SMQT CORRECT EXAMS QUESTIONS AND
ANSWERS SET A+
✔✔State Agency function-- Title XVIII, Section 1864(a): Records & Reports - ✔✔State
agencies must maintain pertinent survey, certification, statistical, and other records for a
period of at least FOUR years
State agencies must make reports in the form and content as the Secretary may
require.
✔✔Title XIX (19) of the Social Security Act, Section 1902(a)(9)(A) - MEDICAID -
✔✔Requires that a State use this same agency to set and maintain additional standards
for the State Medicaid program.
✔✔Title XIX (19) of the Social Security Act, Section 1902(a)(33)(B) - ✔✔This section of
the SSA requires the state to use the same agency utilized for Medicare.
If such agency is not the state agency responsible for licensing health institutions, it
requires the state to use the agency responsible for such licensing in order to determine
whether institutions meet all applicable Federal health standards for Medicaid
participation.
Licensing under this section is subject to validation by the Secretary.
✔✔Chapter 1865 of SSA establishes five different nationally approved accreditation
organizations. List them: - ✔✔1) The Joint Commission (TJC)
2) American Osteopathic Association (AOA)
3) Community Health Accreditation Program (CHAP)
4) Accreditation Association for Ambulatory Healthcare, Inc. (AAAHC)
5) American Association for Accreditation for Ambulatory Surgery Facilities (AAAASF)
,✔✔The providers that may be deemed as meeting Medicare conditions of participation
based on their accreditation include: - ✔✔Home Health Agencies (HHAs)
Ambulatory Surgical Centers (ASCs)
Hospices
Critical Access Hospitals (CAHs)
✔✔Section 1865(b) of the SSA - ✔✔1865(b) allows providers accredited as Critical
Access Hospitals (CAHs) by The Joint Commission (TJC) or the American Osteopathic
Association (AOA) to be deemed to meet the CoPs.
✔✔Hospitals - ✔✔Section 1865(a) of the Act states that hospitals accredited by The
Joint Commission (TJC) are deemed to meet the CoPs.
Section 1865(b) of the Act allows hospitals accredited by the American Osteopathic
Association (AOA) to be deemed to meet the CoPs.
Hospitals accredited by TJC and AOA as of 1965 are deemed to meet the Medicare
CoPs.
✔✔Exceptions to State Agency certifications - ✔✔- The utilization review (UR) condition
- The two special Conditions for psychiatric hospitals
- Special requirements for hospital providers on long term care services (i.e., swing
beds)
- A standard promulgated by the Secretary which is a higher-than-accreditation
requirement
- Any higher-than-national standards approved by the Secretary & applied in a State
✔✔Center for Medicare Management (CMM) - ✔✔CMM serves as the focal point for all
Agency interactions with healthcare providers, intermediaries, and carriers representing
fee-for-service policies and operations.
✔✔Center for Beneficiary Choices (CBC) - ✔✔CBC serves as Medicare Beneficiary
Ombudsman, as well as the focal point for all CMS interactions with the people who use
our programs, their families, care givers, health care providers, and others operating on
their behalf.
,✔✔Center for Medicaid, CHIP and Survey & Certification (CMCS) - ✔✔CMCS serves as
the focal point for all Agency activities related to Medicaid, including the following
programs::
- The State Children's Health Insurance Program (SCHIP)
- The Clinical Laboratory Improvement Act (CLIA)
CMCS is also responsible for the survey and certification of health facilities and all
interactions with State and local governments (including the Territories).
✔✔Additional exceptions to State Agency certification (1 of 2) - ✔✔Federal & Indian
Health Institutions:
Because of questions of intergovernmental jurisdiction, the survey and certification of a
hospital or SNF that is either owned or operated by the Indian Health Service (IHS)- and
therefore considered to be a Federal provider of services- is handled by the CMS
regional office (RO).
***The state agency is responsible for determining whether the facility meets Medicaid
certification requirements.***
The state agency may accept Medicare certification as sufficient evidence of meeting
Medicaid requirements, or the state agency may conduct a survey.
The Indian health tribal facilities are not considered to be Federal providers and are
surveyed by the STATE AGENCY.
