N108: Transition to the Registered Professional Nurse

N108: Transition to the Registered Professional Nurse Role Study Guide of 171 Medicare/Medicaid Certificati n Those agencies that seek Medicare or Medicaid funding must meet specific standards termed the conditions of participation (COP) and be Medicare certified, in addition to meeting the basic state standards for operation. For Medicare or Medicaid to reimburse nursing home care, the state inspection must include Medicare/Medicaid standards, which relate to many aspects of care. Healthcare institutions and agencies may seek accreditation from nongovernment bodies that set standards for high quality and provide guidelines to assist in developing procedures. Medicare and Medicaid have granted several nongovernment agencies what is called “deemed status.” This means that the standards of the agency are considered equal to or exceeding the Medicare standard. The Joint Commission The Joint Commission is a nonprofit, voluntary organization originally established by the American College of Surgeons and the American Society of Internal Medicine to set standards for hospital care. The Joint Commission accredits hospitals, nursing homes, and related organizations may seek accreditation. It has deemed status for federal programs and in 2001 began providing accreditation for assisted living facilities. It has the power to demand change to maintain accreditation status. The Joint Commission surveys facilities approximately every three years in which they investigate aspects of the organization, including the physical plant, the entire delivery of care process, and the evaluation and quality improvement plans used. Community Health Accreditation Program (CHAP) The Community Health Accreditation Program was established to provide a voluntary accreditation for community health and home health agencies, hospices, and home medical equipment providers. This is a peer reviewed process governed entirely by community health agencies with public representation. Medicare and Medicaid do not require a separate Medicare certification for an organization that has CHAP accreditation. National Committee for Quality Assurance (NCQA) This committee reviews and evaluates health plans and provides recognition of plans that meet standards of excellence. The NCQA established a set of statistical measures called the Healthcare Effectiveness Data and Information Set (HEDIS) and is a tool used by more than 90 percent of America’s health plans to measure performance on important dimensions of care and service. These data provide a set of standards of information that both employers and consumers can use to compare and evaluate health plans. Magnet Status A magnet hospital is described as one where nursing delivers excellent patient outcomes, where nurses have a high level of job satisfaction, and where there is a low staff nurse turnover rate and appropriate grievance resolution. In the early 1980s, the American Academy of Nursing recognized that acute care facilities had difficulty attracting and retaining RNs. They appointed a task force on hospital nursing practice to examine the situation. The task force determined that it was necessary to ©2017 Achieve Test Prep Page 108

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