Conditions of Participation

What are Conditions of Participation?

Conditions of Participation are the terms healthcare organizations must meet in order to participate in federally funded healthcare programs, such as Medicaid, Medicare, CHIP, etc. The Centers for Medicare and Medicaid Services (CMS) developed and oversees the Conditions of Participation, which healthcare organizations must abide by to begin and continue participation in the associated programs.

The Conditions of Participation include health and safety guidelines that enforce patient rights and improve the quality of care.

How are Conditions of Participation important in healthcare?

Conditions of Participation were established because up to a third of all hospitals, especially those located in rural areas, did not seek the voluntary accreditation program offered by the Joint Commission on Accreditation of Hospitals. The Medicare program aimed to maximize healthcare access, but it was clear that existing accreditation programs could not guarantee minimum health and safety compliance. In response, Medicare put forth a set of requirements upon its establishment, which then evolved into the Conditions of Participation.

The Conditions of Participation were designed to protect patient health and safety. They ensure that anyone using a federally funded healthcare program, such as Medicaid, Medicare, or CHIPS, receives quality care from any participating organizations.

Different facilities and services, such as outpatient services, respiratory care, or surgical centers, have their own conditions of participation, ensuring that specialized functions adhere to specialized health and safety guidelines.