Name of Presentation An Overview

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SURVEY AND CERTIFICATION 101
Tracey B. Mummert, MT (ASCP) Special
Assistant CMSO, Survey and Certification Group
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Here we are
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WELCOME TO BALTIMORE, HON
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CMS ROLE
CMS
SCHIP
MEDICARE
MEDICAID
CLIA
CLIA
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Centers for Medicare Medicaid Services Mark B.
McClellan, M.D., Ph.D. Administrator
Here we are
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CMS Regional Office Structure
Boston
New York
Seattle
Denver
Chicago
Kansas City
San Francisco
Philadelphia
Atlanta
Dallas
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CMS Regional Consortia Structure
Northeast Consortium
Western Consortium
Midwest 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 non-compliance of
  providers and suppliers of services and
  re-surveying 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?

• Hospitals
• Nursing Homes
• Rehabilitation Facilities
• Home Health Agencies
• Hospices
• Community Mental Health Centers

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WHO ARE SUPPLIERS?

• Laboratories
• Rural Health Clinics
• Ambulatory Surgical Centers
• Organ Procurement Organizations
• End-stage Renal Dialysis Facilities

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Determining Compliance With The Federal
Conditions Of Participation, Requirements (for
SNFs and NFs), and Conditions Of Coverage

• CERTIFICATION

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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
• 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 SC
  training
• Teaches surveyors hands-on skills necessary for
  successfully surveying Medicare and Medicaid
  facilities
• Facilitates satellite training

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Training Staff

• FY04 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 Coordinators 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