Deemed status
Deemed status is a designation granted by the Centers for Medicare & Medicaid Services (CMS) to a health care provider in the United States that has been accredited by an approved national accreditation organization, allowing the accreditation to substitute for a compliance survey by a state agency.
Conditions of participation and conditions for coverage
[edit]For any organization to receive funding from CMS, it must meet either the conditions for coverage (CfCs) or the conditions of participation (CoPs). These are sets of minimal standards which must be met before CMS will issue reimbursement for Medicare and Medicaid services. Areas covered by these standards include the End Stage Renal Disease Program,[1] ambulatory surgical centers,[2] and organ procurement organizations.[3] The standards for nursing homes were distributed as a result of the Nursing Home Reform Act.[4]
Outpatient clinics cannot receive deemed status.[5] A consequence of this is that the CMS payment systems can be more complicated at small clinics than at large hospitals for the same procedures.[5]
Conditions for coverage and conditions of participation apply to the following kinds of organizations:[6]
- Ambulatory surgical centers (ASCs)
- Community mental health centers (CMHCs)
- Comprehensive outpatient rehabilitation facilities (CORFs)
- Critical access hospitals (CAHs)
- End-stage renal disease facilities
- Federally qualified health centers
- Home health agencies
- Hospices
- Hospitals
- Hospital swing beds
- Intermediate care facilities for individuals with intellectual disabilities (ICF/IID)
- Organ procurement organizations (OPOs)
- Portable X-ray suppliers
- Programs for all-inclusive care for the elderly organizations (PACE)
- Clinics, rehabilitation agencies, and public health agencies as providers of outpatient physical therapy and speech-language pathology services
- Psychiatric hospitals
- Religious nonmedical health care institutions
- Rural health clinics
- Long-term care facilities
- Transplant centers
Accreditation and deeming
[edit]Two kinds of organizations can review a health care provider for compliance with the conditions of participation or conditions for coverage: a state-level agency acting on behalf of CMS, or a national accreditation organization such as the Joint Commission.[7]
When an organization is reviewed, the survey checks quality assurance rather than continuous quality improvement.[8] The process checks for minimal expectations, not whether the facility is improving.[8]
History
[edit]In 1994, about 5,000 hospitals were eligible to receive CMS funding as a result of being reviewed by the Joint Commission.[9]
The Medicare Improvements for Patients and Providers Act of 2008 removed the deemed status of the Joint Commission and directed it to reapply to CMS to seek continued authority to review hospitals for conditions for coverage and conditions of participation.[10]
References
[edit]- ↑ Centers for Medicare & Medicaid Services (CMS), HHS (1 April 2008). "Medicare and Medicaid programs; conditions for coverage for end-stage renal disease facilities. Final rule". Federal Register. 73 (73): 20369–20484. ISSN 0097-6326. PMID 18464351. Wikidata Q34777204.
- ↑ Centers for Medicare & Medicaid Services (CMS), HHS (1 October 2011). "Medicare program; changes to the ambulatory surgical centers patient rights conditions for coverage. Final rule". Federal Register. 76 (205): 65886–65890. ISSN 0097-6326. PMID 22022736. Wikidata Q34226952.
- ↑ Centers for Medicare & Medicaid Services (CMS), HHS (1 May 2006). "Medicare and Medicaid programs; conditions for coverage for organ procurement organizations (OPOs). Final rule". Federal Register. 71 (104): 30981–31054. ISSN 0097-6326. PMID 16749219. Wikidata Q34533882.
- ↑ The National Consumer Voice for Quality Long-Term Care (n.d.). "Deemed Status for Medicare and Medicaid Providers - Federal Requirements for Skilled Nursing Facilities". theconsumervoice.org. Archived from the original on 14 March 2022. Retrieved 18 June 2015.
- 1 2 J. A. Settles (1 October 1995). "Deemed status accreditation of nonhospital-based ambulatory surgery centers". Seminars in perioperative nursing. 4 (4): 199–204. ISSN 1056-8670. PMID 7581344. Wikidata Q34297155.
- ↑ Centers for Medicare & Medicaid Services (6 November 2013). "Conditions for Coverage (CfCs) & Conditions of Participations (CoPs)". cms.gov. Retrieved 18 June 2015.
- ↑ Joint Commission (1 August 2014). "Facts about federal deemed status and state recognition". jointcommission.org. Archived from the original on 16 April 2025. Retrieved 18 June 2015.
- 1 2 J B Wish (1 December 1998). "Role of external oversight in quality activities: accreditation, credentialing, licensure, and deemed status". American Journal of Kidney Diseases. 32 (6 Suppl 4): S177-81. doi:10.1016/S0272-6386(98)70184-2. ISSN 0272-6386. PMID 9892388. Wikidata Q56673807.
- ↑ Jost TS (1 January 1994). "Medicare and the Joint Commission on Accreditation of Healthcare Organizations: a healthy relationship?". Law and Contemporary Problems. 57 (4): 15–45. doi:10.2307/1192055. ISSN 0023-9186. JSTOR 1192055. PMID 10140656. Wikidata Q56673808.
- ↑ Juliet Battard Menendez (1 July 2010). "The Impetus for Legislation Revoking the Joint Commission's Deemed Status as a Medicare Accrediting Agency". JONA'S healthcare law, ethics and regulation. 12 (3): 69-76; quiz 77-8. doi:10.1097/NHL.0B013E3181EE276F. ISSN 1520-9229. PMID 20733410. Wikidata Q53065248.