State Obligations to Survey to the Entirety of Medicare and Medicaid Health and Safety Requirements under the 1864 Agreement

Mary Madison, RN, RAC-CT, CDP 
Clinical Consultant – Briggs Healthcare

CMS issued QSO-22-12-ALL today with the same title as this blog.

“States that fail to perform survey and certification functions in a manner sufficient to assure the CMS of the full certification of compliance with all Conditions of Participation, Conditions for Coverage, and Requirements for Participation for providers and suppliers, may, among other things, receive a revised Survey and Certification budgetary allocation. The Medicare and Medicaid certification of providers and suppliers in a State whose oversight process is substantially deficient may be jeopardized if CMS cannot ensure that the regulatory minimum health and safety standards have been met. Also, CMS will provide additional information to providers in such states clarifying the expected process to demonstrate compliance with federal requirements.”

“CMS has consistently worked with states to identify and mitigate State Performance and/or resource issues. However, a state that unilaterally acts to reduce or suspend survey and certification activities in a manner inconsistent with the Act, regulations and Secretary’s direction does not support their full budgetary Survey and Certification allocation as federal oversight activities would be added to ensure compliance with the minimum standards.”

“Medicare and Medicaid certified providers and suppliers within every State continue to be responsible for compliance with the federal requirements for all Conditions of Participation, Conditions for Coverage, and Requirements for Participation.”

Individuals with a quality of care complaint related to a Medicare or Medicaid health and safety regulation that the state is not surveying for may contact the CMS location, directly, at the email below:

  •  Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, and Tennessee.
  •  Arkansas, Louisiana, New Mexico, Oklahoma, and Texas.
  • Delaware, District of Columbia, Maryland, Pennsylvania, Virginia, West Virginia, New York, New Jersey, Puerto Rico, Virgin Islands, Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, and Vermont.
  •  Illinois, Indiana, Michigan, Minnesota, Ohio, Wisconsin.
  •  Iowa, Kansas, Missouri, and Nebraska.
  • Colorado, Montana, North Dakota, South Dakota, Utah, Wyoming.
  • Alaska, Idaho, Oregon, Washington, Arizona, California, Hawaii, Nevada, and the Pacific Territories.