New Staff Orientation 1

SURVEY AND CERTIFICATION 101

Tracey B. Mummert, MT (ASCP) Special AssistantCMSO, Survey and Certification Group

New Staff Orientation 2

Here we are

New Staff Orientation 3

New Staff Orientation 4

WELCOME TO BALTIMORE, HON

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New Staff Orientation 6

CMS’ ROLE

CMS

CLIASCHIPMEDICARE MEDICAID CLIA

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NortheasternConsortium

SouthernConsortium

MidwesternConsortium

Western Consortium

ROs 1 ,2, and 3 ROs 4 and 6 ROs 8, 9 and 10

State agencies

ROs 5 and 7

Family and ChildrensHealth Programs Groups

Disabled & ElderlyHealth Programs Group

Survey & CertificationGroup

Finance, Systems &Budget Group

Center for M edicaid and State Operations

Here we are

Centers for Medicare & Medicaid Services Mark B. McClellan, M.D., Ph.D. Administrator

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Dallas

SanFrancisco

SeattleDenver

KansasCity

Chicago

Atlanta

Boston

New York

Philadelphia

CMS Regional Office Structure

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WesternConsortium

SouthernConsortium

MidwestConsortium

NortheastConsortium

CMS Regional Consortia Structure

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State Agencies

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• 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………………..

What is Survey and Certification?

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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

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

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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

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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

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

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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