Medicare Health Care Provider/Supplier Enrollment

2005 - Medicare Health Care Provider/Supplier Enrollment (Rev. 123, Issued: 10-03-14, Effective: 10-03-14, Implementation: 10-03-14) The Centers for Medicare & Medicaid Services (CMS) is authorized to collect enrollment information in order to ensure that correct payments are made to providers and suppliers under the Medicare program established by Title XVIII of the Act for payment under Part A of Title XVIII [42 U.S.C. §1395f(a)(1) and 1395g(a)] and §1833(e) [42 U.S.C. §13951(e)] for payment under Part B. In addition, CMS is required to ensure that no payments are made to providers or suppliers who are excluded from participation in the Medicare program under §1128 of Title XVIII [42 U.S.C. §1320a-7], or who are prohibited from providing services to the federal government under §2455 of the Federal Acquisition Streamlining Act of 1994 (P.L. 103-355) [31 U.S.C. §6101 note]. The primary use of this information is to verify the eligibility of providers/suppliers to participate in the Medicare program, which will more effectively prevent fraud and abuse. The protocol that CMS uses to ensure that providers/suppliers meet these requirements is referred to as the enrollment process. The enrollment process is also to be used for providers/suppliers that plan to seek certification for participation in Medicare based on deemed status through a CMS-approved Medicare accreditation program. An applicant must complete the enrollment application process in order for CMS to obtain certain required information before a certification survey is conducted or, in the case of an FQHC, the RO countersigns the self-attestation. Providers/suppliers should be informed of the enrollment and certification process so that they do not have unrealistic expectations about the effective date of their provider or supplier agreement with Medicare, e.g., an applicant should not expect its effective date to be the date it submitted its enrollment application. Should the applicant have any questions concerning the enrollment process form, it should be referred to the following Web site: http://www.cms.gov/Medicare/Provider-Enrollment-and- Certification/MedicareProviderSupEnroll/index.html. The Medicare enrollment process is not applicable to the Medicaid program. State Medicaid Agencies use their own enrollment process. 2005A - Approval or Denial (Rev. 123, Issued: 10-03-14, Effective: 10-03-14, Implementation: 10-03-14) 2005A1 - Enrollment Denial Based on MAC Review When the MAC determines, after reviewing the Form CMS 855 application, that an applicant has failed to meet the enrollment process requirements, the MAC will issue a written denial to the applicant. The RO is not involved in the issuance of the denial or in the processing of any request by the applicant for reconsideration or appeal. Reconsideration requests or appeals are handled by the Center for Program Integrity Provider Enrollment Operations Group in the CO. Additionally, when an applicant is denied enrollment by the MAC, no survey is conducted. 2005A2 - Approval or Denial of Certification Based on Survey Findings The SA (or RO, when applicable – all references below to SA surveys also apply to surveys conducted by the RO), surveys applicants that are subject to an on-site certification survey after it receives the recommendation of approval from the MAC, unless the applicant has the option of participation via deemed status (See Sections 2003C and 2005A4). Additionally, the applicant must be operational and providing care to patients/residents in order for a certification survey to be conducted. (See Section 2008A.) All surveys are unannounced. Applicant in Compliance - The SA surveys the applicant and certifies or recommends Medicare approval if it determines that the applicant is in compliance with all conditions of participation/coverage/certification or requirements, as applicable. (See Section 2008D for more information on the circumstances under which the SA certifies the applicant is or is not in compliance.) The SA forwards the survey results and certification kit to the RO which determines whether and when all Federal requirements have been met by the applicant. If all Federal requirements have been met, the RO proceeds with the provider’s or supplier’s Medicare participation approval. (In the case of HHAs, there is a requirement for the MAC to conduct a second verification of the enrollment information after the SA or accrediting organization survey is completed. However, a second MAC review that takes place after the on-site certification survey will only delay the effective date of the HHA’s Medicare agreement if that review identifies noncompliance with any Federal requirements. If the HHA is found upon a post-survey second MAC review to continue to meet all requirements, there would be no change in the initial certification effective date previously provided by the MAC to the RO. However, if the MAC finds the HHA does not meet all Federal requirements during the second review, there would be a delay in the effective date of any provider agreement that might eventually be issued to the HHA applicant until all requirements are determined to be met.) The RO will issue a provider or supplier agreement with an effective date, and assign a CMS Certification Number (CCN). (See Section 2008.) The RO will notify the MAC of the applicant’s approval for participation in the Medicare program by sending the Provider Tie-In Notice (Form CMS-2007), and/or