North Carolina Association Medical Staff Services MAY 15, 2008 Renee Aird Dengler, RN, MS, CPMSM, CPCS Advocate Health Care Director, Medical & Professional Affairs

The Joint Commission History 1910 – Ernest Codman, MD 1951 – American College of Physicians, American Hospital Association, American Medical Association, Canadian Medical Association 1965 - Social Security Amendments of 1965 – Deemed Status – accredited hospitals are in compliance with most of the Medicare Conditions of Participation for Hospitals

Centers for Medicare and Medicaid Services (CMS) History 1965 – Medicare and Medicaid enacted under Social Security Act 1973 – HMO Act 1977 – Health Care Financing Authority (HCFA)\ 1982 – PROs 1983 – Prospective Payment System 1985 – EMTALA

Centers for Medicare and Medicaid Services (CMS) 1996 – Health Insurance Portability and Accountability Act (HIPPA) 2001 – HCFA is renamed CMS - Center for Medicare Management - Center for Beneficiary Choice - Center for Medicaid and State Operations 2003 – Medicare Prescription Drug Improvement and Modernization Act

Centers for Medicare and Medicaid Services (CMS) State Operations Manual Conditions of Participation Regulations and Interpretive Guidelines

Centers for Medicare and Medicaid Services (CMS) Deemed Status TJC AOA - HFAP DNV - NIAHO

Centers for Medicare and Medicaid Services (CMS) Survey Process Validation Survey Web Sites State Operation Manual / Interpretive Guidelines http://cms.hhs.gov/manuals/Downloads/som107ap_a_hospitals.pdf Email updates http://www.cms.hhs.gov/AboutWebsite/20_EmailUpdates.asp#TopOfPage

Centers for Medicare and Medicaid Services (CMS) “Familiar” Standards Review of Conditions of Participation, Standards & Interpretive Guidelines

The Joint Commission & CMS August 2008 Letter Re: Deeming Authority

The Joint Commission & CMS Revised 2009 Accreditation Requirements as of March 26, 2009 MS.01.01.01 MS.02.01.01 MS.03.01.01 MS.03.01.03 MS.05.01.01 MS.06.01.03

Clarifying Standards Core Privileges Telemedicine H&Ps – APRNs, PA, Medical Students

Clarifying Standards Expedited Credentialing Health Care Industry Representatives (HCIR) LIP Health Screening

Clarifying Standards Ongoing Professional Practice Evaluation (OPPE) Focused Professional Practice Evaluation (FPPE)

National Committee on Quality Assurance (NCQA) Credentialing Standards NPDB – Proactive Disclosure Service (PDS) Verification of “lifetime” board certification

National Committee on Quality Assurance (NCQA) Verification of CDS and DEA Verification of Education & Training for Expired Board Certification Pen or Pencil?