CMS Posts AO Oversight Final Rule with Comment 

CMS Posts AO Oversight Final Rule with Comment 

Medicare Program; Strengthening Oversight of Accrediting Organizations (AOs) and 

Preventing AO Conflicts of Interest, and Related Provisions was posted on the Federal Register Public Inspection desk on 6/12/2026 and is estimated to post in the Federal Register on June 16, 2026. The Centers for Medicare and Medicaid Services (CMS) will accept comments related to the proposed rule through August 17, 2026, 11:59 pm. Information about submitting comments appears at the beginning of the rule. This final rule is effective June 16, 2027. 

Rationale For More CMS Oversight of AO’s 

CMS’s rationale for increased oversight of AOs centers on their concerns over patient safety, conflicts of interest, and inconsistent survey standards. Specific drivers for these stricter regulations include: 

• Severe Conflicts of Interest: Some AOs were offering fee-based consulting services to the same healthcare facilities they were tasked with evaluating and accrediting, compromising objective survey results.  

• Regulatory Discrepancies: Some AOs were found to apply inconsistent standards compared to state survey agencies (SAs), including providing unauthorized advance notice of onsite surveys.  

• Disparate Outcomes: Disparity rates revealed inconsistencies in how AOs handled critical compliance issues, sometimes allowing hospitals to retain accreditation even after significant quality and safety breaches or termination from Medicare/Medicaid.  

• Performance Evaluations: Direct observations and performance data analyses highlighted ongoing weaknesses in AO performance and a lack of standardized surveyor training.  

Summary of the Major Provisions  

The highlights of the major provisions in this rule are tailored to those that will impact providers. Providers are strongly encouraged to review the entire content of the final rule to understand all provisions and the requirements for AO’s.  

I. Additions to Definitions – CMS finalized the following definitions at § 488.1: 

• Fee-based consulting services mean those services provided by an accrediting organization (AO), or its consulting division or separate business entity (such as a company or corporation) that provides such services, for the review of a [particular] facility’s standards, processes, policies, and functions for compliance with the AO’s standards and the Medicare requirements through simulation of a real survey, such as a mock survey, with comprehensive written reports of findings and early intervention and action to correct deficiencies prior to an actual accreditation survey. 

• Geographic regions – CMS uses specified geographic regions of the United States to measure whether an accrediting organization’s accreditation program meets the definition of “national in scope.” For this purpose, the United States is divided into the following five geographic regions: 

• National accrediting organization means an accrediting organization that is national in scope and accredits provider or suppliers, under a specific accreditation program. 

• National in scope means that the providers and suppliers accredited by an accrediting organization under a specific accreditation program, are widely located geographically across the United States. 

• Unannounced survey means a survey that is conducted without any prior notice of any type, through any means of communication or forums, to the facility to be surveyed, and therefore, is unexpected to the facility until the arrival onsite by surveyors. This also means that the accrediting organizations must schedule their surveys so that the facility is unable to predict when they will be performed. 

II. CoP Language – CMS finalized the following new requirement at § 488.4(a)(1): 

• AOs that accredit Medicare-certified providers and suppliers must include the applicable Medicare regulatory language as their minimum accreditation standards. This is the language contained in the Medicare Conditions of Participation (CoPs). 

• AOs would also be free to establish additional accreditation requirements that exceed Medicare conditions. 

• CMS will require AOs to develop a detailed crosswalk (in table format, as specified by CMS) that identifies, for each of the applicable Medicare conditions (as defined in § 488.1) or requirements, the exact language of the organization’s comparable accreditation requirements and standards. Such crosswalk must include the language of the CMS requirements and standards, and those accreditation standards that exceed the CMS conditions. 

Provider impact: CHAP will be updating their standards for applicable provider types to match the language in the specific provider CoPs.  

Timing: CHAP is currently clarifying the timing requirements with CMS. 

III. Comparable Survey Process – CMS finalized the following new requirement at § 488.4(a)(1): 

• AOs that accredit Medicare-certified providers and suppliers must use a survey process comparable to the processes set out in the CMS State Operations Manual, or as issued via policy memorandums, and approved by CMS, as defined in § 488.5. 

