Transcript Name of Presentation – An Overview

SURVEY AND CERTIFICATION 101
Tracey B. Mummert, MT (ASCP)
Special Assistant
CMSO, Survey and Certification Group
New Staff Orientation
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Here we are
New Staff Orientation
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New Staff Orientation
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WELCOME TO BALTIMORE, HON
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CMS’ ROLE
CMS
MEDICARE
MEDICAID
SCHIP
New Staff Orientation
CLIA
CLIA
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Centers for Medicare & Medicaid Services
Mark B. McClellan, M.D., Ph.D. Administrator
Here we are
Center for Medicaid and State Operations
Family and Childrens
Health Programs Groups
Northeastern
Consortium
ROs 1 ,2, and 3
Disabled & Elderly
Health Programs Group
Southern
Consortium
Survey & Certification
Group
Midwestern
Consortium
ROs 4 and 6
ROs 5 and 7
Finance, Systems &
Budget Group
Western Consortium
ROs 8, 9 and 10
State agencies
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CMS Regional Office Structure
Boston
New York
Seattle
Denver
San
Francisco
Kansas
City
Chicago
Philadelphia
Atlanta
Dallas
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CMS Regional Consortia Structure
Western
Consortium
Midwest
Consortium
Northeast
Consortium
Southern
Consortium
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State Agencies
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What is Survey and Certification?
• Survey for the purpose of certifying
to the Secretary compliance and noncompliance of providers and
suppliers of services and resurveying such entities at such time
as the Secretary may direct.
• In other words………………..
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What is Survey and Certification?
• We inspect health care providers for
compliance with the Medicare health
and safety standards
• If compliance, provider gets paid
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What is Survey and Certification?
• Providers wanting to receive
payment for services provided to
Medicare and Medicaid beneficiaries
must meet the Medicare health and
safety standards
• Standards are found in 42 CFR
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STATE AGENCIES
• Contract With CMS as per 1864 Agreement
• Survey Providers For Compliance With
Medicare Requirements – Conditions of
Participation (COPs)
• Report Certification Issues To Regional
Offices
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1864 AGREEMENT
• Lists Providers and Suppliers the State
Will Be Surveying
• Details Functions Performed by the State
• Provides for Payment to States
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WHO ARE PROVIDERS?
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Hospitals
Nursing Homes
Rehabilitation Facilities
Home Health Agencies
Hospices
Community Mental Health Centers
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WHO ARE SUPPLIERS?
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Laboratories
Rural Health Clinics
Ambulatory Surgical Centers
Organ Procurement Organizations
End-stage Renal Dialysis Facilities
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CERTIFICATION
Determining Compliance With The
Federal Conditions Of Participation,
Requirements (for SNFs and NFs), and
Conditions Of Coverage
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IT IS NOT STATE
LICENSURE
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Survey and Cert – Program Areas
• Division of Nursing Homes
• Division of Acute Care Services
• Division of Continuing Care
Providers
• Division of Laboratories
• Training Staff
• Budget Staff
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Division of Nursing Homes Highlights
• Ensures compliance with Medicare nursing
home standards
• Collects resident assessment data to create
quality indicators – Minimum Data Set
• Provides Data for Nursing Home Compare
Website
• Publishes Nursing Home Data Compendium
• National Complaint Tracking System
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Division of Nursing Homes Highlights
• Feeding Assistant Regulation
• New Life Safety Code requirements
• Oversees Federal Contract Surveys
for Nursing Homes
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Division of Acute Care Services Highlights
• Ensures compliance with Medicare
health and safety standards for:
– Hospitals
– Ambulatory Surgery Centers (ASCs)
– Rural Health Clinics (RHCs)
– Critical Access Hospitals (CAHs)
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Division of Acute Care Services Highlights
• Monitors compliance with
Emergency Medical Treatment and
Labor Act (EMTALA) requirements
• Monitors “deemed status” programs
• Assists Division of Nursing Homes
with Life Safety Code implementation
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Division of Continuing Care
Providers - Highlights
• Ensures compliance with Medicare health
and safety requirements for:
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home health agencies (HHAs)
hospice
dialysis facilities (ESRD)
intermediate care facilities for the mentally
retarded (ICF/MR)
– Psych hospitals
– Rehab facilities
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Division of Continuing Care
Providers - Highlights
• Collects home health patient assessment
data to create quality indicators
– Outcome and Assessment Information
Set (OASIS)
• Provides data for Home Health Compare
Website
• Oversees Federal Contract Surveys for
ICF/MR and Psych Hospitals
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Division of Laboratories
• Ensures compliance with the
Clinical Laboratory Improvement
Amendments (CLIA)
requirements for all laboratories
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CLINICAL LABORATORY
IMPROVEMENT AMENDMENTS
• Participation Is Mandatory
• “Laboratory” - A Facility That Tests Human
Specimens For Health Reasons For The
Purpose Of Providing Information For The
Diagnosis, Prevention, Or Treatment Of Any
Disease Or Impairment Of, Or The
Assessment Of The Health Of, Human
Beings
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Budget Staff
• Develops and executes State
Certification and CLIA budgets
• Serves as the central information
point for all State Certification and
CLIA budgetary matters.
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Training Staff
• Manages the operational aspects of all
S&C training
• Teaches surveyors hands-on skills
necessary for successfully surveying
Medicare and Medicaid facilities
• Facilitates satellite training
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Training Staff
• FY’04: 56 on-site courses
– 19 basic (LTC, HHA, ICF/MR, Psych Hospital,
LSC, Hospital, Hospice and ESRD)
– 35 specialty courses
– 2 national conferences (Leadership Summit
and State Training Coordinator’s Conference
• 26 satellite broadcasts
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CMS CENTRAL OFFICE
• Provide Guidance to Implement Medicare
Health and Safety Standards
• State Operations Manual
• Survey and Certification Policy Memos
• National Training
• State Oversight
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Survey and Cert Related Websites
• http://www.cms.gov/medicaid/survey-cert
• http://cms.internetstreaming.com
• http://www.medicare.gov/NHCompare/home.asp
• http://www.medicare.gov/HHCompare/home.asp
• http://www.cms.gov/oasis
• http://www.cms.gov/medicaid/mds20/default.asp
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