court officer of the judicial district in which the proposed psychiatric medical institution for children would be located and the applicant's licensor from the department of inspections and appeals or department of public health.


State: Iowa
Program: Behavioral Health Care
Agency: Human Services Department
State Reference: IA ADC 441-77.25(249A)
Setting/Service: Day Habilitation Agencies, Home-Based Habilitation Agencies, and Supported Employment Habilitation
Type of Recognition: Licensure

77.25(6) Day habilitation.

The following providers may provide day habilitation:

i. An agency that is accredited by the Joint Commission on Accreditation of Healthcare Organizations.

(1) The facility must have policies in place by June 30, 2007, consistent with the accreditation being sought.

(2) A facility that has not received accreditation within 12 months after application for accreditation is no longer a qualified provider. 77.25

(7) Home-based habilitation.

The following agencies may provide home-based habilitation services:

a. An agency that is certified by the department to provide supported community living services under:

(1) The home- and community-based services mental retardation waiver pursuant to rule 441-77.37(249A);

or

(2) The home- and community-based services brain injury waiver pursuant to rule 441-77.39(249A).

f. An agency that is accredited by the Joint Commission on Accreditation of Healthcare Organizations.

77.25(9) Supported employment habilitation.

The following agencies may provide supported employment services:

a. An agency that is certified by the department to provide supported employment services under:

(1) The home- and community-based services mental retardation waiver pursuant to rule 441-77.37(249A);

(2) The home- and community-based services brain injury waiver pursuant to rule 441-77.39(249A).

d. An agency that is accredited by the Joint Commission on Accreditation of Healthcare Organizations.


State: Iowa
Program: Critical Access Hospitals
Agency: Inspections and Appeals Department
State Reference: IA ADC 481-51.53(135B)
Setting/Service: Critical Access Hospitals
Type of Recognition: Licensure

Critical Access Hospitals shall meet the following conditions: 51.53(7)

The department shall recognize, in lieu of its own inspection, the comparable inspections and inspections findings of The Joint Commission (TJC) or the American Osteopathic Association (AOA) if the department is provided with copies of all requested materials relating to the inspections and the inspection process.


State: Iowa
Program: Hospitals
Agency: Iowa Department of Inspections and Appeals
State Reference: IA ADC 481-51.2(135B)
Setting/Service: Hospital
Type of Recognition: Licensure

51.2(5) The department shall recognize, in lieu of its own licensure inspection, the comparable inspections and inspection findings of The Joint Commission (JC) or the American Osteopathic Association (AOA), if the department is provided with copies of all requested materials relating to the inspection process. In cases of the initial licensure, the department may require its own inspection when needed in addition to comparable accreditations to allow the hospital to begin operations. The department may also initiate its own inspection when it is determined that the inspection findings of the JC or the AOA are insufficient to address concerns identified as possible licensure issues.

51.2(6) Hospitals not accredited by the JC or the AOA shall be inspected by the department utilizing the current Medicare conditions of participation found in Title XVIII of the federal Social Security Act and 42 CFR Part 482, Subparts A, B, C, D, and E, or 42 CFR Part 485, Subpart F, as of October 1, 2006. Licensed-only hospitals shall be inspected utilizing the requirements of this chapter. The department may promulgate additional standards. The department may recognize, in lieu of its own licensure inspection, the comparable inspection and inspection findings of a Medicare conditions of participation survey.


State: Iowa
Program: Ambulatory Health Care
Agency: Medicaid Department of Human Services
State Reference: IowaCare (11-W-00189/7)
Setting/Service: Primary Care Medical Home
Type of Recognition: Medicaid Reimbursement

Medical homes in the IowaCare Medical Home Pilot must:

The provider shall meet Medical Home standards. If the Iowa Department of Public Health adopts rules that provide statewide medical home standards or provide for a statewide medical home certification process, those rules shall apply to the Medical Home Provider and shall take precedence over the requirements in this paragraph.

