CMS has instructed states to place a higher priority on recertification of existing providers, on complaint investigations, and on similar work for existing providers than for initial surveys of providers/suppliers newly seeking to participate in the Medicare program. Due to severe resources limited for Medicare survey and certification functions, in most states few providers that have an approved CMS accreditation organization (AO) option will be surveyed by CMS or the State. Home Health Agencies have the option of “Deemed Accreditation” status through Accreditation Organization (ACHC, CHAP or Joint Commission); and have the option of applying to one of the CMS approved AOs attached to this memorandum. If the facility would incur a hardship by going through a CMS approved AO; then the provider may apply by letter to the state agency for CMS consideration to grant an exception to the priority assignment of the initial survey if lack of Medicare certification would cause significant access-to-care problems for Medicare beneficiaries served by the provider or supplier. The state agency may choose to make a recommendation to CMS before forwarding the request to CMS.
There is no special form required to make a priority exception request. However, the burden is on the applicant to provide data and other evidence that effectively establishes the probability of adverse beneficiary health care access consequences if the provider is not enrolled to participate in Medicare. CMS will not endorse any request that fails to provide such evidence and fails to establish the special circumstances surrounding the provider’s or supplier’s request.
We regret that the resource limitations under which we operate may complicate the process of enrolling in Medicare as a certified provider or supplier.
Annual & Complaint Surveys:
The Bureau of Survey and Certification is responsible for conducting on-site surveys for compliance federal regulations. HHAs are not currently subject to an annual survey visit but do receive an unannounced survey on a schedule established by the Centers for Medicare and Medicaid Services. During these surveys, all aspects of care and services are evaluated based on federal laws and regulations.
You may view quarterly and annual quality of care reports online through our publications page.