The Centers for Medicare and Medicaid Services (CMS) is responsible for administering the mission-critical Medicare/Medicaid surveyor and certification training program and other programs as directed by the Secretary, under contracts with States as provided in Section 1864 of the Social Security Act. CMS is responsible for training State and Federal staff in regard to various Survey & Certification issues.
The CMS CCSQ QSOG, and QSED are responsible for providing leadership, overall programmatic direction and training to Regional Offices (ROs) and State Survey Agencies (SAs) for implementation and enforcement of health quality and safety requirements for Medicare/Medicaid providers and suppliers of health care services. The QSOG/QSED provides nationwide training to State and Federal agencies that carry out Survey and Certification work. The legislation that mandates surveyor training is as follows:
Section 1819(g) of the Social Security Act mandates that the “Secretary of HHS, through the CMS Administrator, assure that surveyors are trained to make determinations about the Conditions of Participation (CoP) of providers.” Related authority: US Code, Section 1396 – 1396v, Subchapter XIX, Chapter 7 and Title 42. Also: Chapter IV, Title 42, and Title 45, Code of Federal Regulations. And, Section 1919(g), “Survey and Certification Process,” subparagraph (iii), “The Secretary shall provide for the comprehensive training of State and Federal Surveyors in the conduct of standard and extended surveys….” No individual shall serve as a member of a survey team unless the individual has successfully completed a training and testing program in survey and certification techniques that has been approved by the Secretary.”
QSOG is responsible for the management of the survey and certification process of all health facilities that provide care to Medicare or Medicaid beneficiaries. This process begins with a survey. There are approximately 8,700 Federal and State surveyors across the nation. Surveyors conduct on-site inspections or surveys, at health facilities, to evaluate and report the extent to which facilities are in compliance with Medicare and Medicaid requirements, to assure basic levels of quality and safety for beneficiaries.
Surveyors inspect various healthcare provider types and are grouped by occupational designations. These occupational groupings include: Long Term Care (LTC), Home Health Agency (HHA), Life Safety Code (LSC), End Stage Renal Disease (ESRD), Hospice, Hospital, Skilled Nursing Facility (SNF), and Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID) along with several smaller provider types for which training is offered. Recent initiatives toward more effective quality improvement have resulted in QSOG/QSED making surveyor training also available to Healthcare Service Providers. Below are the guidances that various surveyor occupations are trained on:
- Medicare Conditions of Participation (CoPs)
- Skilled Nursing Facilities (SNFs) and Nursing Facilities (NFs)
- Conditions for Coverage (CfCs) are sets of requirements for acceptable quality in the operation of health care entities.
According to the Centers for Disease Control and Prevention (CDC), there were about 350,000 service providers in the U.S. in 2018. This provides an estimation of the number of individuals from the provider community who may require access to the QSEP. The average number of training completions per month is between 3,000 to 6,000.
CMS has primarily been charged with tracking the federal training provided to health care surveyors. The online and web-based courses are currently housed and made available through the integrated learning management system, housed at https://qsep.cms.gov/welcome.aspx. Due to the costs associated with on-site training, the increasing demand for immediate training upon new surveyor hires, increasing number of facilities approved for Medicare/Medicaid participation, and ongoing changes to laws, regulations, policies and procedures, CMS is continuously seeking alternative methods of providing quality training. The QSEP provides access to live and archived online training 24 hours a day, 7 days a week via the internet. Additionally, on-demand training is also available 24 hours a day, 7 days a week. QSEP maintains transcripts of all surveyors.
