Regulation and Enforcement

CMS will continue to conduct regulation and enforcement activities to ensure that Medicare hospitals comply with federal standards for patient health and safety and quality of care. The survey and certification program is a joint effort of the federal and state governments to ensure safety and improve the quality of care in health-care facilities. At the federal level, CMS establishes standards for safe and effective operation of hospitals, develops guidelines and procedures, provides training for conducting surveys, and coordinates the survey activities of the individual states. Medicare non-accredited participating hospitals are surveyed approximately every three years. Additionally, state survey agencies conduct surveys to investigate complaints on an "as needed" basis.

As an alternative to routine surveys by the state survey agencies, hospitals may choose to be accredited by one of the two private accreditation organizations recognized by CMS. Hospitals that apply for and are awarded accreditation are deemed to meet the health and safety requirements for participation in Medicare by virtue of that accreditation. Approximately 80 percent of Medicare hospitals are accredited. CMS is responsible for the oversight of these accreditation organizations, performs validation surveys of a sample of accredited hospitals, and investigates complaints that indicate possible noncompliance with Medicare requirements in accredited hospitals. These activities will continue without change during this initiative and provide an important view of the quality of care in hospitals.