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2018 IHS/Tribal/Urban Indian Educational Event

2018 IHS/Tribal/Urban Indian Educational Event. CMS Dallas Division of Survey & Certification (DSC). Introductions. Gerardo Ortiz, Associate Regional Administrator, Dallas DSC Shannon Hills-Cline, Manager, Certification Branch, Dallas DSC Theresa Bennett, Technical Advisor

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2018 IHS/Tribal/Urban Indian Educational Event

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  1. 2018 IHS/Tribal/Urban Indian Educational Event CMS Dallas Division of Survey & Certification (DSC)

  2. Introductions • Gerardo Ortiz, Associate Regional Administrator, Dallas DSC • Shannon Hills-Cline, Manager, Certification Branch, Dallas DSC • Theresa Bennett, Technical Advisor • DodjieGuioa, Hospital Lead, Enforcement Branch, Dallas DSC

  3. Today’s Objectives • Understand the role and function of the CMS Dallas Division of Survey & Certification • Understand the Federal survey process. • Understand the certification process. • Understand the enforcement process.

  4. Dallas Division of Survey & Certification (DDSC) • Our focus is certification of institutional providers and suppliers for participation in the Medicare program. Most of this is done in conjunction with our agents, the State Survey Agencies (SA). • Each of the three branches and our Technical Advisor work on the annual State Performance Standards of the SA performance, compiling and analyzing data, developing and presenting reports, and monitoring corrective action.

  5. DDSC, continued We provide oversight of 17 provider and supplier types: • CLIA Laboratories • Home Health Agencies • Nursing Homes • Portable X-Ray • Intermediate Care Facilities for the Intellectually Disabled • Hospitals • Dialysis Facilities • Hospices • Federally Qualified Health Centers • Ambulatory Surgical Centers • Rural Health Clinics • Outpatient Physical Therapists • Transplant Programs at 39 Transplant Hospitals • Comprehensive Outpatient Rehabilitation Facilities • Community Mental Health Centers • Psychiatric Residential Treatment Facilities (under 21 years of age) • Organ Procurement Organizations

  6. Certification Branch • We process and track Medicare certification actions for providers and suppliers • We partner with State Survey agencies (SAs) to oversee the Medicare certification process • We provide ongoing oversight, training and technical assistance to SAs related to certification • We interpret policy/regulations and provide technical expertise to variety of partners (i.e. providers, associations, SAs, public, etc.)

  7. Certification Branch • We coordinate the Division’s State Performance Standards Systems program (SPSS) • We coordinate the Division’s communication with the Accrediting Organizations, including validation surveys and deemed status programs. • We coordinate the Division’s Freedom of Information Act (FOIA) program

  8. Certification Branch We primarily process 3 types of Certification actions: • Initial • Change of Ownership (CHOW) • Voluntary Termination

  9. Survey Branch • Federal Surveyors/qualified clinicians (nurses, social workers, dietitians, professional engineer and medical technologists) perform over 100 health surveys, 100 fire safety surveys and 25 Clinical Laboratory Improvement Amendments of 1988 (CLIA) surveys each year to monitor state survey performance. • These surveys represent 5% of the LTC providers and 1% of the non-LTC providers. • While states perform the vast majority of “Federal” surveys for us, these are the only surveys with actual Federal surveyors.

  10. Survey Branch, continued • We compile and analyze data related to LTC, non-LTC and CLIA Federal Monitoring Survey findings to assure consistent and appropriate application of Federal requirements. • We coordinate the Federal training program for Survey and Certification activities. • We provide oversight of over 30,000 CLIA laboratories through the oversight of State Agency CLIA activities, the Federal Monitoring Surveys (FMS), validation surveys and State Agency Performance Review (SAPR).

  11. Survey Branch, continued • We provide technical assistance to laboratories to ensure compliance and provide support and assistance to facilitate SA work. • We participate in the state survey agencies CLIA budget development, oversight and long-term planning. • We provide technical assistance/oversight to State Survey Agencies for ICF/ID survey and certification activities. • We review Federal contractor survey activity for ICF/ID facilities.

  12. Enforcement Branch • We provide technical assistance to and oversight of State Survey Agencies related to enforcement actions against Medicare/Medicaid certified provider entities. • For nursing homes and home health agencies, we have a variety of tools to ensure compliance, including: • Civil Monetary Penalties of up to $10,000 per instance or up to $10,000 per day • Denial/Suspension of Payment for New Admissions • Directed In-Service • Directed Plan of Correction • State Monitoring • Temporary Management • Termination

  13. Enforcement Branch, continued • The primary compliance tool for other providers/suppliers is to issue a notice of termination of their Medicare participation. • Last fiscal year, we processed • 898 nursing home enforcement actions. • Approximately 120 other enforcement actions, primarily related to hospitals and including EMTALA (Emergency Medical Treatment and Labor Act) cases. • We oversee the State Agency budget process and monitor all expenditures charged to the Medicare, Medicaid and CLIA (clinical laboratory) programs.

  14. Enforcement Process • Survey findings of non-compliance • Quality review process • Enforcement decision • Monitoring of compliance progress • Closure of enforcement action

  15. Hospitals Hospital Survey Protocol (Appendix A): • https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/som107ap_a_hospitals.pdf Critical Access Hospital Survey Protocol (Appendix W): • https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/som107ap_w_cah.pdf

  16. Hospitals Hospital Surveyor Worksheet for hospitals: • Used by State & Federal surveyors to assess compliance. • Quality Assessment and Performance Improvement (QAPI), • Infection Control, and • Discharge Planning.

  17. Hospitals Hospital Surveyor Worksheet for hospitals: https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Policy-and-Memos-to-States-and-Regions-Items/Survey-and-Cert-Letter-15-12.html? DLPage= 1&DLEntries=10&DLFilter=public%20release&DLSort=3&DLSortDir=descending

  18. Many thanks!

  19. Contact Information: • Gerardo Ortiz, gerardo.ortiz@cms.hhs.gov • Shannon Hills-Cline, shannon.hills@cms.hhs.gov • Theresa Bennett, theresa.bennett@cms.hhs.gov • DodjieGuioa, dodjie.guioa@cms.hhs.gov

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