At a minimum, the Medical Home Provider will:

a. Have National Committee for Quality Assurance (NCQA) Patient Centered Medical Home (PCMH) Level 1 recognition/certification or equivalent within 18 months of start of this contract. Medical homes recognition/certification status shall be designated as such for purposes of payment.

i. Practices must complete NCQA PCMH Level 1 recognition (or the equivalent, as determined by the Department), transitioning to permanent recognition, as determined by the Medical Home Reform Committee.

NOTE:  The Joint Commission's PCMH certification option has been determined to be equivalent

 


State: Iowa
Program: Behavioral Health Care
Agency: Public Health Department
State Reference: IA ADC 641-162.19
Setting/Service: Gambling Treatment Programs
Type of Recognition: Licensure

162.19(4) The department shall exempt problem gambling treatment programs accredited by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) from all the standards required pursuant to rule 641-162.20(135), except for the standards set forth in the following sub rules:

a. 162.20(6), Personnel;

b. 162.20(9), Client screening, admission and assessment;

and

c. 162.20(20), Financial counseling services.


State: Kansas
Program: Laboratory Services
Agency: Department of Health
State Reference:
Setting/Service: Laboratory
Type of Recognition: Licensure

CLIA Certification

State: Kansas
Program: Office-Based Surgery
Agency: Department of Health and Environment
State Reference: KS ADC 100-25-4
Setting/Service: Office-Based Surgery
Type of Recognition: Licensure

(b) On and after July 1, 2006, each physician who performs any office-based surgery or special procedure using general anesthesia or a spinal or epidural block shall perform the office-based surgery or special procedure only in an office that meets at least one of the following sets of standards, all of which are hereby adopted by reference except as specified:

(1) Sections 110-010 through 1031-02 in the “standards and checklist for accreditation of ambulatory surgery facilities” by the American association for accreditation of ambulatory surgery facilities, inc., revised in 2005;

(2) “section two: accreditation” and the glossary, except the definition of “physician,” in “accreditation requirements for ambulatory care/surgery facilities” by the healthcare facilities accreditation program of the American osteopathic association, 2001-2002 edition;

(3) section 1 and section 2 in “accreditation manual for office-based surgery practices” by the joint commission on accreditation of healthcare organizations, second edition, dated 2005;

(4) “accreditation standards for ambulatory facilities” by the institute for medical quality, 2003 edition. The appendices are not adopted; or

(5) chapters 1 through 6, 8 through 10, 15, 16, 19, 22, and 24 and appendices A and I in the “accreditation handbook for ambulatory health care” by the accreditation association for ambulatory health care, inc., 2005 edition.


State: Kansas
Program: Ambulatory Health Care
Agency: Department of Health and Environment
State Reference: K.S.A. 65-429
Setting/Service: Ambulatory Surgical Center
Type of Recognition: Licensure

A medical care facility which has been licensed by the licensing agency and which has received certification for participation in federal reimbursement programs and which has been accredited by the joint commission on accreditation of health care organizations or the American osteopathic association may be granted a license renewal based on such certification and accreditation.

"Medical care facility" means a hospital, ambulatory surgical center or recuperation center, but shall not include a hospice which is certified to participate in the Medicare program


State: Kansas
Program: Hospitals
Agency: Department of Health and Environment
State Reference: K.S.A. 65-429  
Setting/Service: Hospital
Type of Recognition: Licensure

K.S.A. 65-429 A medical care facility which has been licensed by the licensing agency and which has received certification for participation in federal reimbursement programs and which has been accredited by the joint commission on accreditation of health care organizations or the American osteopathic association may be granted a license renewal based on such certification and accreditation. KS ADC 28-34-2 (e) If during the term of its current license a facility is surveyed by the joint commission on accreditation of health care organizations (JCAHO) or the American osteopathic association (AOA), the facility shall submit the survey report to the licensing agency toward satisfying the survey requirements for licensure. After reviewing the survey report, the licensing agency may notify the facility that a licensing survey will be conducted.

