CMS tightens oversight of accreditation facilities, limits fee-based consulting

The Centers for Medicare and Medicaid Services (CMS) has locked in tighter oversight of accrediting organizations’ alignment with Medicare standards, as well as new protections against potential conflicts of interest. 

In a final rule published Friday, the agency laid out its updated requirements for the nine organizations that regularly survey and accredit more than 9,000 providers participating in Medicare (excluding those that accredit clinical laboratories and noncertified suppliers). 

The changes, first floated in early 2024, reflected the agency’s concerns that some providers and suppliers had retained their accreditation from these organizations after they’d been terminated from Medicare or Medicaid due to quality and safety concerns. 

CMS also said it had seen inconsistencies in survey results that stemmed from differing standards between the accrediting organizations and state survey agencies, and worried that “the integrity” of their surveys could be impacted by the fee-based consulting services offered to the same providers being surveyed. 

“The work accrediting organizations do is vital, but it also raises an age-old question: who watches the watchmen? The answer is, we do,” CMS Administrator Mehmet Oz, M.D., said in Friday’s announcement. “With this new rule, CMS is advancing its commitment to upholding rigorous standards for accrediting organizations and ensuring the health and safety of American patients.”

Among the changes in the new final rule are requirements that will bring the accrediting organizations’ survey processes, survey activity requirements and staff training more closely in line with state survey agencies.

It also outlines a new definition of an “unannounced survey,” codifying existing statutory requirements and specifying that a provider or supplier may not be informed of a survey until a team arrives on site. 

“Some providers or suppliers have informed us that they know when an [accrediting organization] is scheduled to survey the facility,” CMS wrote in the final rule. “The [accrediting organization] may schedule the facility for survey within the same week or month every survey cycle, or has narrowed its schedule via the use of blackout days, or informed the facility close to the time of the survey via administrative contact from the [accrediting organization], such as payment collection, confirmation or change of address notification or other facility-[accrediting organization] specific information. All of these practices undermine the integrity of the unannounced survey process.”

Accrediting organizations will also face a new ongoing review process in which their own performance is monitored through a direct observation validation survey conducted by CMS. Those that fall short will be required to submit a publicly reported correction plan to the agency within 10 business days. 

On conflicts of interest, the organizations will have new limitations on their fee-based consulting services for providers and suppliers they accredit any time prior to an initial survey, during the last 12 months of a 36-month accreditation period and in response to a complaint received about the accredited provider. CMS noted that the restrictions do not prevent other communications between the parties during restricted periods, and that organizations are free to seek fee-based consulting from third parties at any time. 

Additionally, the final rule prohibits accrediting organization stakeholders, such as owners or employees with ties to a healthcare facility being accredited, from taking a role in surveys and decision-making, as well as from having access to related records. 

The final rule took effect on June 16, with some changes, such as those related to fee-based consulting services being delayed for another year in order to allow additional public comment.