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
Dodjie Guioa, 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. We primarily process 3 types of Certification actions:
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):
Critical Access Hospital Survey Protocol (Appendix W):

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: SurveyCertificationGenInfo/Policy-and-Memos-to-States-and-Regions-Items/Survey-and-Cert-Letter html? DLPage= 1&DLEntries=10&DLFilter=public%20release&DLSort=3&DLSortDir=descending

18. Many thanks!

19. Contact Information:
Gerardo Ortiz,
Shannon Hills-Cline,
Theresa Bennett,
Dodjie Guioa,