new staff orientation1 survey and certification 101 tracey b. mummert, mt (ascp) special assistant...
TRANSCRIPT
New Staff Orientation 1
SURVEY AND CERTIFICATION 101
Tracey B. Mummert, MT (ASCP) Special AssistantCMSO, Survey and Certification Group
New Staff Orientation 7
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
8New Staff Orientation
Dallas
SanFrancisco
SeattleDenver
KansasCity
Chicago
Atlanta
Boston
New York
Philadelphia
CMS Regional Office Structure
9New Staff Orientation
WesternConsortium
SouthernConsortium
MidwestConsortium
NortheastConsortium
CMS Regional Consortia Structure
New Staff Orientation 11
• 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 Orientation 12
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 Orientation 13
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 Orientation 14
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 15
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
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
New Staff Orientation 28
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
New Staff Orientation 31
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 Orientation 32
CMS CENTRAL OFFICE
• Provide Guidance to Implement Medicare Health and Safety Standards
• State Operations Manual• Survey and Certification Policy Memos• National Training• State Oversight