State: Kansas
Program: Behavioral Health Care
Agency: Department of Social and Rehabilitation Services
State Reference: KS ADC 30-63-20
Setting/Service: Community Services for the Developmentally Disabled
Type of Recognition: Licensure

30-63-20 Mandated requirements.

(c) Attainment of national accreditation by an applicant from an organization that evaluates and accredits providers of mental retardation or developmental disabilities services, or the recommendation of a local CDDO's quality assurance committee, shall be considered by the commissioner in determining compliance by the applicant with any one or more of the requirements of this article.


State: Kansas
Program: Behavioral Health Care
Agency: Social and Rehabilitation Services
State Reference: KS ADC 30-5-109
Setting/Service: Free-Standing Inpatient Psychiatric Facilities
Type of Recognition: Medicaid

(a) Services shall be available to program recipients who are 65 and over if the services are provided by a facility that meets the Medicare requirements.

(b) Services shall be available to program recipients who are under 21 years of age if the services are provided by a facility accredited by the joint commission on accreditation of hospitals.


State: Kentucky
Program: Office-Based Surgery
Agency: Board of Medical Licensure
State Reference: Board of Medical Licensure – Guidelines for Office-Based Surgery
Setting/Service: Practices Performing Office-Based Surgery That Require the Administration of Moderate or Deep Sedation, or General Anesthesia
Type of Recognition: Licensure

Practices performing office-based surgery or procedures that require the administration of moderate or deep sedation, or general anesthesia (Level II and III facilities as defined below) should be accredited by an accreditation agency, including the American Association of Ambulatory Surgical Facilities (AAAASF), Accreditation Association for Ambulatory Health Care (AAAHC) or the Joint Commission on Accreditation of HealthCare Organizations (JCAHO), or any other agency approved by the Board within the first year of operation. The accrediting agency must submit a yearly summary report for each facility to the Board. Any licensee performing Level II or Level III office surgery should register with the Board. Such registration should include each address at which Level II or Level III office surgery is performed and identification of the accreditation agency that accredits each location (when applicable). Rule of Thumb: The capacity of the patient at all times to retain his/her life-protective reflexes and to respond to verbal command (i.e., the depth of sedation or anesthesia) – rather than the specific procedure performed.


State: Kentucky
Program: Laboratory Services
Agency: Cabinet for Health Services
State Reference: 902 KY ADC 11:020
Setting/Service: Laboratory
Type of Recognition: Licensure

Section 3. Provisions for Acceptance by National Licensing or other Accrediting Bodies. With the exception of 902 KAR 11:030 and Section 1 of this administrative regulation, medical laboratories inspected and certified pursuant to 42 USC 263a, Public Health Service Act, and medical laboratories which have been inspected and accredited by the commission on inspection and accreditation of the College of American Pathologists or by any other national accreditation body approved by the cabinet, shall be deemed to meet all of the requirements for licensure, if the standards applied by the commission or body in determining accreditation of the medical laboratory are equal to, or more stringent than, the provisions of KRS Chapter 333 and the rules and regulations issued pursuant to KRS Chapter 333; and there is adequate provision for assuring the standards continue to be met by the laboratory.

State: Kentucky
Program: Behavioral Health Care
Agency: Department for Community Based Services, Protection, and Per
State Reference: 922 KY ADC 1:460
Setting/Service: Private Child-Caring Facility With an Operational Youth Wilderness Camp
Type of Recognition: Licensure

Section 1. Definitions.

(1) “Accrediting body” means the:

(a) Joint Commission on Accreditation of Healthcare Organizations;

and

(b) Association for Experiential Education;

or

(c) Council on Accreditation for Children and Family Services.

