Hospital Quality

States historically have been responsible for hospital accreditation and licensure, but since the federal government is the nation’s single largest purchaser of hospital services, through Medicare, Medicaid and other programs, it has played an increasingly prominent role in ensuring hospital quality through Medicare and Medicaid Conditions of Participation (COPs). COPs cover many different aspects of hospital care, but most are motivated by a concern to protect patient health and safety. All states have the authority to impose accreditation or licensure requirements on hospitals. Medicare and Medicaid COPs are above and beyond any requirements imposed by individual states and are codified in 42 CFR pt. 483 (1997). The Duke Center for Health Policy has developed a draft working paper assessing the costs and benefits of hospital accreditation and licensure regulation, including Medicare conditions of participation and state accreditation and licensure (pdf)


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