The Center for Medicare and Medicaid Services (CMS) oversees the Medicare and Medicaid programs and is responsible for establishing Conditions of Participation (CoPs) and Conditions for Coverage (CfC) through federal rules; the CMS Emergency Preparedness and Fire Safety Rules are different CoPs and CfCs, yet there is much interrelation.
The CMS Emergency Preparedness and Fire Safety Rules are Conditions of Participation and Conditions of Coverage that are applicable to varying types of healthcare providers and suppliers
providers and suppliers are surveyed to determine if a certificate of compliance is warranted
Healthcare providers and suppliers show that they are in compliance with their applicable Medicare and Medicaid CoPs or CfCs, through the survey process carried out by the states, deemed accreditation organizations or CMS itself
The Survey and Certification Process is the activity conducted by State survey agencies or other CMS agents under the direction of CMS and within the scope of applicable regulations whereby surveyors determine compliance or noncompliance of Medicare providers and suppliers with applicable Medicare requirements for participation. The survey and certification process for each provider and supplier is outlined in detail in the State Operations and Regional Office Manuals published by CMS.
Facility surveys may be conducted by State Survey Agencies (SA), which are usually state health departments, deemed accreditation organizations (AO), such as The Joint Commission, and CMS Regional Offices.
Certification means a provider or supplier has passed a survey done by CMS, SA or AO. Passing a survey means that the provider or supplier has shown that they are in compliance with the Conditions of Participation or Conditions for Coverage, including the emergency preparedness rule. Medicare only covers (pays for) care provided in facilities that are certified or accredited by deemed accreditation organization.
providers and suppliers must meet their conditions of participation or conditions for coverage
When healthcare providers and suppliers show that they are in compliance with their applicable Medicare and Medicaid CoPs or CfCs, they are issued a certification of compliance
To qualify for Medicare and Medicaid certification and reimbursement, providers and suppliers of health services must comply with minimum health and safety standards termed 'Conditions of Participation' (CoPs) and Conditions for Coverage (CfC).
In 1946, Congress passed the Hill-Burton Hospital Survey and Construction Act, which included application of uniform healthcare standards. To receive Hill-Burton funding, states were required to license hospitals to ensure they adhered to several quality of service requirements. The standards could only be placed on states that chose to accept Hill-Burton funding.
With the establishment of Medicare and Medicaid under Title XVIII and Title XIX of the Social Security Act in 1965, Congress had to decide whether control of the quality of medical care provided by individual hospitals would be based on uniform federal standards – as they did under Hill-Burton – or remain under state supervision and control. Congress chose to establish uniform minimum national standards to be certified by state health agencies. The minimum national standards are the CoPs that states are required to enforce upon healthcare providers who participate in the programs.
Since their inception, CoPs for emergency preparedness have been developed independently by subject matter experts operating within programs overseeing specific provider types within CMS. There was little concern for consistency within CMS or with national preparedness programs managed by the Federal Emergency Management Agency (FEMA), the Centers for Disease Control and Prevention (CDC), or the Assistant Secretary for Preparedness and Response (ASPR). The effort to connect the Nation's healthcare preparedness regulatory strategy with the Nation's overarching preparedness efforts can be found in the proposed CMS Emergency Preparedness Rule.
economics drive providers and suppliers to participate in the medicare and medicaid programs
Healthcare providers and suppliers must be in compliance with their applicable CoPs or CfCs to participate in the Medicare and Medicaid programs
The Centers for Medicare & Medicaid Services (CMS), formerly known as the Health Care Financing Administration HCFA, is an agency within the U.S. Department of Health & Human Services responsible for administration of the Medicare and Medicaid programs.
CMS is the agency that sets the Conditions of Participation (CoPs) for emergency preparedness that help ensure continuity of health care services for those affected by health emergencies, disasters.
In addition to Medicare and Medicaid, CMS oversees the Children’s Health Insurance Program (CHIP), the Health Insurance Portability and Accountability Act (HIPAA) and the Clinical Laboratory Improvement Amendments (CLIA), among other services.
The Medicare program is governed exclusively by the federal government through CMS. It is paid for by payroll taxes, deductions from Social Security income, and out-of-pocket by program participants. The four-part program includes:
Medicare is attached to Social Security and is available to all U.S. citizens 65 years of age or older, and it also covers people with certain disabilities. It is available regardless of income.
The Medicaid program is governed by the states with minimum compliance standards set by CMS. The program is jointly funded by the federal government and states.
The federal government pays states for a specified percentage of program expenditures, called the Federal Medical Assistance Percentage (FMAP). States must ensure they can fund their share of Medicaid expenditures for the care and services available under their state plan.
Medicaid recipients must be U.S. citizens or legal permanent residents and may include low-income adults, their children, and people with certain disabilities. Poverty alone does not necessarily qualify someone for Medicaid.
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