West Virginia Society for Healthcare Engineering

Check out this HFM Insider article : "CMS sharpens oversight for survey noncompliance."

CMS Ensures Accrediting Organizations Uphold Trust in Standards and Oversight

Final Rule Reduces Burden and Strengthens Patient Safety

The Centers for Medicare & Medicaid Services (CMS) is taking steps to improve healthcare quality and patient safety through enhanced oversight of Accrediting Organizations (AO). Today’s final rule, Strengthening Oversight of AO and Preventing AO Conflicts of Interest, ensures that the organizations responsible for the oversight of more than 9,000 healthcare providers and suppliers use Medicare standards, and creates greater consistency  between State Survey Agencies (SAs) and AOs in their respective survey processes. These changes will reduce provider burden, strengthen survey policies, and increase transparency.

“The work accrediting organizations do is vital, but it also raises an age-old question: who watches the watchmen? The answer is, we do,” said CMS Administrator Dr. Mehmet Oz. “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.”

Today’s final rule is designed to:

• Ensure AO accreditation standards continue to meet or exceed those of the Medicare program.
• Align accreditation and survey processes with CMS requirements.
• Confirm AO enforcement of CMS requirements.
• Reinforce that all accredited entities must deliver safe, effective care.
• Prevent AO conflicts of interest that may arise from related consulting services.

Additionally, the rule creates a brand new process for monitoring AO performance; establishes consistent standards, processes, and definitions; updates validation and performance systems; requires AO surveyors to take the same CMS training as SA surveyors; and reduces burden on SAs, AOs, and providers by streamlining the CMS AO validation process.

Certified facilities, whether surveyed by state agencies or AOs, must meet the same rigorous health and safety standards. The rule requires accreditation surveys be conducted without advance notice, ensuring consistency with previously established CMS policy. 

The rule addresses longstanding concerns by prohibiting AOs from conducting mock surveys for providers they accredit before initial surveys and within 12 months of re-accreditation. This prohibition helps ensure consulting activities do not compromise the objectivity and integrity of the accreditation process. Additionally, variability in accreditation standards has led to inconsistent survey findings and enforcement across Medicare-certified facilities. This rule establishes clear, uniform requirements to eliminate ambiguity. By applying Medicare conditions and requirements as the baseline standards, CMS ensures the application of consistent safety requirements across facilities. 

CMS Takes Bold New Approach to Stewarding Medicaid Demonstration Project Spending

 Plans to Update Section 1115 Medicaid Demonstration Budget Neutrality Policy Will Strengthen Accountability and Protect Federal Taxpayers

With nearly one-third of all federal Medicaid dollars flowing through demonstration projects, the Centers for Medicare & Medicaid Services (CMS) is issuing new guidance about its plans to strengthen budget neutrality standards for Medicaid section 1115 demonstrations. While states use demonstrations to test innovative ways to deliver care and improve health outcomes, the bounds of what is considered “budget neutral” have expanded over time to reflect evolving policy priorities and increased section 1115 demonstration spending. This new guidance previews CMS’ plans to propose a rule that would ensure consistent oversight and clear budget neutrality requirements for proposed demonstration projects, which will help states cost-effectively enhance programs and ensure fiscal integrity, while lowering costs and improving outcomes.

“Medicaid works best when states can innovate and are held accountable for results,” said CMS Administrator Dr. Mehmet Oz. “The budget neutrality requirements we plan to propose are designed to ensure that testing new ideas doesn’t cost taxpayers more than current approaches, while improving health outcomes for the people we serve. We're committed to making this transition smooth for states.”

Part of the Working Families Tax Cut (WFTC) legislation requires the CMS Chief Actuary to certify that Medicaid section 1115 demonstrations are budget neutral, meaning they will not cost the federal government more than running Medicaid programs the usual way. Beginning January 1, 2027, CMS will not approve new demonstrations, demonstration renewals, or demonstration amendments unless the CMS Chief Actuary certifies that the demonstration project is not expected to increase federal spending compared to the state’s Medicaid program without the demonstration.

To aid state planning efforts, CMS is publishing this guidance to provide states with early notice regarding the changes to budget neutrality that CMS intends to propose to implement this new requirement. CMS expects to begin applying the approach described in this guidance to new demonstration, amendment, and renewal approvals until a final rule is effective, in light of the statutory language requiring the Chief Actuary’s certification for these demonstration approvals on or after January 1, 2027.

Medicaid section 1115 demonstrations have long served as policy laboratories through which states might modify coverage or test new care models, subject to required evaluation standards. Although CMS has historically required budget neutrality as a condition of its approval of demonstrations, budget neutrality has never been required in statute, and CMS has applied shifting methodologies to determining budget neutrality over time. Our planned guidelines would establish a more rigorous, transparent, and consistent quantitative framework for evaluating budget neutrality before demonstrations are approved.

The requirements we are developing are expected to:

• Implement the statutory requirement for an independent certification of a demonstration’s budget neutrality by the CMS Chief Actuary;
• Ensure states clearly demonstrate how proposals will be budget neutral through improved beneficiary health outcomes;
• Maintain state flexibility to test new approaches within defined fiscal guardrails; and
• Strengthen accountability and support careful stewardship of federal dollars to deliver measurable value for patients and taxpayers.

CMS recognizes that these changes could affect states differently based on where they are in the demonstration approval and renewal process. States with demonstrations up for renewal in 2027 may need to take additional steps. CMS is committed to offering technical assistance to support a smooth transition as well as providing information on the updated review methodologies to be proposed in future rulemaking.

I am so completely proud to announce that WVSHE will pay for your Training and Certifications. At our Annual Conference last year it was voted to approve a Reimbursement program for WVSHE Active Voting Members and Associate Members. To qualify you need to meet a simple criteria...

• You must be an Active Member or Associate Member with Paid Dues.

• You must have attended One WVSHE event in the last Year.

• You must provide proof of the Training or Testing that you took with a valid receipt.

With this Criteria met, WVSHE will reimburse you for the cost of the Education or Certification!!