Differentiate between CMS surveys and state licensure surveys and when each occurs.

• A. CMS surveys evaluate Medicare/Medicaid eligibility and compliance; state licensure surveys address facility licensure and reported complaints; CMS may participate for federal programs
• B. CMS surveys evaluate building code compliance; state licensure handles patient care decisions; CMS may not participate
• C. CMS surveys are only for hospitals; state licensure only for nursing homes; CMS sets facility insurance requirements
• D. CMS surveys set marketing and advertising rules; state licensure handles patient privacy

Answer: (A)

CMS surveys focus on whether a facility meets the requirements to participate in Medicare and Medicaid and remain in good standing for federal program reimbursement. They assess compliance with the conditions of participation that govern federal funding and program rules, which directly affect funding and certification.

State licensure surveys, on the other hand, are conducted by the state agency responsible for facility licensure. They ensure the facility meets state licensure standards and investigations into complaints or safety concerns fall under this purview. These surveys determine whether the facility can legally operate within the state.

CMS may participate or be involved in surveys when federal program requirements are at stake, or during joint survey activities tied to a facility’s certified participation in Medicare/Medicaid. This is why the statement notes CMS involvement “for federal programs.”

Other options pair activities that aren’t what these surveys cover, such as building codes, patient care decisions, marketing, advertising, or privacy rules, which are outside the described CMS vs. state licensure scope.