CMS published a final rule June 12 to increase oversight of the nine accrediting organizations that survey more than 9,000 healthcare organizations annually for compliance with federal health and safety requirements.
CMS highlighted several areas of concern and potential conflicts of interest the final rule aims to address. These include accredited healthcare providers retaining status after termination from Medicare or Medicaid, accrediting organizations selling consulting services to the same facilities they survey, and survey inconsistencies that undermine standardization across the accreditation process.
“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, MD, said in a June 12 news release. “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.”
Eight things to know:
1. The rule codifies in regulation a long-standing CMS policy requiring that accreditation surveys be conducted without advance notice, and explicitly prohibits two practices some accrediting organizations had been allowing. The first is pre-arrival notifications, or same-day alerts sent to facilities via email or electronic portal before surveyors arrive, sometimes up to 60 minutes ahead. CMS argues the notifications give providers enough time to call in extra staff, clean hallways or pull medical records in ways that wouldn’t reflect their typical day-to-day operations. The second is blackout dates, which allowed facilities to designate periods during which surveys could not be conducted.
2. The rule restricts pre-survey consulting by accrediting organizations. Accrediting organizations are prohibited from conducting mock surveys for providers they accredit before initial surveys, within 12 months of re-accreditation or in response to a complaint the accrediting organization has received about that provider.
3. Accrediting organization owners, surveyors and other employees — along with their immediate family members — are barred from participating in surveys, contributing to survey results or accessing survey records for any facility in which they have had a financial interest or relationship within the previous two years.
4. The rule also creates a new performance monitoring process for accrediting bodies. CMS is establishing a direct observation validation survey process to assess accrediting organizations’ performance. Organizations with unacceptable scores must submit a correction plan, which will be publicly reported.
5. Surveyor training requirements are being standardized. The rule requires accrediting organization surveyors to complete the same CMS training as state survey agency surveyors, a step designed to reduce variability in how federal standards are interpreted and applied across the country.
6. In addition, the rule establishes uniform accreditation standards aligned with Medicare conditions, addressing variability that had produced inconsistent findings and enforcement across facilities.
7. Providers involuntarily terminated from Medicare or Medicaid can no longer use accreditation from a CMS-approved accrediting organization to fast-track re-entry into the programs. Under the new rule, a terminated provider must first be placed under state survey agency oversight for a period determined by CMS, during which it must demonstrate full compliance with Medicare conditions. CMS will not recognize any accrediting organization’s deeming status during that oversight period, and the state survey agency, not an accrediting organization, must certify compliance before a new participation agreement can be approved.
8. The rule takes effect June 16, 2027.
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