(2) A licensed private child-caring facility with an operational youth wilderness camp shall:

(a) Obtain accreditation on the youth wilderness camp component from an accrediting body, within one year of the effective date of this administrative regulation;

and

(b) Apply for a youth wilderness camp component license with the OIG, DLCC, upon receipt of youth wilderness camp accreditation.

(3) Prior to operating a youth wilderness camp program, a licensed private child-caring facility without an operational youth wilderness camp shall:

(a) Obtain a provisional accreditation from an accrediting body which includes:

1. Review by the accrediting body of the private child-caring facility's plan to operate a youth wilderness camp program, including review of proposed policy and procedure;

and

2. Standards and timeframes for performance, established by the accrediting body;

(b) Achieve full accreditation from an accrediting body;

and

(c) Apply for a youth wilderness camp component license, as specified in subsection (2)(b) of this section.


State: Kentucky
Program: Behavioral Health Care
Agency: Department for Community Based Services, Protection, and Per
State Reference: 922 KY ADC 1:360
Setting/Service: Child-Caring Facility or Child-Placing Agency
Type of Recognition: Licensure

3. To the gatekeeper and designated cabinet staff, a copy of the following completed forms:

a. On a quarterly basis, for a private child care residential placement, CRP-001, Children's Review Program Residential Application for Level of Care Payment;

or

b. On a semiannual basis for a foster care placement, CRP-003, Children's Review Program Foster Care Application for Level of Care Payment;

(d) Provide outcomes data and information as requested by the gatekeeper;

and

(e) Obtain accreditation within two (2) years of initial licensure or within two (2) years of acquiring an agreement with the cabinet, whichever is later, from a nationally-recognized accreditation organization, such as:

1. The Council on Accreditation;

or

2. The Joint Commission on Accreditation for Healthcare Organizations.


State: Kentucky
Program: Behavioral Health Care
Agency: Department for Medicaid Services
State Reference: 907 KY ADC 3:030 
Setting/Service: Behavioral Health Organization
Type of Recognition: Medicaid

Section 1. Definitions.

(1) “Behavioral health organization” means:

(a) A hospital licensed and operating in accordance with: 1. 902 KAR 20:009, 902 KAR 20:012 and 902 KAR 20:016; or 2. 902 KAR 20:170 and 902 KAR 20:180;

(b) A community mental health center;

(c) A child-caring facility licensed in accordance with 922 KAR 1:305 and operating in accordance with 922 KAR 1:300, 902 KAR 1:380 and 902 KAR 1:390;

(d) A child-placing facility licensed in accordance with 922 KAR 1:305 and operating in accordance with 922 KAR 1:310;

(e) An organization accredited by the Joint Commission on Accreditation of Healthcare Organizations, the Commission on Accreditation of Rehabilitative Facilities or the Council on Accreditation for Children and Family Services


State: Kentucky
Program: Home Care
Agency: Department of Medicaid Services
State Reference: 907 KY ADC 1:330
Setting/Service: Hospice Organizations
Type of Recognition: Medicaid

Section 1. Definition of Hospice Care. Hospice care means the care described in Section 1905(o) of the Social Security Act. Summarized, hospice care may be described as a package of palliative and supportive services provided by a hospice program to a terminally ill Medicaid recipient and his family to alleviate the patient's pain and suffering and assist the patient and his family to cope with dying and the circumstances surrounding terminal illness. The hospice package of services is provided in lieu of certain benefits described in Section 1812(d)(2)(A) of the Social Security Act and intermediate care facility services. The patient must voluntarily elect the hospice care. Hospice care may be provided an individual in a skilled nursing or intermediate care facility but in that circumstance coverage does not exist under the program for skilled nursing and intermediate care facility services, i.e., a payment may be made for only the hospice care. Hospice care must be provided by an appropriately licensed, accredited and certified hospice program (as defined in Section 1861(dd)(2) of the Social Security Act) participating in both Medicare and Medicaid.

