Comment on CMS-2024-0016-0060

CMS-3367-FC Medicare Program; Strengthening Oversight of Accrediting Organizations and Preventing AO Conflicts of Interest 91 FR 36370 File Code: CMS‑3367‑FC To the Centers for Medicare & Medicaid Services: I submit this comment on the Collection of Information and Regulatory Impact Analysis sections of CMS‑3367‑FC. Section 1865 of the Social Security Act authorizes Medicare‑certified providers and suppliers to receive deemed status through CMS‑approved accrediting organizations (AOs) when accreditation demonstrates that applicable Medicare conditions are met or exceeded. Because accreditation can substitute for direct federal oversight, the information CMS collects from AOs is not ancillary. It is the evidentiary foundation that allows CMS to exercise the oversight authority Congress intended. Accreditation is not a private quality label. It is a public gateway. If CMS lacks sufficient, structured, and analyzable information about AO conflicts of interest, surveyor relationships, consulting services, survey comparability, validation outcomes, and corrective actions, then the oversight framework becomes harder to enforce. A conflict‑of‑interest rule is only as strong as the record that reveals the conflict. The human consequence is patient safety. Patients do not experience accreditation as a regulatory concept. They experience it as whether unsafe conditions are identified, whether deficiencies are corrected, whether psychiatric hospitals are surveyed with appropriate rigor, and whether a provider terminated for serious noncompliance can reenter the Medicare system through paperwork rather than demonstrated correction. The structural question is this: Will the required information collections allow CMS to detect patterns across accrediting organizations, facilities, consulting relationships, survey outcomes, and validation findings before those patterns become patient harm? To support that goal, CMS should ensure that the collection instruments capture, at minimum: Identifying information for the AO, related consulting divisions, parent entities, subsidiaries, affiliates, and relevant ownership or governance relationships; The date, type, duration, and scope of any fee‑based consulting services provided to an accredited provider or supplier; Whether consulting services involved accreditation preparation, condition‑level compliance, plan‑of‑correction support, mock surveys, policy drafting, staff training, or similar activities; Surveyor declarations of employment, business, financial, consulting, family, or other interests related to surveyed facilities; The process used to screen, update, and verify those declarations before a survey occurs; Any recusal, reassignment, enforcement, or corrective action taken after a conflict is identified; Timelines and required content for CMS notification when accreditation status is revoked, withdrawn, revised, or otherwise materially changed. CMS should also consider publishing aggregate, non‑identifying information about AO performance, conflict reporting, validation survey outcomes, and corrective actions. Public trust requires not only that CMS possess the record, but that the public can see enough to know whether the oversight system is functioning. The cost of collecting conflict and performance information should not be measured only in staff hours. It should be measured against the cost of missed deficiencies, unsafe care, avoidable harm, and delayed correction. Under the Administrative Procedure Act, a rule that lacks sufficient information to support its enforcement risks becoming arbitrary, capricious, or unsupported by the administrative record. The principle is simple: When private accreditation carries public legal effect, public oversight must be strong enough to see through the accreditation label to the condition of care beneath it. Respectfully submitted, Makita Thatcher Georgia resident