CMS issues final rule to enhance AO oversight

CMS recently issued a final rule to enhance oversight of accrediting organizations (AO) through new standards, process alignments, and more. The changes in the final rule align with the agency’s National Quality Strategy, and they are intended to improve survey consistency, reduce conflicts of interest, and increase transparency.

CMS first proposed these changes in 2024 after identifying several concerns related to AO performance, including the following:

• Certain providers and suppliers that retain accreditation despite having been terminated from the Medicare/Medicaid program
• Conflicts of interest arising from AOs providing fee-based consulting services to the providers and suppliers they accredit
• Inconsistent survey results due to AO standards or practices that differ from those of state survey agencies (SA)

A key provision in the final rule is new restrictions on fee-based consulting services. To prevent conflicts of interest, CMS will prohibit AOs from conducting mock surveys for facilities they accredit before an initial survey. The agency will also prohibit AO owners, surveyors, employees, and others with close ties to the facility accredited by an AO from participating in surveys. These individuals will not be allowed to have input into survey results, be involved in pre- or post-survey activities of that facility, or have access to the related survey records.

AOs with unacceptable performance measure scores will be required to submit a publicly reported corrective action plan within 10 business days. These scores will be determined through CMS’ direct observation validation survey, a new process established in the rule for monitoring AO performance.

CMS will also require AOs to conduct Medicare accreditation surveys on an unannounced basis. This is one of the many changes in the final rule designed to increase alignment between AO and SA survey practices, as well as hold AOs accountable to Medicare standards.

CMS has approved nine AOs to survey and accredit Medicare-certified facilities. The final rule provisions apply to all AOs except those that accredit clinical laboratories and non-certified suppliers.

The final rule takes effect on June 16, 2027; however, CMS is taking comments on certain provisions through August 17, 2026. View the agency’s fact sheet and press release on the rule for more information.