✔✔Additional exceptions to State Agency certification (2 of 2) - ✔✔Section 1861(e) of
the Act includes in the definition of "hospital," a Christian Science Sanatorium that is
operated or listed and certified by the First Church of Christ Scientist, based out of
Boston, Massachusetts.
Section 1861(e) also deals with respect to certain items and hospital services furnished
to inpatients.
Section 1861(y) includes sanatoria with respect to items and services furnished to
inpatients in a long-term care setting.
All approvals are handled by the Boston RO (CMS).
***No state agency certifications are necessary. The State may also include these
services under the State plan for Medicaid.***
✔✔Exemption of Laboratories Licensed by States - ✔✔CLIA will exempt laboratories in
States that have been determined to have laws and regulations in effect that are equal
to or more stringent than CLIA requirements.
, Exempt laboratories must hold a valid State license within the exempt State.
✔✔42 CFR Part 488.6----- Eligibility for Medicaid Facilities - ✔✔Eligibility for Medicaid
participation can be established through Medicare deemed status for providers and
suppliers that are not required under Medicaid regulations to comply with any
requirements other than Medicare participation requirements for that provider or
supplier type.
See 42 CFR Part 488.6.
SOM, Ch. 6
✔✔CLIA Laboratories - ✔✔Each accrediting organization that has received deeming
authority (under CLIA) is approved for specific laboratory specialties / subspecialties.
Refer to Chapter 6 of the State Operations Manual (SOM) for additional information on
accrediting organizations.
✔✔CLIA Laboratories approved for distinct specialties and subspecialties: - ✔✔-
American Association of Blood Banks
- American Osteopathy Association
- American Society of Histocompatibility & Immunogenetics
- The Joint Commission
- College of American Pathologists
- Commission on Office Laboratory Accreditation
✔✔CERTIFICATION - ✔✔Certification is a recommendation made by the State Agency
(SA) on the compliance of providers and suppliers with the conditions of participation,
requirements, and conditions of coverage.
State Agencies officially certify the findings that health care entities do the following:
- Meet the Act's provider or supplier definitions
- Comply with standards required by Federal regulations
✔✔CMS Headquarters - ✔✔- Located in Baltimore, MD
- Overall policy-making responsibility is centralized at CMS Baltimore headquarters
ANSWERS SET A+
✔✔State Agency function-- Title XVIII, Section 1864(a): Records & Reports - ✔✔State
agencies must maintain pertinent survey, certification, statistical, and other records for a
period of at least FOUR years
State agencies must make reports in the form and content as the Secretary may
require.
✔✔Title XIX (19) of the Social Security Act, Section 1902(a)(9)(A) - MEDICAID -
✔✔Requires that a State use this same agency to set and maintain additional standards
for the State Medicaid program.
✔✔Title XIX (19) of the Social Security Act, Section 1902(a)(33)(B) - ✔✔This section of
the SSA requires the state to use the same agency utilized for Medicare.
If such agency is not the state agency responsible for licensing health institutions, it
requires the state to use the agency responsible for such licensing in order to determine
whether institutions meet all applicable Federal health standards for Medicaid
participation.
Licensing under this section is subject to validation by the Secretary.
✔✔Chapter 1865 of SSA establishes five different nationally approved accreditation
organizations. List them: - ✔✔1) The Joint Commission (TJC)
2) American Osteopathic Association (AOA)
3) Community Health Accreditation Program (CHAP)
4) Accreditation Association for Ambulatory Healthcare, Inc. (AAAHC)
5) American Association for Accreditation for Ambulatory Surgery Facilities (AAAASF)
,✔✔The providers that may be deemed as meeting Medicare conditions of participation
based on their accreditation include: - ✔✔Home Health Agencies (HHAs)
Ambulatory Surgical Centers (ASCs)
Hospices
Critical Access Hospitals (CAHs)
✔✔Section 1865(b) of the SSA - ✔✔1865(b) allows providers accredited as Critical
Access Hospitals (CAHs) by The Joint Commission (TJC) or the American Osteopathic
Association (AOA) to be deemed to meet the CoPs.
✔✔Hospitals - ✔✔Section 1865(a) of the Act states that hospitals accredited by The
Joint Commission (TJC) are deemed to meet the CoPs.
Section 1865(b) of the Act allows hospitals accredited by the American Osteopathic
Association (AOA) to be deemed to meet the CoPs.