State: Kentucky
Program: Behavioral Health Care
Agency: Department of Medicaid Services
State Reference: 907 KY ADC 1:710
Setting/Service: Community Mental Health Centers
Type of Recognition: Medicaid

(10) A behavioral health care provider authorized by the MBHO to provide rehabilitation or a support service covered under 907 KAR Chapters 1 and 3 or which may be covered as an early and periodic screening, diagnosis and treatment (EPSDT) service in accordance with 907 KAR 1:034, shall be a community mental health center licensed in accordance with 902 KAR 20:091, or an organization that shall be: (

a) Accredited by a national accrediting organization for agencies that provide behavioral health services;

or

(b) Assessed on site prior to providing an MBHO service and at least every three (3) years thereafter by the MBHO using standards of participation approved by the MBHO's board of directors.


State: Kentucky
Program: Behavioral Health Care
Agency: Department of Public Health
State Reference: KRS § 216B.455
Setting/Service: Psychiatric Residential Treatment Facilities
Type of Recognition: Licensure

(4) All psychiatric residential treatment facilities shall be certified by the Joint Commission on Accreditation of Healthcare Organizations, or the Council on Accreditation, or any other accrediting body with comparable standards that is recognized by the state.

State: Kentucky
Program: Behavioral Health Care
Agency: Department of Public Health
State Reference: 902 KY ADC 20:091
Setting/Service: Health Services and Facilities – Mental Health Treatment Facilities
Type of Recognition: Licensure

3. The requirement for completion of a training course approved by the Department of Mental Health and Mental Retardation, prior to using therapeutic holds.

(f) The requirement that a licensed psychiatrist shall be available to evaluate, provide treatment and participate in treatment planning on a regular basis.

(g) The procedure for proper management of Pharmaceuticals, consistent with the requirements of Section 4(6) of this administrative regulation.

(h) Except for a program accredited by the Joint Commission for Accreditation of Health Organizations or the Commission on Accreditation of Rehabilitation Facilities


State: Kentucky
Program: Hospitals
Agency: Office of the Inspector General
State Reference: KRS § 216B.185
Setting/Service: Hospital
Type of Recognition: Licensure

The Office of the Inspector General shall accept accreditation by the Joint Commission on Accreditation of Healthcare Organizations or another nationally recognized accrediting organization with comparable standards and survey processes, that has been approved by the United States Centers on Medicare and Medicaid Services, as evidence that a hospital demonstrates compliance with all licensure requirements under this chapter. An annual on-site licensing inspection of a hospital shall not be conducted if the Office of the Inspector General receives from the hospital:

(a) A copy of the accreditation report within thirty (30) days of the initial accreditation and all subsequent reports; or

(b) Documentation from a hospital that holds full accreditation from an approved accrediting organization on or before the effective date of this act.


State: Louisiana
Program: Behavioral Health Care
Agency: Department of Health & Hospitals
State Reference: LAC 48:I.5001, and following
Setting/Service: Home and Community Based Services
Type of Recognition: Licensure

LAC 48:I.5016. Deemed Status through Accreditation*
A. An HCBS provider may request deemed status from the department. The department may accept accreditation in lieu of a routine on-site resurvey provided that:

1. the accreditation is obtained through an organization approved by the department;

2. all services provided under the HCBS license must be accredited; and

3. the provider forwards the accrediting body's findings to the Health Standards Section within 30 days of its accreditation.

B. The accreditation will be accepted as evidence of satisfactory compliance with all provisions of these requirements.
 
Accredited means:  the process of review and acceptance by an accreditation body such as the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), the Commission on Accreditation of Rehabilitation Facilities (CARF) or Council on Accreditation (COA)

 


State: Louisiana
Program: Behavioral Health Care
Agency: Department of Health and Hospitals
State Reference: LAC 48:I.7317. Deemed Status
Setting/Service: Substance Abuse/Addiction Setting (24-hour facility, outpatient facility, opioid treatment program)
Type of Recognition: Licensure/Certification

