The mission of the Quality, Safety & Oversight Group, formerly known as the Survey & Certification (S&C) program is to assure basic levels of quality and safety for all patients, residents and clients receiving care from Medicare and Medicaid certified institutional providers. This page provides information regarding the S&C mission and priority of the program as well as downloadable documents relevant to the specific programs.
Survey and certification is the system that provides onsite, objective and outcome-based verification by knowledgeable and trained individuals to assure that basic standards of quality are being met by healthcare providers across the nation or, if not met, that appropriate remedies are promptly applied and implemented effectively. More than 200,000 providers, suppliers and laboratories are subject to survey & certification. Approximately 85,000 onsite, unannounced recertification surveys are conducted each year, and more than 85,000 onsite complaint investigations. The system covers the following:
- Ambulatory Surgical Centers (ASCs)
- Clinical Laboratories
- Comprehensive Outpatient Rehabilitation
- Community Mental Health Centers (CMHCs)
- Dialysis (ESRD) Facilities
- Federally Qualified Health Centers (FQHCs)
- Home Health Agencies
- Hospitals- Acute, Critical Access Hospitals (CAHs), Rehabilitation, Long-term Care, Psychiatric
- Organ Transplant Programs
- Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID)
- Portable X-Ray Suppliers
- Psychiatric Residential Treatment Facilities
- Rural Health Clinics (RHCs)
- Nursing Homes/ Long Term Care (LTC)
- Organ Procurement Organizations
- Outpatient PT and SLP (Rehab Agency)
The Centers for Medicare & Medicaid Services (CMS) accomplishes these quality assurance functions under specific direction from the Social Security Act (the Act) and jointly with States, accrediting organizations (AOs) and contracts with qualified organizations.
When significant problems are determined, through onsite observation during periodic comprehensive surveys or complaint investigations, CMS is backed by legislated authority to impose remedies on the provider or supplier. Failure to implement appropriate remedial action for serious deficiencies on the part of any provider can result in termination of the Medicare (and where applicable, also Medicaid) provider agreements or supplier approval (which also terminates funding from those sources).
In the case of clinical laboratories, failure to implement corrective action may also result in sanctions including revocation of the CLIA certificate. Once revoked, the laboratory can no longer perform any human specimen testing, including waived, provider performed microcopy, and moderate or high complexity testing, used for healthcare purposes, as delineated in the Clinical Laboratory Improvement Amendments of 1988.
The Act mandates the establishment of minimum health and safety standards that must be met by participating providers and suppliers. For laboratories, Section 353 of the Public Health Service Act is the basis for such standards. The Secretary of the Department of Health and Human Services (DHHS) has designated CMS to administer the standards compliance aspects of these programs.
Agreements between the Secretary and States, territories and the District of Columbia stipulate that State Survey Agencies (SAs) designated by the Governors are responsible for the performance of the certification functions created by §1864 of the Act. The Secretary agrees to provide funds for the reasonable and necessary costs to the States to perform the functions authorized by the agreements. Payments to States under §1864 of the Act are made from the Federal Hospital and Supplementary Medical Insurance Trust Funds to cover the costs of services performed under the agreement as authorized by §1864 of the Act. However, expenditures from the Trust Funds for S&C functions are authorized only through the regular appropriation process of Congress.
If the SA is also performing Medicaid certification activities pursuant to an approved State Plan, the Federal financial grant mechanisms are used to pay the State for a percentage of the cost of those activities during each quarter of the year. The matching grants come from appropriated general revenues of the United States. The Secretary is authorized to pay a percentage of these costs for the proper and efficient administration of the State Plan. Whereas the Title XVIII trust funds are controlled under terms of the State agreement, the grant funds are controlled by the established rules of Federal grant laws and regulations. Among the responsibilities of the parties to the §1864 agreements are obligations imposed upon the Federal government (delegated to CMS) dealing with the States’ program administration, which include:
- Setting policy and providing policy interpretations on the provider and supplier certification program standards;
- Providing consultation to agencies involved in administering the Federal requirements;
- Paying the appropriate and allowable costs of the SA functions relating to administration of regulations and provisions of the agreement and State Plan;
- Making determinations of allowable State costs to submit for Federal payment;
- Controlling payment of Federal trust funds and grant awards to appropriate SAs for S&C costs incurred in administering Title XVIII and Title XIX programs; and
- Training and qualifying Federal and State personnel to conduct Medicare and Medicaid surveys and provider certification.
Under the downloads section of this page, you will find specific provider/supplier information.