Hospitals accredited by TJC and AOA as of 1965 are deemed to meet the Medicare
CoPs.
✔✔Exceptions to State Agency certifications - ✔✔- The utilization review (UR) condition
- The two special Conditions for psychiatric hospitals
- Special requirements for hospital providers on long term care services (i.e., swing
beds)
- A standard promulgated by the Secretary which is a higher-than-accreditation
requirement
- Any higher-than-national standards approved by the Secretary & applied in a State
✔✔Center for Medicare Management (CMM) - ✔✔CMM serves as the focal point for all
Agency interactions with healthcare providers, intermediaries, and carriers representing
fee-for-service policies and operations.
✔✔Center for Beneficiary Choices (CBC) - ✔✔CBC serves as Medicare Beneficiary
Ombudsman, as well as the focal point for all CMS interactions with the people who use
our programs, their families, care givers, health care providers, and others operating on
their behalf.
,✔✔Center for Medicaid, CHIP and Survey & Certification (CMCS) - ✔✔CMCS serves as
the focal point for all Agency activities related to Medicaid, including the following
programs::
- The State Children's Health Insurance Program (SCHIP)
- The Clinical Laboratory Improvement Act (CLIA)
CMCS is also responsible for the survey and certification of health facilities and all
interactions with State and local governments (including the Territories).
✔✔Additional exceptions to State Agency certification (1 of 2) - ✔✔Federal & Indian
Health Institutions:
Because of questions of intergovernmental jurisdiction, the survey and certification of a
hospital or SNF that is either owned or operated by the Indian Health Service (IHS)- and
therefore considered to be a Federal provider of services- is handled by the CMS
regional office (RO).
***The state agency is responsible for determining whether the facility meets Medicaid
certification requirements.***
The state agency may accept Medicare certification as sufficient evidence of meeting
Medicaid requirements, or the state agency may conduct a survey.
The Indian health tribal facilities are not considered to be Federal providers and are
surveyed by the STATE AGENCY.
✔✔Additional exceptions to State Agency certification (2 of 2) - ✔✔Section 1861(e) of
the Act includes in the definition of "hospital," a Christian Science Sanatorium that is
operated or listed and certified by the First Church of Christ Scientist, based out of
Boston, Massachusetts.
Section 1861(e) also deals with respect to certain items and hospital services furnished
to inpatients.
Section 1861(y) includes sanatoria with respect to items and services furnished to
inpatients in a long-term care setting.
All approvals are handled by the Boston RO (CMS).
***No state agency certifications are necessary. The State may also include these
services under the State plan for Medicaid.***
✔✔Exemption of Laboratories Licensed by States - ✔✔CLIA will exempt laboratories in
States that have been determined to have laws and regulations in effect that are equal
to or more stringent than CLIA requirements.
, Exempt laboratories must hold a valid State license within the exempt State.
✔✔42 CFR Part 488.6----- Eligibility for Medicaid Facilities - ✔✔Eligibility for Medicaid
participation can be established through Medicare deemed status for providers and
suppliers that are not required under Medicaid regulations to comply with any
requirements other than Medicare participation requirements for that provider or
supplier type.
See 42 CFR Part 488.6.
SOM, Ch. 6
✔✔CLIA Laboratories - ✔✔Each accrediting organization that has received deeming
authority (under CLIA) is approved for specific laboratory specialties / subspecialties.
Refer to Chapter 6 of the State Operations Manual (SOM) for additional information on
accrediting organizations.
✔✔CLIA Laboratories approved for distinct specialties and subspecialties: - ✔✔-
American Association of Blood Banks
- American Osteopathy Association
- American Society of Histocompatibility & Immunogenetics
- The Joint Commission
- College of American Pathologists
- Commission on Office Laboratory Accreditation
✔✔CERTIFICATION - ✔✔Certification is a recommendation made by the State Agency
(SA) on the compliance of providers and suppliers with the conditions of participation,
requirements, and conditions of coverage.
State Agencies officially certify the findings that health care entities do the following:
- Meet the Act's provider or supplier definitions
- Comply with standards required by Federal regulations
✔✔CMS Headquarters - ✔✔- Located in Baltimore, MD
- Overall policy-making responsibility is centralized at CMS Baltimore headquarters
