CMS Administrator Dr. Mehmet Oz: “Who watches the watchmen?”

On June 16, the Centers for Medicare & Medicaid Services published the final rule “Strengthening Oversight of Accrediting Organizations (AOs) and Preventing AO Conflicts of Interest, and Related Provisions” effective June 16, 2027. A public comment period is open until August 17, 2026. The final rule applies to the following nine CMS-approved accrediting organizations that survey and accredit Medicare-certified facilities for deemed status purposes (it does not apply to AOs that accredit laboratories (under the Clinical Laboratory Improvement Amendments of 1988 (CLIA)).

• American Association for Accreditation of Ambulatory Surgery Facilities (Quad A)
• Accreditation Association for Ambulatory Health Care (AAAHC)
• Accreditation Commission for Health Care (ACHC)
• Center for Improvement in Healthcare Quality (CIHQ)
• Community Health Accreditation Partner (CHAP)
• DNV Healthcare
• National Dialysis Accreditation Commission (NDAC)
• The Compliance Team (TCT)
• The Joint Commission

CMS concerns

CMS identified several concerns about AOs’ survey performance, such as:

• Providers and suppliers retaining their accreditation after they were terminated from Medicare or Medicaid programs for quality and safety concerns.
• Conflicts of interest arising from AOs providing fee-based consulting services to the providers and suppliers they accredit (often just before an accreditation survey), potentially compromising the integrity of the process.
• Inconsistent survey results due to AO standards or practices that differ from those of state agencies (e.g., AOs notifying facilities before the date of their on-site surveys, which is against CMS policy).

What’s in the final rule

Key regulatory changes are as follows:

• Establishes new conflict-of-interest requirements for accrediting organizations, including:

o   Required conflict-of-interest policies and procedures

o   Annual disclosures from surveyors regarding relationships with accredited facilities

o   Restrictions on surveyors, owners, and employees participating in accreditation activities involving facilities with which they have current or recent relationships

• Restricts fee-based consulting services provided by accrediting organizations to facilities they accredit, including:

o   Prohibiting consulting before an initial accreditation survey

o   Prohibiting consulting within 12 months before a reaccreditation survey

o   Prohibiting consulting related to complaint investigations

o   Requiring regular reporting of consulting activities to CMS

• Requires accrediting organizations to incorporate Medicare Conditions of Participation, Conditions for Coverage, and Conditions for Certification as minimum accreditation standards, while allowing AOs to impose more stringent requirements if desired.
• Strengthens survey process comparability between accrediting organizations and state survey agencies by:

o   Revising survey methodology requirements

o   Enhancing survey documentation standards

o   Strengthening complaint investigation procedures

o   Revising accreditation decision-making requirements

• Requires accrediting organizations to develop detailed crosswalks demonstrating how their accreditation standards meet or exceed Medicare requirements.
• Mandates CMS surveyor training for AO surveyors, requiring completion of applicable CMS online training programs.
• Requires accrediting organizations to submit survey findings to CMS, increasing transparency and facilitating federal oversight.
• Creates new performance measurement and validation standards, including:

o   New definitions for process and outcome disparity rates

o   Expanded validation survey activities

o   Publicly reportable corrective action plans when AO performance falls below CMS standards

• Requires accrediting organizations to revoke accreditation within five business days when CMS notifies them that an accredited provider or supplier has been involuntarily terminated from Medicare or Medicaid.
• Creates barriers to reentry for terminated deemed providers and suppliers, requiring:

o   State survey agency oversight during a CMS-determined reasonable assurance period.

o   Demonstration of compliance before Medicare participation is restored.

o   Prohibition on using AO accreditation alone to regain participation after termination.

• Revises the psychiatric hospital survey process by integrating psychiatric services more fully into hospital survey and accreditation activities.

Conclusion

The rule represents CMS's most significant update to accrediting organization oversight in more than a decade. It aims to improve transparency, reduce conflicts of interest, align AO surveys more closely with state survey agency practices, strengthen performance accountability, and ensure that deemed-status providers meet Medicare's health and safety standards.