CMS proposed rule strengthens oversight of Accrediting Organizations 

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The Centers for Medicare and Medicaid Services has released a Notice of Proposed Rulemaking to bolster oversight of Accrediting Organizations in the Medicare and Medicaid program.

In recent years, CMS has identified several concerns related to Accrediting Organization performance. These include:

• Providers and suppliers have been terminated from the Medicare/Medicaid program, but retain accreditation despite significant quality and safety concerns.
• AOs provide fee-based consulting services to the providers and suppliers they accredit, potentially affecting the integrity of the onsite survey process and decreasing public trust by creating conflicts of interest.
• Inconsistent survey results due to differing AO standards or practices (such as AOs notifying facilities of the date of their onsite surveys in advance contrary to CMS policies).

CMS's annual AO oversight Reports to Congress (RTCs) highlight the agency's significant concerns regarding AO performance that need to be addressed. 

WHY THIS MATTERS

The proposed changes would strengthen oversight of Accrediting Organizations, reduce conflicts of interest and strive for enhanced consistency of survey processes, CMS said. They also would ensure that providers meet health and safety standards. 

Additional changes would reduce the burden on providers, strengthen survey policies, and increase the transparency of AO practices.

The 60-day comment period closes on April 15.

The proposed standards align with CMS's National Quality Strategy, which includes: 

• Holding AOs accountable to the same standards as State Survey Agencies.
• Ensuring that AOs remain independent reviewers by addressing conflicts of interest and placing certain limitations on the fee-based consulting services.
• Preventing AO conflicts of interest by prohibiting AO owners, surveyors, and other employees, and as well as their immediate family members, from participating in surveys.
• Addressing potential and actual conflicts of interest by requiring AOs to report specific information to CMS about how they will monitor, prevent and handle conflicts of interest and the fee-based consulting services they provide.
• Improving AO performance by requiring AOs with poor performance to submit a publicly reported correction plan to CMS.
• Improving consistency and standardization in surveys nationwide by more closely aligning AO survey activity requirements and staff training with those of state agencies.

THE LARGER TREND

Each year, Accrediting Organizations with a CMS-approved program survey over 9,000 accredited health care providers and suppliers participating in the Medicare/Medicaid program for compliance with health and safety requirements. 

The most recent AO oversight Report to Congress, the 2021 RTC, covers the 2020 oversight and validation activities for all AOs in fiscal year 2020, as well as those under the Clinical Laboratory Improvement Amendments of 1988 (CLIA).

Currently, CMS has approved nine AOs to survey and accredit Medicare-certified facilities. 

The changes outlined in the NPRM affect all AOs except those that accredit clinical laboratories and noncertified suppliers, which include suppliers of advanced diagnostic imaging (ADI), home infusion therapy (HIT), and diabetes self-management training (DSMT), as well as durable medical equipment (DME) suppliers and suppliers of durable medical equipment prosthetics, orthotics, and supplies (DMEPOS).

Email the writer: SMorse@himss.org