Today, the Centers for Medicare & Medicaid Services (CMS) of the U.S. Department of Health and Human Services (HHS) published in the Federal Register a Final Notice entitled: “Medicare and Medicaid Programs: Approval of an Application From the Accreditation Association for Hospitals and Health Systems/Healthcare Facilities Accreditation Program for Continued CMS Approval of its Hospital Accreditation Program.” The Summary, as published, is:
“This final notice announces our decision to approve the Accreditation Association for Hospitals and Health Systems/Healthcare Facilities Accreditation Program (AAHHS/HFAP) (formerly known as the American Osteopathic Association/ Healthcare Facilities Accreditation Program (AOA/HFAP)) for continued recognition as a national accrediting organization for hospitals that wish to participate in the Medicare or Medicaid programs.”
The Final Notice is effective from September 25, 2019, through September 25, 2023.
The Final Notice outlines the conditions for a healthcare provider to “enter into an agreement with Medicare to participate in the program as a hospital…and hospitals that wish to be paid under the Medicaid program must be approved to participate in Medicare.” Continued participation is based on State certification surveys of compliance with agreed upon conditions, or, as an alternative, voluntary, but not required, “[a]ccreditation by a nationally recognized Medicare accreditation program approved by CMS.”
In the Final Notice, CMS highlighted several provisions related to emergency preparedness where AAHHS/HFAP revised its standards and certification processes to conform to the CMS Emergency Preparedness Regulations. They are:
- 42 CFR 482.15(d)(1)(i) regarding emergency preparedness training, to ensure AAHHS/HFAP’s standards require a comparable standard to the CMS requirement.
- 42 CFR 482.15(d)(1)(iii) regarding documentation of emergency preparedness training, to ensure AAHHS/HFAP’s standards require compliance with the CMS requirement.
- 42 CFR 482.15(d)(1)(iv) regarding demonstration of staff knowledge of emergency preparedness procedures, to ensure AAHHS/HFAP’s standards require compliance with the CMS requirement.
- 42 CFR 482.15(d)(2)(i) through 482.15(d)(2)(ii)(B), to ensure AAHHS/ HFAP’s standards require compliance with CMS requirements regarding staff emergency preparedness testing.
- 42 CFR 482.15(e)(3), to clarify AAHHS/ HFAP’s requirement related to maintaining an emergency onsite fuel source.
- 42 CFR 482.15(f)(4) through 482.15(f)(5), to address CMS requirements regarding emergency plans, policies, and procedures for integrated health care systems.
An additional provision related to emergency preparedness at 42 CFR 482.41(a)(2) also was revised, “to ensure that the requirement for emergency water supply for structures is adequately addressed.”
With these and other revisions, CMS approved “AAHHS/HFAP as a national accreditation organization for hospitals that request participation in the Medicare program, effective September 25, 2019 through September 25, 2023.