Validation Surveys - General

3240 - Validation Surveys - General (Rev. 123, Issued: 10-03-14, Effective: 10-03-14, Implementation: 10-03-14) A “deemed” provider or supplier means a provider or supplier which has voluntarily applied for and has been accredited by a CMS-approved Medicare accreditation program whose recommendation for deemed status for that provider or supplier has been accepted by the RO. A list of current CMS-approved Medicare accreditation programs may be found at: https://www.cms.gov/Medicare/Provider-Enrollment-and- Certification/SurveyCertificationGenInfo/Downloads/AOContactInformation.pdf NOTE: For the purposes of this section, the term “Condition” refers to any Condition of Participation, Condition for Coverage, or Condition for Certification. (See Chapter VI for discussion of validation surveys for accredited laboratories.) SAs may not conduct a Medicare survey of a deemed provider or supplier unless specifically authorized by the RO to do so. Sections 1864(c) and 1865 of the Act provide the basis for conducting validation surveys of deemed providers and suppliers. Regulations authorizing such surveys are found in 42 CFR Part 488. The CMS may require a survey of a deemed provider or supplier to validate the accreditation organization’s process. These surveys will be conducted on either a representative sample basis (i.e., representative sample validation survey), or in response to a substantial allegation of noncompliance (i.e., complaint survey). A representative sample validation survey is usually a standard or full survey of all applicable conditions. A substantial allegation/complaint survey is authorized by the RO in response to a credible allegation which, if substantiated, would result in a condition-level citation. The RO advises the SA which conditions are to be assessed for compliance, based on the nature of the complaint. See Chapter 5, Sections 5100 – 5110 for more information on substantial allegation survey policies, procedures and timeframes. The Form CMS 2802 is transmitted from the RO to the SA via the ASPEN Central Office (ACO) system, for a representative sample validation survey, or via the ASPEN Complaint Tracking System (ACTS) for a substantial allegation validation survey. The RO uses this form to: • authorize the SA to conduct a validation survey of a particular provider/supplier; • identify the applicable AO(s); • indicate the type of validation survey to be conducted; • indicate, when applicable in the case of a representative sample validation survey, the AO’s survey end-date; and • in the case of a substantial allegation validation survey, identify the specific conditions for which the SA must assess compliance. If a provider or supplier selected for a validation survey (representative sample or substantial allegation) is found to have one or more condition-level deficiencies, it will no longer be deemed to meet the Medicare Conditions. The RO advises the provider or supplier that its deemed status is removed and that it is being placed under SA jurisdiction. However, no change is made to the provider’s or supplier’s deemed status in the Automated Survey Process Environment (ASPEN). Instead, the placement of the provider or supplier under SA jurisdiction is noted under the Deeming tab within the certification kit in ACO.