Certification Surveys - Citations and Responsibility

2000 - Certification Surveys - Citations and Responsibility (Rev. 1, 05-21-04) Section 1864 of the Social Security Act (the Act) establishes the framework within which SAs, under agreements between the State and the Secretary, carry out the Medicare certification process. Sections 1902(a)(9) and (33) of the Act stipulate that the same agency is authorized to set and enforce standards for Medicaid. (The SA may partially redelegate the functions to local agencies.) 42 CFR 488 requires the SA to perform surveys to support its certifications. 42 CFR Part 431, Subpart M, sets forth the functions the SA performs for the SMA. SAs perform initial surveys and periodic resurveys of all providers and certain kinds of suppliers. These surveys are conducted to ascertain whether a provider/supplier meets applicable requirements for participation in the Medicare and/or Medicaid programs, and to evaluate performance and effectiveness in rendering a safe and acceptable quality of care. Although the regional office (RO) is ultimately responsible for deciding whether a provider/supplier may participate in the Medicare program, certification is an SA function. After the SA completes an inspection for the Medicare program, it submits evidence and a certification recommendation for a final RO determination. When the SA certifies for Medicaid purposes, it is reporting its own adjudicative determination.