Centers for Medicare & Medicaid Services (CMS)
Health care organizations that want to participate in and receive payment from the Medicare or Medicaid programs must be certified as complying with the Conditions of Participation (CoPs) as set forth in federal regulations.
CMS certification is achieved through a survey conducted by a state agency on behalf of the Centers for Medicare & Medicaid Services (CMS). However, most health care organizations opt to partner with a national accrediting organization such as the Joint Commission or DNV that develop and enforce standards that meet the federal CoPs. CMS grants “deemed status” to these organizations to allow them to survey and "deem" that a health care organization meets the Medicare and Medicaid certification requirements through its accreditation process.
CMS still conducts a random sampling of validation surveys to ensure that the AO is complying with the certification requirements. CMS also conducts surveys to investigate complaints filed against organizations with deemed status. In addition, each year the accrediting organizations must provide CMS with information and documentation on the performance of the health care organizations it accredits.
For the codes and standards guidance from CMS, see the following survey and certification memoranda.