For a health care organization to participate in and receive payment from the Medicare or Medicaid program, it must be certified as complying with the Conditions of Participation (CoP), 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" each accredited health care organization as meeting the Medicare and Medicaid certification requirements. The health care organization would have "deemed status" and would not be subject to the Medicare survey and certification process.
The Joint Commission and Deemed Status
Deemed status options are available for Joint Commission-accredited ambulatory surgical centers, clinical laboratories, home health agencies, hospice organizations, and hospitals.
Ambulatory Surgical Centers
The deemed status option for accredited ambulatory surgery centers has been available since December 1996. Joint Commission-accredited centers are deemed to meet the Medicare Conditions for Participation for Ambulatory Surgical Services.
Behavioral Health Care
The Joint Commission has been involved in Behavioral Health Accreditation since 1969.
Laboratories that receive accreditation through a biennial survey are deemed to meet the requirements of the federal Clinical Laboratory Improvement Amendments of 1988 (CLIA ‘88). The Joint Commission began conducting surveys for CLIA certification in January 1995.
Critical Access Hospitals
Critical access hospitals (CAH) are small and rural hospitals that are recognized by CMS as meeting certain requirements and in doing so are eligible for different levels of reimbursement. Some of the requirements include:
- Maintain no more than 25 acute care and/or swing beds
- Keep hospitalized patients for fewer than 96 hours
- Receive authorization to become a CAH from the state office of rural health
The Joint Commission began providing deemed status accreditation for critical access hospitals in 2002. They have deemed status recognition from CMS for their Critical Access Hospital Accreditation Program, including conversion surveys (the initial survey to become a CAH), and for recertification.
The deemed status option for Joint Commission-accredited home health agencies became effective in June 1993. Surveys to be used for deemed status must be unannounced. Survey intervals of one, two, or three years will be determined using CMS criteria. More frequent surveys may be necessary for an accredited home health agency that, for example, has had a change of ownership.
CMS approved the Joint Commission’s application for hospice deemed status in June 1999. Hospice deemed status surveys must be unannounced. This deemed status option is open to organizations seeking Medicare funding for hospice services as well as those already Medicare certified. Organizations choosing this option will be evaluated against both Joint Commission standards and Hospice Medicare Conditions of Participation. Accreditation remains voluntary and seeking deemed status through accreditation is not a requirement for Medicare certification.
Since the enactment of the Social Security Act in 1965, hospitals with Joint Commission accreditation have been deemed as meeting the federal Conditions of Participation for the Medicare and Medicaid programs. The Medicare Improvement Act of 2008 required the Joint Commission to apply to CMS to continue to receive deemed status. In November 2009, the Joint Commission announced it had been granted deemed status by CMS, meaning that hospitals accredited by the Joint Commission would continue to be considered in compliance with the CMS Conditions of Participation and eligible to receive Medicare/Medicaid funds.
Two accreditation options exist for long-term care accreditation:
Traditional long-term care accreditation (LTC): Requires the organization to be in compliance with all applicable Joint Commission long-term care accreditation requirements in the Comprehensive Accreditation Manual for Long-Term Care.
Medicare/Medicaid certification-based accreditation (LT2): Requires the organization to be in compliance with applicable Joint Commission standards not addressed by the Medicare/Medicaid Conditions of Participation. All Joint Commission corporate policies apply, including the sentinel event policy, accreditation participation requirements, and compliance with the National Patient Safety Goals. The accreditation certificate indicates that accreditation is substantially based on the organization’s most recent Medicare/Medicaid certification survey evaluation of its long term care services.
CMS conducts random validation surveys and complaint investigations of organizations with deemed status through Joint Commission accreditation. In addition, the Joint Commission is obliged to provide CMS with a listing of, and related documentation for, organizations receiving conditional accreditation, preliminary non-accreditation, and non-accreditation. The Joint Commission also provides CMS with accreditation decision reports for hospitals involved in CMS validation surveys and any other survey report CMS requests.
Costs of Deemed Status Survey
CMS has determined that fees for surveys by the Joint Commission or another accreditation organization are allowable costs and may be included in a health care organization’s costs on its annual cost report for those organizations required to file cost reports.
Voluntary Accreditation, Deemed Status
Accreditation is voluntary and seeking deemed status through accreditation is an option, not a requirement. Organizations seeking Medicare approval may choose to be surveyed either by an accrediting body, such as the Joint Commission, DNV, and HFAP, or by state surveyors on behalf of CMS.