2026-12069RuleSignificantWallet

Medicare Tightens Accrediting Organization Conflict Rules

Published Date: 6/16/2026

Rule

Summary

This new rule makes sure the groups that check Medicare providers play fair and follow clear rules to avoid conflicts of interest. It updates how psychiatric hospitals are reviewed and tightens rules for providers who lost their Medicare status but want back in. These changes affect Medicare providers and accrediting groups, start June 16, 2027, and aim to keep care safe and trustworthy.

Analyzed Economic Effects

6 provisions identified: 2 benefits, 4 costs, 0 mixed.

Stricter Re-entry Rules After Termination

If a Medicare-certified provider or supplier is involuntarily terminated from Medicare, CMS will no longer recognize that facility's AO accreditation for deemed compliance and the provider must meet the requirements of Sec. 489.57 before a new Medicare participation agreement is approved. While re-enrolling, the terminated provider will be placed under State Agency (SA) oversight for a 'reasonable assurance period' (length set by CMS) and may not rely on AO deeming while a new agreement is pending; AOs must terminate accreditation of such facilities within 5 business days of CMS written notice.

AOs Must Use Medicare Conditions

Accrediting organizations (AOs) that accredit Medicare-certified providers must use the language of the applicable Medicare Conditions of Participation, Conditions for Coverage, or Conditions for Certification as the minimum accreditation requirements. This change becomes effective June 16, 2027 and means AO accreditation must at least match Medicare rules even if the AO adds stricter requirements.

Limits on AO Fee-Based Consulting

AOs may not provide fee-based consulting to a healthcare provider before that provider's initial accreditation survey, and may not provide consulting within 12 months prior to the provider's next scheduled re-accreditation survey. AOs also may not provide consulting in response to a complaint, must keep firewall policies, and must report consulting activity to CMS on a bi-annual basis.

Psychiatric Hospital Survey Changes

CMS will integrate psychiatric hospital survey processes with acute care hospital surveys and requires AOs that currently accredit hospitals to expand their hospital programs to include psychiatric services. This change aims for systematic and integrated surveys of psychiatric hospital quality and safety.

Annual Surveyor Conflict Declarations

AOs must obtain and submit declarations from each surveyor disclosing any interests or relationships with healthcare providers they accredit, on at least an annual basis. When an AO owner, surveyor, or employee currently or within the previous 2 years has an interest or relationship with a facility, the AO must prevent that person from involvement in surveying or accreditation activities for that facility.

Public Plans of Correction & Validation

When an AO's performance on survey activities shows disparity concerns (via outcome or process disparity rates), the AO must submit a publicly reportable plan of correction. CMS is also expanding and revising AO validation survey types and requires AOs to provide survey findings to CMS under the revised rules.

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Key Dates

Published Date

Rule Effective

6/16/2026

6/16/2027

Department and Agencies

Department

Independent Agency

Agency

Health and Human Services Department

Centers for Medicare & Medicaid Services

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