Termination or Other Adverse Accreditation Action for a

3258 - Termination or Other Adverse Accreditation Action for a Deemed Provider or Supplier (Rev. 123, Issued: 10-03-14, Effective: 10-03-14, Implementation: 10-03-14) Termination A CMS-approved AO must notify CMS, whenever it terminates the accreditation of a Medicare deemed provider or supplier. The notice must be submitted by e-mail simultaneously to: • the CMS AO oversight program electronic mailbox; and • the applicable CMS RO electronic mailbox: CMS provides the specific electronic mailbox addresses to the AOs. The AO’s notice to CMS notice must provide the effective date of the termination of accreditation, as well as the reason for the termination. The RO forwards the termination notice electronically to the applicable SA. • Accreditation termination is concurrent with switch to another CMS-approved Medicare accreditation program, or provider/supplier was previously also deemed by another AO whose accreditation remains in effect: • Unless there was an involuntary termination for failure to comply with the AO’s accreditation standards, if the provider’s/supplier’s termination by one AO is concurrent with a new recommendation for accredited, deemed status by another CMS-approved AO, or if the provider/supplier was previously deemed based on multiple accreditations, each by a different AO, then the provider/supplier remains deemed and under the jurisdiction of the other AO. The recommendation for deeming is sent by the AO to the CMS AO oversight program and the applicable CMS RO, which forwards the AO’s recommendation letter electronically to the applicable SA. An update packet including the new recommendation for deemed status by another AO must be submitted by the SA to the RO. The SA also updates the information in the deemed status tab of the provider’s/supplier’ certification information in ASPEN to reflect both the termination of the first AO’s accreditation and, where there was a switch to another AO, the accreditation by the second AO. • If the termination was involuntary due to failure to comply with the AO’s accreditation standards and if the provider or supplier’s deemed status has not already been removed due to a prior enforcement action, the RO must consider this a substantial allegation of noncompliance with Medicare standards and must authorize the SA to conduct a complaint investigation survey. The SA surveys the provider/supplier within 45 days (or, if the RO’s reason for termination suggests an immediate jeopardy, according to the immediate jeopardy timeline for complaints) in order to provide assurance that the facility is in substantial compliance with the applicable health and safety standards. If the SA’s survey finds no condition-level deficiencies, the provider/supplier retains deemed status under the other/new AO. If the SA finds condition-level deficiencies, then deemed status is removed in the same manner as for any other survey of a deemed provider/supplier. • Accreditation termination is not concurrent with switch to another AO, or provider/supplier was not previously deemed by multiple AOs: If there is no concurrent recommendation of deemed status for the provider/supplier from another AO or if the provider/supplier was not previously deemed based on multiple accreditations, each by a different AO, the provider’s/supplier’s deemed status is removed and it is placed under SA jurisdiction. The SA updates the information in the deemed status tab of the provider’s/supplier’s certification information in ASPEN to reflect the termination of the AO’s accreditation and removal of deemed status. The SA surveys the provider or supplier in order to provide assurance that the facility is in substantial compliance with the applicable health and safety standards. Timing of the SA survey is as follows: • When the AO advises CMS that the provider’s/supplier’s accreditation was involuntarily terminated due to failure to comply with the AO’s accreditation standards, the SA must conduct the compliance survey within 45 days or, if the RO’s reason for termination suggests an immediate jeopardy, according to the immediate jeopardy timeline for complaints.. • In all other cases the SA prioritizes the provider’s/supplier’s survey on the basis of the current CMS policy concerning survey frequencies and SA workload priorities, using the date of the most recent accreditation survey to calculate the survey interval, unless: • The facility is a home health agency (HHA). then the SA must conduct the survey no later than 3 years after the last accreditation survey; or • The RO exercises its discretion to request the SA to conduct the survey by a specified date. Adverse accreditation action other than termination When an AO takes an adverse action that is not termination against the accreditation status of a provider/supplier, the AO is required to inform both the CMS CO and the appropriate RO of the adverse action. As long as provider’s/supplier’s accreditation is not terminated, the provider’s/supplier's participation in Medicare is not affected. Generally the RO will not authorize a validation survey by the SA, but it has the discretion to do so in rare circumstances. Note that none of the above scenarios concerning termination or other adverse accreditation actions apply to the situation where a provider or supplier is acquired by a new owner who rejects assignment of the prior Medicare agreement. In such a situation CMS terminates the provider agreement of the seller as a voluntary cessation of business. It does not matter whether the terminated provider or supplier was deemed, whether under one or multiple CMS-approved Medicare accreditation programs, nor are any further actions taken by CMS or the SA in response to a notification by an AO of an accreditation termination or other adverse accreditation action related to the provider or supplier covered by that prior Medicare agreement. (See Section 2003B.) Handling Public Inquiries