Advocacy

Centers for Medicare & Medicaid Services (CMS)

In order for a health care organization to participate in and receive payment from the Medicare or Medicaid programs, it must be certified as complying with the Conditions of Participation, or standards, set forth in federal regulations. This certification is based on a survey conducted by a state agency on behalf of the Centers for Medicare & Medicaid Services (CMS). However, if a national accrediting organization, such as the Joint Commission, has and enforces standards that meet the federal Conditions of Participation, CMS may grant the accrediting organization "deeming" authority and "deem" that each accredited health care organization meets the Medicare and Medicaid certification requirements. The health care organization then has "deemed status" and is not subject to the Medicare survey and certification process.

CMS conducts random validation surveys and complaint investigations of organizations with deemed status through the Joint Commission accreditation process. In addition, the Joint Commission is obliged to provide CMS with a list of, and related documentation for, organizations receiving conditional accreditation, preliminary nonaccreditation, and nonaccreditation. The Joint Commission also provides CMS with accreditation decision reports for hospitals involved in CMS validation surveys and any other survey report CMS requests.

Note: CMS was formerly titled the Health Care Financing Administration (HCFA).

Forms and Worksheets