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November 23/30, 2011

Improving the Rules for Hospital Participation in Medicare and Medicaid

Author Affiliations

Author Affiliations: Centers for Medicare & Medicaid Services, Baltimore, Maryland (Drs Conway and Berwick); and Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio (Dr Conway).

JAMA. 2011;306(20):2256-2257. doi:10.1001/jama.2011.1611

The hospital “conditions of participation” establish the quality and safety standards that all US hospitals must follow to participate in the Medicare and Medicaid programs. The conditions of participation are the basis for onsite surveys that determine if a hospital meets the standards for accreditation. Such accreditation surveys are conducted by the Centers for Medicare & Medicaid Services (CMS), the Joint Commission, state survey agencies, and others.1 The CMS can terminate hospital provider agreements that have been found to be out of compliance with the conditions of participation, thus making hospitals ineligible for payment by the Medicare and Medicaid programs. Since updated in 1986, the last major change to the conditions of participation was attempted in 1997, but failed due to more than 60 000 public comments and dissenting opinions.

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