• CMS will require the AO to evidence a detailed description of the organization’s survey process including, but not limited to, the core activities of the survey process such as, but not limited to, documentation supporting Pre Survey Preparation/Offsite Preparation, Entrance Interview/Activities, Information Gathering/Investigation, Analysis of Information, Exit Conference, Post Survey Activities/Statement of Deficiencies activities, to confirm that a provider or supplier meets or exceeds the Medicare program requirements, and maintains the integrity of the survey process, which is intended to be a non-biased evaluation of a facility’s ability to provide safe care and protect the health and safety of patients. 

• AOs will be expected to have comparable survey team composition as outlined within CMS SOM Appendices. 

Provider impact: CHAP currently uses a comparable survey process that is set out in the CMS State Operations Manual, so there should be no provider impact. However, we will review our current survey process to ensure compliance with CMS requirements and performance improvement opportunities. 

IV. Termination of Provider Agreement – CMS finalized the following new requirement at § 488.4(b): 

• If CMS terminates the participation agreement of a provider or supplier, CMS will no longer recognize or accept the accreditation provided by an accreditation organization to that provider or supplier as demonstrating that such provider or supplier has met the Medicare requirements; and 

• If CMS terminates the participation agreement of a provider or supplier, the terminated provider or supplier must meet all requirements set forth at §  489.57 before a new agreement with that provider or supplier for Medicare participation will be approved. 

• The provider or supplier will remain under the exclusive oversight of the SA until the SA has certified and/or CMS has determined its full compliance with all Medicare conditions, and CMS has approved the new agreement for participation in the Medicare/Medicaid program. 

• While a provider or supplier is terminated from Medicare, remains under SA oversight, and has a new Medicare participation agreement pending, CMS will not accept or recognize deeming accreditation from a CMS-approved accrediting organization. 

V. Conflicts of Interest – CMS finalized the following new requirement at § 488.5(a)(10): 

• CMS will require an AO to develop and implement policies and procedures to avoid conflicts of interest, including the appearance of conflicts of interest, involving individuals who conduct surveys or participate in accreditation decisions. 

• When an AO owner, surveyor, or other employee, currently or within the previous 2 years, has an interest in or relationship with a healthcare facility that the AO accredits, the AO would be required to take steps to prevent the surveyor from having any involvement with the survey of that facility; having input into the results of the survey and accreditation for that facility; having involvement with the pre- and post-survey activities for that facility; and having contact with or access to the records for the survey of that healthcare facility. 

• Explicitly prohibiting AO owners, surveyors, employees, and their immediate family members from having financial or operational interests in any healthcare facility they accredit. 

VI. Restrictions on AO Fee-Based Consulting Services – CMS finalized the following new requirement at 488.8(i)(1):    

• CMS placed restrictions on fee-based consulting services provided by AOs to the healthcare providers and suppliers they accredit.  

• An AO or its associated fee-based consulting division or company may not provide fee-based consulting services to any healthcare provider or supplier prior to an initial accreditation survey.  

• CMS will prohibit AOs from providing fee-based consulting services to healthcare providers and suppliers they accredit within 12 months prior to the next scheduled re-accreditation survey of that provider or supplier.  

• AOs may not provide fee-based consulting services to a healthcare provider or supplier in response to a complaint received by the AO regarding that provider or supplier.  

• CMS defined circumstances in which the restrictions to the provision of AO fee-based consulting services would not apply. (see Section I. definition of Fee-based consulting services. 

• CMS will take actions against AOs for the provision of prohibited fee-based consulting services.  

VII. Changes to the Validation Program – CMS finalized the following related to AO validation visits: 

A CMS AO Validation Visit refers to an oversight review conducted by CMS or a contracted entity to evaluate the accrediting organization’s survey performance—not the facility itself. 

• CMS is phasing out traditional retrospective “look-back” AO validation surveys and replacing them with direct observation validation surveys. This approach aims to reduce administrative burdens on healthcare facilities while making the oversight of Accrediting Organizations (AOs) more effective and transparent. 

• By removing the look-back validation survey method and keeping only the direct observation validation survey process, CMS states that provider burden will be greatly reduced by not requiring an additional validation survey, thus essentially eliminating the number of healthcare providers that would have to undergo two full surveys within a 60-day period.  

View the Proposed Rule on the Federal Register’s Public Inspection Desk. 

For further information, see the CMS summary of the hospice proposed rule. 

View current PART 488—SURVEY, CERTIFICATION, AND ENFORCEMENT PROCEDURES 

Questions about the content of this rule? Contact CHAP