A. If a licensed SA/A facility becomes accredited by the Joint Commission on Accreditation of Healthcare Organizations,the Commission on Accreditation of Rehabilitation Facilities, or the Council on Accreditation, or ifa SA/A facility that provides an opioid treatment program becomes accredited by an organization approved bySAMSHA, the SA/A facility may request deemed status from the department. The department may accept accreditation

in lieu of an on-site licensing survey provided that:

1. the accreditation is obtained through an organization approved by the department;

2. all services provided under the SA/A license must be accredited; and

3. the facility forwards the accrediting body's findings to the Health Standards Section within 30 days of its accreditation.

B. If approved, accreditation will be accepted as evidence of satisfactory compliance with all of the provisionsof these requirements.

The Joint Commission is recognized.


State: Louisiana
Program: Behavioral Health Care
Agency: Department of Health and Hospitals
State Reference: LAC 48:I.6217. Deemed Status
Setting/Service: Therapeutice Group Home
Type of Recognition: Licensure/Certification

A. A licensed TGH may request deemed status from the department. The department may accept accreditation in lieu of a routine on-site licensing survey provided that:

1. the accreditation is obtained through an organization approved by the department;

2. all services provided under the TGH license must be accredited; and

3. the provider forwards the accrediting body's findings to the Health Standards Section within 30 days of its accreditation.

B. If approved, accreditation will be accepted as evidence of satisfactory compliance with all of the provisions of these requirements.


State: Louisiana
Program: Behavioral Health Care
Agency: Department of Health and Hospitals
State Reference: LAC 48:I.9013. Deemed Status
Setting/Service: PRTF
Type of Recognition: Licensure/Certification

A. A licensed PRTF may request deemed status from the department. The department may accept accreditation in lieu of a routine on-site licensing survey provided that:

1. the accreditation is obtained through an organization approved by the department;

2. all services provided under the PRTF license must be accredited; and

3. the provider forwards the accrediting body's findings to the Health Standards Section within 30 days of its accreditation.

B. If approved, accreditation will be accepted as evidence of satisfactory compliance with all of the provisions of these requirements.


State: Louisiana
Program: Hospitals
Agency: Department of Health and Hospitals
State Reference: LAC 48: I. Chap 93
Setting/Service: Hospital
Type of Recognition: Licensure

A. Exceptions to these Rules and standards governing hospitals are as follows.

1. If a hospital does not provide an optional service or department, those relating requirements shall not be applicable.

2. If a hospital is accredited by the Joint Commission on Accreditation of Healthcare Organizations or the American Osteopathic Association, the Department shall accept such accreditation in lieu of its annual on-site resurvey. This accreditation will be accepted as evidence of satisfactory compliance with all provisions except those expressed in §9305.O and P.


State: Louisiana
Program: Behavioral Health Care
Agency: Department of Public Health and Safety
State Reference: LSA-R.S. 40:2009
Setting/Service: Residential Treatment Facilities (Participating in the LSA Medicaid Residential Treatment Option)
Type of Recognition: Medicaid

A. Any facility participating in the Medicaid Residential Treatment Option, providing residential supports and services, shall be accredited by the Joint Commission on the Accreditation of Health Care Organizations, the Council on the Accreditation of Rehabilitation Facilities, or the Council on Accreditation for Children and Family Services.

State: Louisiana
Program: Behavioral Health Care
Agency: Department of Public Health and Safety
State Reference: LSA-R.S. 46:153.5
Setting/Service: Mental Health Rehabilitation Providers
Type of Recognition: Licensure

The secretary is authorized to promulgate rules and regulations requiring any provider participating in the Mental Health Rehabilitation Program and providing mental health rehabilitation services to be accredited by an accreditation body. The rules shall be adopted in accordance with the Administrative Procedure Act.

