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SURVEY AND CERTIFICATION 101

SURVEY AND CERTIFICATION 101. Tracey B. Mummert, MT (ASCP) Special Assistant CMSO, Survey and Certification Group. Here we are. WELCOME TO BALTIMORE, HON. CMS’ ROLE. CMS. MEDICARE. MEDICAID. SCHIP. CLIA. CLIA. Centers for Medicare & Medicaid Services

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SURVEY AND CERTIFICATION 101

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  1. SURVEY AND CERTIFICATION 101 Tracey B. Mummert, MT (ASCP) Special Assistant CMSO, Survey and Certification Group New Staff Orientation

  2. Here we are New Staff Orientation

  3. New Staff Orientation

  4. WELCOME TO BALTIMORE, HON New Staff Orientation

  5. New Staff Orientation

  6. CMS’ ROLE CMS MEDICARE MEDICAID SCHIP CLIA CLIA New Staff Orientation

  7. Centers for Medicare & Medicaid Services Mark B. McClellan, M.D., Ph.D. Administrator Here we are New Staff Orientation

  8. CMS Regional Office Structure Boston New York Seattle Denver Chicago Kansas City San Francisco Philadelphia Atlanta Dallas New Staff Orientation

  9. CMS Regional Consortia Structure Northeast Consortium Western Consortium Midwest Consortium Southern Consortium New Staff Orientation

  10. State Agencies New Staff Orientation

  11. 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……………….. New Staff Orientation

  12. What is Survey and Certification? • We inspect health care providers for compliance with the Medicare health and safety standards • If compliance, provider gets paid New Staff Orientation

  13. 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 New Staff Orientation

  14. 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 New Staff Orientation

  15. 1864 AGREEMENT • Lists Providers and Suppliers the State Will Be Surveying • Details Functions Performed by the State • Provides for Payment to States New Staff Orientation

  16. WHO ARE PROVIDERS? • Hospitals • Nursing Homes • Rehabilitation Facilities • Home Health Agencies • Hospices • Community Mental Health Centers New Staff Orientation

  17. WHO ARE SUPPLIERS? • Laboratories • Rural Health Clinics • Ambulatory Surgical Centers • Organ Procurement Organizations • End-stage Renal Dialysis Facilities New Staff Orientation

  18. Determining Compliance With The Federal Conditions Of Participation, Requirements (for SNFs and NFs), and Conditions Of Coverage CERTIFICATION New Staff Orientation

  19. IT IS NOT STATE LICENSURE New Staff Orientation

  20. 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 New Staff Orientation

  21. 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 New Staff Orientation

  22. Division of Nursing Homes - Highlights • Feeding Assistant Regulation • New Life Safety Code requirements • Oversees Federal Contract Surveys for Nursing Homes New Staff Orientation

  23. 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) New Staff Orientation

  24. 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 New Staff Orientation

  25. 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 New Staff Orientation

  26. 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 New Staff Orientation

  27. Division of Laboratories • Ensures compliance with the Clinical Laboratory Improvement Amendments (CLIA) requirements for all laboratories New Staff Orientation

  28. 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 New Staff Orientation

  29. Budget Staff • Develops and executes State Certification and CLIA budgets • Serves as the central information point for all State Certification and CLIA budgetary matters. New Staff Orientation

  30. 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 New Staff Orientation

  31. 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 New Staff Orientation

  32. CMS CENTRAL OFFICE • Provide Guidance to Implement Medicare Health and Safety Standards • State Operations Manual • Survey and Certification Policy Memos • National Training • State Oversight New Staff Orientation

  33. 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 New Staff Orientation

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