All patient healthcare organizations providing services must have a state license for all physical locations. In addition, regulatory agencies (i.e., the local authority, state legislation, or federal government) require the following:
- The Department of Health requires a license plus certification for those who receive funding from the U.S. Centers for Medicare or Medicaid Services.
- Though accreditation by the Joint Commission is not mandatory, failure to obtain and maintain it can result in loss of private insurance and Medicare/Medicaid reimbursement for care. Without payment from those three funding sources, a healthcare organization may file for bankruptcy.
- Healthcare professionals must pass a proficiency examination after completing a predetermined number of years of training at a school approved by the State Board for their Profession. After passing the exam, they receive a license from their Board. The Professional Boards establish renewal requirements for licensure.
Failure to meet the requirements to maintain the license or certification noted above results in losing the privilege to operate that service or practice that Profession. However, not in all circumstances does a violation alone result in a complete loss of licensure. A professional or facility may lose partial service, as in a suspension, or face remedial action. Surveyors prefer that option if remediation occurs, but it depends on whether prior history indicates previous breaks.
I’ll write a separate post on each of these organizations to help you better understand what they monitor and what they can do for you. A post specific to each agency will give you insight into what you can learn from them and why they are important.
In the meantime, here are the websites for the ones mentioned above.
Virginia Department of Health https://www.vdh.virginia.gov/licensure-and-certification/division-of-acute-care-services/hospitals/
Centers for Medicare and Medicaid https://www.cms.gov/medicare/health-safety-standards/enforcement
The Joint Commission https://www.jointcommission.org