State: Louisiana
Program: Ambulatory Health Care
Agency: Public Health - Medical Assistance
State Reference: LAC 50:I.2901, 2903, 2905, 2907, 2911, 2913, 2917, 2919
Setting/Service: Primary Care Medical Home
Type of Recognition: Additional Reimbursement

Community Care 2.0

B. Pay-for-Performance Measures and Reimbursement


1. P4P payments will be based on a pre-determined PMPM in accordance with PCP compliance with the following performance measures and shall be reimbursed on a quarterly basis. The PCP must attest to meeting certain performance standards and the department will monitor the PCPs for program compliance.


a. Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Screenings. A payment of $0.25 PMPM for recipients under the age of 21 will be made if all screenings are performed in the PCP's office.


b. National Committee for Quality Assurance (NCQA) Patient-Centered Medical Home Level 1 Recognition or Joint Commission on Accreditation of Healthcare Organizations (JCAHO) Primary Care Home Accreditation. A payment of $0.50 PMPM will be made if the PCP provides verification of NCQA patient centered medical home Level 1 or higher status recognition, or JCAHO primary care home accreditation.


State: Louisiana
Program: Office-Based Surgery
Agency: State Board of Medical Examiners
State Reference: 46 LA ADC Pt XLV, § 7305
Setting/Service: Office-Based Surgery – Exempt Clinical and Surgery Settings
Type of Recognition: Licensure

A. This Chapter shall not apply to the following surgical procedures or clinical settings:

1. exempt surgical procedures include those:

a. requiring no anesthesia, using only local, oral, topical or intra-muscular anesthesia, those using regional anesthesia as defined by this Chapter or those using conscious sedation either individually or in combination; and/or
b. performed by a physician oral and maxillofacial surgeon under the authority and within the scope of a license to practice dentistry issued by the Louisiana State Board of Dentistry;

2. excepted clinical settings include:

a. a hospital, including an outpatient facility of the hospital that is separated physically from the hospital, an ambulatory surgical center, abortion clinic or other medical facility that is licensed and regulated by the Louisiana Department of Health and Hospitals;
b. a facility maintained or operated by the state of Louisiana or a governmental entity of this state;
c. a clinic maintained or operated by the United States or by any of its departments, offices or agencies; and
d. an outpatient setting currently accredited by one of the following associations or its successor association:

i. the Joint Commission on Accreditation of Healthcare Organizations relating to ambulatory surgical centers;
ii. the American Association for the Accreditation of Ambulatory Surgery Facilities; or
iii. the Accreditation Association for Ambulatory Health Care.

Chapter 73 continues on to say that any surgical procedures or clinical settings that do not fit into its exemptions must follow the standards/regulations laid out in the rest of the chapter for Office-Based surgery settings


State: Maine
Program: Behavioral Health Care
Agency: Department of Behavioral and Developmental Sciences
State Reference: ME ADC 14-118 Ch. 5, § 19
Setting/Service: Medically Managed Intensive Inpatient Detoxification Programs and Freestanding Residential Detoxification Programs
Type of Recognition: Licensure

19.0 SUBSTANCE ABUSE TREATMENT SERVICES

19.1 Medically Managed Intensive Inpatient Detoxification Programs (ASAM Level IV-D).

19.1.5.2 Also required is proof of appropriate accreditation by the Joint Commission for the Accreditation of Health Care Organizations, or the Commission on Accreditation of Rehabilitation Facilities. Detoxification programs that employ the services of a physician certified by the American Society of Addiction Medicine must provide a copy of such certificate. 19.2 Freestanding Residential Detoxification Programs (ASAM Level III 7-D/medically monitored inpatient detoxification).

19.2.5.2 Also required is proof of appropriate accreditation by the Joint Commission for the Accreditation of Health Care Organizations, or the Commission on Accreditation of Rehabilitation Facilities. Detoxification programs who employ the services of a physician certified by the American Society of Addiction Medicine must provide a copy of such certificate.


