Patton Post – June 2026

June 2026

Inside This Issue

Smoke and Fire Barrier Penetrations:

The lead article in this month’s edition of EC News is about sealing smoke and fire barrier penetrations. Flaws in sealing penetrations have been frequently scored on accreditation surveys since long before anyone practicing in healthcare today first graduated and began to work in a health care facility.

The author does a great job of describing the multiple different fire sealant materials that are available today and the settings/areas in which different products should be used, in specific settings. Readers may find it helpful to develop product specifications as well as policies and procedures for these different settings and use this guidance when bidding for contractors to perform renovations or repairs.

Most healthcare facilities have been in operation for many years and over those years a multitude of staff and contractors have been drilling holes in walls and floors to run pipes or cables to create risk that the wrong product was used or inadequately applied. Preventing that risk from growing each year may be a useful exercise.

Physical Environment Considerations for Dialysis Centers:

EC News also contains a helpful and timely article on maintaining the physical environment in dialysis centers. We say timely, because in our CMS section we discuss the new CMS State Operations Manual or appendix H for end stage renal disease/dialysis providers. This EC News article helps provide insight on some potential vulnerabilities in the physical environment and equipment maintenance areas such as wall boxes. This ties in nicely with several of the CMS surveyor task documents and checklists for survey, and highlights risk areas worthy of your focus.

Fire Safety Equipment ITM:

Lastly, EC News has a brief article on maintaining fire safety equipment. It promotes a new book they have produced, but they include a link to an inspection checklist they have included in the book that reminds readers to the frequency for conducting inspections on about 40 different unique pieces of fire safety equipment.

DNV: IT Security Webinar:

DNV has posted a link for a webinar they are conducting on information technology security, and more specifically, using ISO 27001 standards to achieve security. The webinar is being held on June 25th, and you can register if interested.

Accrediting Organization Final Rule:

While it is not a QSO, CMS has posted an important document in the Federal Register discussing oversight of accrediting organizations (AOs). You might recall the 2017 article in Wall Street Journal on perceived conflict of interest and a 2024 posting where CMS discussed potential limitations on fee based consulting by CMS deemed accreditors. That 2024 posting seemed to just evaporate, but that is apparently not the case. We have been hearing rumors for several months that this was being revisited, and we have observed JC doing some reorganizing such as moving their official newsletter from their consulting arm back to the accreditation side.

On June 16 CMS posted a final rule with comment period on increasing oversight of deemed accreditors. One such oversight modification is a prohibition on accreditors performing consultation surveys within a year of an organizations next scheduled survey. CMS is also prohibiting accreditor linked consulting firms from performing any initial survey consulting or complaint survey consulting. CMS has also defined firewall protection policies between an accreditor and its consultation side. The posting also discusses conflict of interest restrictions and reporting requirements to CMS on implementation of their conflict policies.

We are fortunate at Patton Healthcare Consulting that we are a consulting only firm and thus are not subject to any of these restrictions. Our consultation is designed to help organizations understand regulations/standards, design safe and effective care delivery practices, that simultaneously embed both CMS and accreditor standards. We are also fortunate that over the past 20 years we been able to recruit many former colleagues from accreditors to join us and that trend is accelerating as a many of the best and the brightest stars that we once worked with at these AOs have recently been able to join us at PHC. We look forward to continuing our relationships with existing clients and acquiring new clients who don’t want to be periodically cut off from consultation support during the accreditation cycle or at time of need, following a complaint.

We have highlighted the key takeaways in our LinkedIn post.

If you have questions about how these changes may affect your organization, please reach out for a complimentary 30 min consult with one of our Principal Consultants. We also encourage you to follow us on LinkedIn, where we regularly share timely accreditation, regulatory, quality, and compliance updates.

End-Stage Renal Disease Providers:

On May 15 CMS posted QSO 26-09 regarding guidance for providers of care for end-stage renal disease (ESRD). This memo will become the state operations manual for evaluating ESRD providers and be named provider Appendix H. The QSO memo itself is only three (3) pages, however the attached Appendix H is 420 pages. CMS uses their customary process of noting changes in red making a scan of the new material somewhat easier, although it is still a long and complex document.

Appendix H is helpful to providers to know what CMS state surveyors will do during a survey and the new appendix highlights multiple tasks that should be studied such as:

• Task 1: Presurvey preparation, or the information surveyors will review about your organization prior to arrival.
• Task 5: Observation, or the things surveyors should be looking at.
• Task 7: Water treatment room, or the things and practices surveyors will evaluate regarding proper water treatment.
• Task 8: Dialysate reprocessing
• Task 9: Dialysis equipment maintenance or the quality control practices to keep the equipment functioning safely.
• Task 11: Medical record review, or the documentation surveyors are advised to carefully examine.
• Task 12: Patient interviews, or questions surveyors might ask of patients.
• Tasks 13 and 14: Personnel record reviews and personnel interviews, or the things staff may be asked to discuss and the supporting documentation for competency.

The new Appendix H also includes surveyor tools that ESRD providers, quality, engineering and infection prevention staff can use to assist in evaluating overall compliance. These surveyor worksheets include:

• ESRD Core Survey Data Worksheet
• Entrance Conference Worksheet
• Observations of Hemodialysis Care and Infection Control Practices Worksheets
• Patient Sample Selection Worksheet
• Water Treatment and Dialysate Review Worksheet
• Dialyzer Reprocessing/Reuse Review Worksheet
• Dialysis Equipment Maintenance Review Worksheet
• Home Dialysis Training and Support Review Worksheets
• Patient Interview Worksheets
• Personnel Record Review Worksheet
• Personnel Interview Worksheets
• Medical Record Review Worksheets QAPI Worksheet

Home Health and Hospice:

On May 20, 2026, CMS posted a second QSO-26-11. You may have read recent media reports on potential fraud in the home health and hospice industry in California. This memo addresses all home health and hospice providers, and it indicates that CMS is imposing a 6-month moratorium on new provider approvals. CMS will not be conducting any initial surveys to approve new providers.

Accreditors, if the perform an initial home health or hospice survey, those surveys will not provide any deemed status recognition for Medicare. CMS indicates that no individual exceptions can be approved, except in the event of a federally declared disaster. CMS did indicate that applications submitted prior to May 13 will continue to be processed.