CMS Conditions of Participation (CoPs) are federal standards that hospitals must meet to participate in Medicare and Medicaid programs, directly tied to reimbursement eligibility.
Option A (Submit core measure data): Core measure submission is a quality reporting requirement, but it is not the primary purpose of CoPs, which focus on broader compliance.
Option B (Receive reimbursement): This is the correct answer. The NAHQ CPHQ study guide states, “Hospitals must comply with CMS Conditions of Participation to be eligible for Medicare and Medicaid reimbursement” (Domain 3). CoPs ensure minimum standards for patient care and safety, a prerequisite for federal funding.
Option C (Be part of the state hospital association): State hospital associations are voluntary, not tied to CMS CoPs.
Option D (Be licensed): Licensing is a state function, not directly linked to CMS CoPs, which are federal requirements.
CPHQ Objective Reference: Domain 3: Organizational Leadership, Objective 3.5, “Ensure compliance with regulatory requirements,” includes understanding CMS CoPs as a condition forreimbursement. The NAHQ study guide notes, “CoPs are critical for maintaining eligibility for CMS funding, impacting hospital operations and quality” (Domain 3).
Rationale: Compliance with CoPs ensures hospitals meet federal standards for care, enabling reimbursement from Medicare and Medicaid, a core requirement for financial sustainability, as per CPHQ regulatory principles.
[Reference: NAHQ CPHQ Study Guide, Domain 3: Organizational Leadership, Objective 3.5., , , ]
