Medicare:

HCFA's Approval and Oversight of Private Accreditation Organizations

HEHS-99-197R: Published: Sep 30, 1999. Publicly Released: Oct 7, 1999.

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Pursuant to a congressional request, GAO provided information on the Health Care Financing Administration's (HCFA) approval and oversight of private Medicare accreditation organizations, focusing on: (1) HCFA's criteria for approving accreditation organizations; (2) HCFA's ongoing oversight of accreditation organizations that have been granted deemed status; and (3) recent evaluations of accreditation organizations' performance.

GAO noted that: (1) HCFA is required to consider several factors when evaluating a private accreditation organization for deemed status; (2) HCFA must assess an organization's standards to ensure that the providers they accredit will meet or exceed Medicare's requirements; (3) the agency is also required to evaluate an accreditation organization's ability to monitor and enforce provider compliance with its requirements; (4) HCFA has not developed specific criteria to prohibit conflict of interest between organizations and the providers they evaluate, even though accreditation organizations are typically governed by a board of directors that includes industry representatives; (5) instead, HCFA requires each organization to document its policies and procedures regarding employee professional or financial affiliation with the facilities being accredited; (6) to monitor the performance of accreditation organizations and ensure continued equivalence to Medicare standards, HCFA requires organizations to provide accreditation survey findings and to submit any proposed changes to its accreditation requirements; (7) a recent evaluation of accreditation organization performance by the Department of Health and Human Services' Office of Inspector General found that the Joint Commission on Accreditation of Healthcare Organizations' (JCAHO) collegial approach to hospital accreditation relies heavily on education and performance improvement, with less emphasis on regulatory approaches, which include unannounced surveys, responding to complaints, and collecting standard performance measures; (8) also, HCFA examined the potential for deeming of nursing homes and, in a report, recommended against relying on JCAHO for such deeming; and (9) specifically, the report questioned whether JCAHO surveyors would identify serious care deficiencies in nursing homes and expressed concerns that JCAHO's requirements for nursing home accreditation were not sufficient to ensure that Medicare conditions and requirements would be met.

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