CMS proposes greater oversight, consulting limitations for accrediting organizations

The Centers for Medicare & Medicaid Services (CMS) is proposing new oversight of accrediting organizations' performance and other changes in response to “several concerns” the agency said have cropped up in recent years.

Accrediting organizations, which regularly survey healthcare providers and suppliers to ensure they meet CMS’ health and safety standards, have lately demonstrated “inconsistent” survey results when their standards or practices sometimes differ from CMS policies, CMS wrote in a Thursday fact sheet accompanying its new proposed rule.

The agency also said it is concerned about cases in which a provider or supplier was terminated from Medicare/Medicaid but retained their accreditation as well as about conflicts of interest that arise when accreditation organizations also provide fee-based consulting services to those they accredit.

CMS wrote in the proposed rule that it became aware of these concerns through a combination of media reports, performance evaluations, direct observation of accreditation programs and analysis of disparities between accrediting organizations and state survey agencies.

To address these, CMS said it has proposed:

  • Holding accrediting organizations to the same standards as state survey agencies
  • Placing “certain limitations” on fee-based consulting services provided to healthcare facilities being accredited
  • Prohibiting accrediting organization owners, surveyors, employees and close relations with ties to a health facility being accredited from having access to that facility’s survey records
  • Requiring accrediting organizations to report to CMS on conflicts of interest
  • Require accrediting organizations with poor performance to submit a correction plan
  • More closely align accrediting organizations and state survey agencies’ survey activity requirements and staff training

CMS also noted a proposed change that would relieve burdens on providers by reducing look-back validation surveys by half. Other proposals broadly strengthen survey policies and increase transparency into accrediting organization practices, the agency said.

There are nine accrediting organizations approved by CMS to survey and accredit Medicare-certified facilities. CMS said its proposals would affect all of these with the exception of those accrediting clinical laboratories and noncertified suppliers.

Shawn Griffin, M.D., president and CEO of Utilization Review Accreditation Commission (URAC), one of the nine approved accrediting organizations, said in a statement that his group “strongly supports” the proposed rulemaking and underscored the agency’s focus on conflicts of interest.

The consulting services addressed by CMS—which URAC does not offer—are “like giving an organization seeking accreditation the answers to the ‘test,’ defeating the purpose of accreditation being a rigorous test of quality,” he said in an emailed response to the proposed rulemaking.

“While we do work closely with the organizations seeking accreditation, we are careful not to have any conflicts of interest in the process,” he continued. “We believe this new rule will improve the quality of healthcare by ensuring organizations are implementing best practices and quality standards on their own accord, before receiving the ‘gold star’ of accreditation.”

The proposed rule (PDF) is scheduled to be published in the Federal Register on Feb. 15. CMS will be accepting public comments on the proposed rule through April 15.