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JCAHO Federal Deemed Status and State Recognition

What is Deemed Status?
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)[1]. 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 Coverage for Ambulatory Surgical Services. The deemed status survey is unannounced.
  • Clinical Laboratories. 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.
  • Home Health. The deemed status option for Joint Commission accredited home health agencies became effective June of 1993. Surveys to be used for deemed status must be unannounced. Survey intervals, which may be 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.
  • Hospices. CMS approved the Joint Commission’s application for hospice deemed status in June of 1999. Hospice deemed status surveys, like ambulatory and home health 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.
  • Hospitals. 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.

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 CMSwith a listing 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.

Costs of Deemed Status Survey Allowable
CMS has determined that fees for surveys by the Joint Commission 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, or by state surveyors on behalf of CMS.


[1] CMS was formerly titled the Health Care Financing Administration (HCFA)