New Staff Orientation1 SURVEY AND CERTIFICATION 101 Tracey B. Mummert, MT (ASCP) Special Assistant CMSO, Survey and Certification Group
New Staff Orientation2 Here we are
New Staff Orientation3
4 WELCOME TO BALTIMORE, HON
New Staff Orientation5
6 CMS’ ROLE CMS CLIA SCHIPMEDICAREMEDICAIDCLIA
New Staff Orientation7 Here we are Centers for Medicare & Medicaid Services Mark B. McClellan, M.D., Ph.D. Administrator
New Staff Orientation8 Dallas San Francisco Seattle Denver Kansas City Chicago Atlanta Boston New York Philadelphia CMS Regional Office Structure
New Staff Orientation9 Western Consortium Southern Consortium Midwest Consortium Northeast Consortium CMS Regional Consortia Structure
New Staff Orientation10 State Agencies
New Staff Orientation11 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?
New Staff Orientation12 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 Orientation13 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 Orientation14 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 AGREEMENT Lists Providers and Suppliers the State Will Be Surveying Details Functions Performed by the State Provides for Payment to States
New Staff Orientation16 WHO ARE PROVIDERS? Hospitals Nursing Homes Rehabilitation Facilities Home Health Agencies Hospices Community Mental Health Centers
New Staff Orientation17 WHO ARE SUPPLIERS? Laboratories Rural Health Clinics Ambulatory Surgical Centers Organ Procurement Organizations End-stage Renal Dialysis Facilities
New Staff Orientation18 Determining Compliance With The Federal Conditions Of Participation, Requirements (for SNFs and NFs), and Conditions Of Coverage CERTIFICATION
New Staff Orientation19 IT IS NOT STATE LICENSURE
New Staff Orientation20 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 Orientation21 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 Orientation22 Division of Nursing Homes - Highlights Feeding Assistant Regulation New Life Safety Code requirements Oversees Federal Contract Surveys for Nursing Homes
New Staff Orientation23 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 Orientation24 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 Orientation25 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 Orientation26 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 Orientation27 Division of Laboratories Ensures compliance with the Clinical Laboratory Improvement Amendments (CLIA) requirements for all laboratories
New Staff Orientation28 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 Orientation29 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 Orientation30 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 Orientation31 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 Orientation32 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 Orientation33 Survey and Cert Related Websites