THE DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE (HEW) IS REQUIRED BY LAW TO CERTIFY THAT ALL HOSPITALS PARTICIPATING IN THE MEDICARE PROGRAM ARE PROVIDING QUALITY CARE TO PATIENTS. HOSPITALS ACCREDITED BY THE JOINT COMMISSION ON ACCREDITATION OF HOSPITALS ARE AUTOMATICALLY CERTIFIED EXCEPT FOR TWO REQUIREMENTS. THE CERTIFICATION SYSTEMS HAS PROBLEMS, HOWEVER, CAUSED BY LIMITED CAPACITY TO MEASURE THE QUALITY OF HEALTH CARE, DIFFERENCES IN STANDARDS USED BY HEW AND THE COMMISSION, DIFFERENCES IN HOW STATES AND THE COMMISSION CONDUCT SURVEYS AND APPLY STANDARDS, AND INEFFECTIVE MONITORING OF STATES' ACTIVITIES. THE CONGRESS SHOULD REVITALIZE THE MEDICARE CERTIFICATION SYSTEM FOR HOSPITALS BY REQUIRING HEW TO CONTRACT WITH THE COMMISSION TO CONDUCT ALL CERTIFICATION SURVEYS, USE FEDERAL SURVEYORS TO SURVEY UNACCREDITED HOSPITALS AND VALIDATE ACCREDITED HOSPITALS, OR SIGNIFICANTLY IMPROVE THE EXISTING PROCESS. IN ANY CASE, HEW MUST MAKE IMPROVEMENTS IN ITS POLICY GUIDANCE AND MONITORING AT ALL LEVELS, INCLUDING STANDARDIZING CONTROLS FOR DISCOVERY AND CORRECTING WEAKNESSES IN THE COMMISSION, THE REGIONS, AND THE STATES. HEW AGREED WITH THE THRUST OF THE CONCLUSIONS AND THE RECOMMENDATIONS. HEW, HOWEVER, WAS NOT SUPPORTIVE OF CONTRACTING WITH THE COMMISSION FOR ALL CERTIFICATION ACTIVITIES BECAUSE OF ANTICIPATED STRONG RESISTANCE FROM THE STATES AND THE STRONG TIES BETWEEN LICENSURE PROGRAMS AND CERTIFICATION IN SOME STATES. FOOTNOTES AND TABLES ARE PROVIDED. THE APPENDIXES REPORT RESPONSES TO THE REPORT FROM THE JOINT COMMISSION ON ACCREDITATION OF HOSPITALS AND HEW. (AUTHOR ABSTRACT MODIFIED--RCB)