www.CancerSupportCommunity.org Uniting The Wellness Community and Gilda’s Club Worldwide

Working with Regulators: A Focus on CMS An Educational Program of the

Cancer Policy Institute at the Cancer Support Community in Partnership with Uniting a Community (UaC): Policy, Advocacy, Education and Action Network

Conditions of Participation

Clinical Standards Group -----

Center for Clinical Standards & Quality

What are Conditions of Participation?

Conditions of Participation (CoPs) and

Conditions for Coverage (CfCs) are health

and safety regulations which must be met

by Medicare and Medicaid-participating

providers and suppliers.

They serve to protect all individuals receiving

services from those organizations.

3 INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and confidential.

It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law.

What are Conditions of Participation?

The CoPs help CMS ensure that all

providers and suppliers participating in the

Medicare and Medicaid programs provide

high quality care, and work towards

continued quality improvement.

4 INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law.

Health Care Organizations & Provider Types

CMS has CoPs or CfCs for the following health

care organizations and provider types:

• Ambulatory Surgical Centers

• Community Mental Health Centers

• Comprehensive Outpatient Rehabilitation Facilities

• Critical Access Hospitals

• End-Stage Renal Disease Facilities

• Federally Qualified Health Centers

• Home Health Agencies

• Hospices

• Hospitals

5 INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law.

Health Care Organizations & Provider Types

• Hospital Swing Beds

• Intermediate Care Facilities for the Intellectually Disabled

• Long Term Care Facilities

• Organ Procurement Organizations

• Portable X-Ray Suppliers

• Providers of Outpatient Services (physical and

occupational therapists in independent practice,

outpatient physical therapy, occupational therapy, and

speech pathology services)

• Religious Nonmedical Health Care Institutions

• Rural Health Clinics

• Transplant Centers

6 INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law.

Revisions to the CoPs

Revisions are made to the CoPs in

response to:

• Statutory Changes

• Administration Policies and Priorities

• National Issues and Events

• Changes in Medical Practice

7 INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law.

Examples of Current Priority Issues in CoPs

• Reduce Healthcare Acquired Conditions

• Reduce avoidable hospital readmissions

• Reduce burden on providers

• Antibiotic Stewardship

8 INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law.

www.CancerSupportCommunity.org Uniting The Wellness Community and Gilda’s Club Worldwide

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Working with Regulators: A Focus on CMS was made possible thanks to the support of GlaxoSmithKline