CMS Role of the State Agency Role of the Surveyor Stephanie Senior, RN Branch Manager, Survey

1. CMS Role of the State Agency Role of the Surveyor Stephanie Senior, RN Branch Manager, Survey Region 2. New York New Staff Orientation

2. Agreements • 1864(a) is the basis of our contract. • 1902(a)(9)(A) provides that standards are set and maintained under Medicaid. • 1902(a)(33)(B) requires the state survey agency to determine compliance with Federal standards for Medicaid participation. New Staff Orientation

3. The Certification Process • The State Agency officially certifies its findings that the entities meet the Act’s definitions and comply with Federal standards. New Staff Orientation

4. The Certification Process • Surveys are necessary in the certification process. • It is crucial evidence. • It is relied upon by the regional offices. New Staff Orientation

5. The Certification Process • State Agencies do not have Medicare determination- making functions or authorities. New Staff Orientation

6. Question:What is a survey ? • A survey is a realistic focus that ascertains that the responsible providers are effectively doing all they must do to protect health and safety. New Staff Orientation

7. The Role of the State Agency Functions includes, but not limited to: • Identifying potential participants. • Conducting investigations and fact finding surveys. . New Staff Orientation

8. The Role of State Agency • Explaining Requirements. • Operating a Toll-Free Home Health Hotline. • Conduct periodic educational programs for staff and residents and their representatives. New Staff Orientation

9. State Agency Role • Identifying prospective payment system excluded Institutions. • Participating on validation surveys of accredited facilities. • Proficiency Testing. New Staff Orientation

10. State Agency Role • Direct Data Entry. • Nurse Aide Training. • Nurse Aide Registry. New Staff Orientation

11. State Agency Role • Resident Assessment Instrument. • Records and Reports. New Staff Orientation

12. Role of the Surveyor • Conducts onsite inspections of health care delivery provided to beneficiaries to evaluate quality of care, quality of life and the provisions of other services. New Staff Orientation

13. The Role of the Surveyor • Surveys are accomplished by scrutinizing the providers records. New Staff Orientation

14. The Role of the Surveyor • Surveys of skilled nursing facilities, nursing facilities home health agencies and immediate care facilities/mentally retarded are conducted in accordance with outcome orientated survey protocols. New Staff Orientation

15. The Role of the Surveyor • Tools are designed to concentrate on patient/resident/client outcomes of care rather than focusing on process orientated requirements. New Staff Orientation

16. The Role of the Surveyor • Analyzes facility data. • Utilizes various survey protocols. • Conducts surveys in accordance with the appropriate protocols. New Staff Orientation

17. The Role of the Surveyor • Decides whether there is a violation of the statute or the regulations based on observations of the facility performance, practices or conditions in the facility. New Staff Orientation

18. The Role of Surveyor • Prepares its certification for the Regional Office. • Sends the institution a Statement of Deficiencies. • Institution is given 10 days in which to respond with a Plan of Correction. New Staff Orientation

19. Role of Surveyor • Plans of correction are either acceptable or unacceptable. • If an institution is not in compliance within the time period accepted as reasonable, the SA certifies noncompliance. • Recommends termination. New Staff Orientation