In order for a health care organization to participate in and receive federal payment from Medicare or Medicaid programs, one of the requirements is that a health care organization meet the government requirements for program participation, including a certification of compliance with the health and safety requirements called Conditions of Participation (CoPs) or Conditions for Coverage (CfCs), which are set forth in federal regulations. The certification is achieved based on either a survey conducted by a state agency on behalf of the federal government, such as the Centers for Medicare & Medicaid Services (CMS), or by a national accrediting organization, such as The Joint Commission, that has been approved by CMS as having standards and a survey process that meets or exceeds Medicare’s requirements. Health care organizations that achieve accreditation through a Joint Commission “deemed status” survey are determined to meet or exceed Medicare and Medicaid requirements.
Voluntary deemed status through The Joint Commission is available for:
- Ambulatory surgical centers
- Clinical laboratories
- Critical access hospitals
- Home health agencies
- Hospice agencies
- Psychiatric hospitals
Accreditation is required (and available through The Joint Commission) for:
- Advanced diagnostic imaging services
- Durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) suppliers
- Opioid treatment programs (deeming authority is granted through the Substance Abuse Mental Health Services Administration or SAMHSA, not CMS)
A health care organization is eligible for reimbursement for the following procedures if the health care organization is both accredited by The Joint Commission and is Medicare certified.
- VAD destination therapy
- Lung volume reduction surgery (LVRS)
CMS oversight of accrediting organizations
CMS conducts complaint investigations and random validation surveys of Joint Commission accredited organizations that have deemed status. In addition, The Joint Commission provides CMS with a listing of, and related documentation for, deemed organizations receiving decisions of accreditation with follow-up survey, preliminary denial of accreditation, and denial of accreditation. The Joint Commission also provides accreditation decision reports for deemed organizations involved in CMS validation surveys and any other deemed status survey report when requested by CMS.
Costs of deemed status survey is allowable for some organizations
CMS has determined that fees for Joint Commission surveys may be included in a health care organization’s costs on its annual cost report for those organizations required to file cost reports.
Recognition for state licensure and certification
The Joint Commission’s accreditation and certification programs are recognized and relied on by many states in the states’ quality oversight activities. Recognition and reliance refers to the acceptance of, requirement for, or other reference to the use of Joint Commission accreditation and certification, in whole or in part, by one or more governmental agencies in exercising regulatory authority. This may include use of Joint Commission accreditation and certification for licensing, certification or contracting purposes by various state agencies.
For more information
For information about deemed status, call The Joint Commission’s Washington, D.C. office, at 202-783-6655. For information about state initiatives, call the Division of Business Development, Government and External Relations, at 630-792-5269.