State: Maine
Program: Critical Access Hospitals
Agency: Department of Health and Human Services
State Reference: 10-144 CMR Ch. 112, Ch. XXVII, § XXVII.AA
Setting/Service: Critical Access Hospitals
Type of Recognition: Licensure

Chapter XXVII. Critical Access Hospital

XXVII.AA. Primary Verification Requirements

Primary verification of the following, directly from the granting or certifying authority, or from a recognized and duly accredited or licensed centralized verification service, or through the affiliate hospital will be made and documented with each appointment and reappointment:

1. Licensure
2. Board certification, when such certification is required for staff appointment by the Medical and Professional Staff Bylaws, Rules and Regulations;
3. Professional liability claims history (from carrier); and
4. Professional sanctions, (e.g. National Practitioner Data Bank).


State: Maine
Program: Hospitals
Agency: Department of Human Services
State Reference: ME ADC 10-144 Ch. 112, Ch. IV, § IV.N
Setting/Service: Hospital
Type of Recognition: Licensure

Each accredited hospital shall receive a hospital licensure survey during the midpoint of their current Joint Commission on Accreditation of Healthcare Organizations or American Osteopathic Association accreditation cycle. The results of accrediting agency surveys must be made available to the Department. Hospitals which are not Joint Commission on Accreditation of Healthcare Organizations or American Osteopathic Association accredited will be surveyed annually for licensure.

State: Maine
Program: Laboratory Services
Agency: Department of Human Services
State Reference:  ME ADC 10-144 Ch. 112, Ch. XIV, § XIV.A
Setting/Service: Laboratory
Type of Recognition: Licensure

1. The laboratory must possess a valid Clinical Laboratory Improvement Amendments (CLIA) certificate or, where applicable, a certificate of waiver issued by the Department of Health and Human Services; or 2. The laboratory must possess a valid Certificate of accreditation issued by a program approved by the Department of Health and Human Services; or 3. The laboratory must possess a valid state license issued from a state program which is approved by the Health Care Financing Administration and is exempt from CLIA requirements for A tests performed within the facility

State: Maine
Program: Behavioral Health Care
Agency: Department of Human Services
State Reference: ME ADC 10-144 Ch. 101, Ch. II, § 46
Setting/Service: Psychiatric Hospitals: Services for Individuals Under 21, Outpatient Services, and Partial Hospitalization Services
Type of Recognition: Insurance

46.02-2 Psychiatric Hospitals Serving Members Under Age Twenty one (21) for Inpatient Services In order to be enrolled as a MaineCare provider, and to receive reimbursement, the provider must be licensed by the Department of Health and Human Services as a psychiatric hospital and must be accredited by the Joint Commission on Accreditation of Health Care Organizations.

46.02-3 Psychiatric Hospitals Providing Outpatient and Partial Hospitalization Services In order to be enrolled as a MaineCare provider and to receive reimbursement, the provider must be licensed by DHHS as a psychiatric hospital and be accredited by the Joint Commission on Accreditation of Health Care Organizations.


State: Maryland
Program: Behavioral Health Care
Agency: Alcohol and Drug Abuse Administration
State Reference: MD Code, Health - General, § 8-403 
Setting/Service: Alcohol and Drug Abuse Programs and Facilities
Type of Recognition: Insurance

Certification requirement exclusions

(d) Unless requested, the certification requirements of this section do not apply to a hospital as defined in § 19-301 of this article accredited by the Joint Commission on Accreditation of Hospitals with a separately accredited alcohol and drug abuse program.

The Joint Commission maintains a listing of state agencies that recognize accreditation/certification. These lists have been compiled from a variety of sources and are intended to identify state regulatory agencies that recognize and/or rely on accreditation in lieu of specific state licensure or certification requirements. The Joint Commission makes no claims about the accuracy of this list and it should be considered a reference document. Joint Commission accredited organizations are strongly encouraged to inquire with their state regulatory agency for a full description of the recognition and any additional requirements the state agency may have.
 

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