a copy of the approval letter that will include the CCN. The RO will send the SA a copy of the applicant’s approval letter. Applicant Not in Compliance – The SA surveys the applicant and certifies that the applicant is not in compliance with the conditions of participation/coverage/certification or requirements, as applicable. (See Section 2008D for more information on the circumstances under which the SA certifies the applicant is or is not in compliance.) The SA forwards the survey results to the RO, which will send the provider/supplier a denial letter. The RO will forward a copy of the denial letter to the MAC and to the SA. Claims will not be paid if the applicant is not approved through both the enrollment and the survey and certification processes. The applicant is issued a denial letter for noncompliance with the conditions of participation/coverage/certification. The applicant may correct the deficiencies and reapply for certification. The applicant who reapplies for certification must undergo a new survey which is a full, standard survey, except: • If on the first survey an applicant subject to the Life Safety Code (LSC) requirements was in substantial compliance with the LSC, the SA has the discretion to not resurvey for LSC compliance (although it must receive an acceptable Plan of Correction for any lower-level LSC deficiencies before it may recommend certification); and • In the case of an applicant seeking to participate as a hospital, the SA has the discretion to conduct a new survey of only those conditions for which the applicant was found non-compliant during the prior survey. If the SA chooses to conduct such a focused subsequent survey, the hospital applicant must submit an acceptable plan of correction for all noncompliance identified in the prior survey, including for conditions where there were only lower-level deficiencies cited, before the SA may conduct the subsequent survey. NOTE: It is not possible for an initial applicant to seek CAH status; the applicant must first be certified as a hospital, and then subsequently the hospital may apply to convert to CAH status. This is technically a conversion, not an initial application. If the SA certifies that the CAH applicant is not in compliance, then the RO sends a letter denying the hospital’s request to convert to CAH status. Unless the denial was based on the applicant not satisfying the CAH location requirements, the applicant may seek to be surveyed again for CAH conversion. As with initial hospital applicants, the SA has the discretion to conduct a new survey of only those conditions for which the CAH applicant was found non- compliant during the prior survey. If the SA chooses to conduct such a focused subsequent survey, the CAH applicant must submit an acceptable plan of correction for all noncompliance identified in the prior survey, including for conditions where there were only lower-level deficiencies cited, before the SA may conduct the subsequent survey. In all cases the RO retains the authority to require a new full survey if it has concerns about a certification recommendation based on a focused survey after a prior survey identified substantial noncompliance. In cases where the RO anticipates that it will require a new full survey, it should notify the SA of this as soon as possible, to facilitate planning for the full survey by the SA. If the SA continues to find the applicant is not in compliance with the conditions of participation/coverage/certification or requirements, as applicable, on the subsequent survey, the above process may be repeated. However: • The applicant may submit no more than two reapplications for certification in connection with one enrollment application; and • No more than six months may elapse between the date of the RO’s first denial of certification and receipt by the RO of a second reapplication for certification (for a total of three certification applications). If the applicant fails to demonstrate compliance by the end of this six month period, the RO not only issues a final denial of certification, but also sends a written recommendation to the MAC that the enrollment application be closed out as denied. If the applicant continues to seek enrollment and certification, the RO must receive a new MAC recommendation for approval before it may process a new certification application. 2005A3 - Reconsideration of Denial Procedure for Reconsideration - An applicant has the right to request a reconsideration of an initial certification denial decision. See Chapter 3, Sections 3050 – 3054 for reconsideration procedures and timeframes. Note that the RO may not simultaneously process a certification reapplication and a request for reconsideration. However, in accordance with Section 3054A, the applicant may withdraw its reconsideration request and reapply for certification if it has corrected the deficiencies identified on the survey. 2005A4 – Deemed Providers/Suppliers, Excluding CLIA Initial Survey by an AO with a CMS-Approved Medicare Accreditation Program The AO’s CMS-approved Medicare accreditation program must provide reasonable assurance that providers or suppliers accredited by the AO meet all Medicare Conditions of Participation (CoPs) or Conditions for Coverage/Certification (CfCs), as applicable. CMS evaluates and reviews AOs seeking recognition of their accreditation programs for Medicare participation on a number of factors specified in 42 CFR §488.8, including the AO’s accreditation standards, survey and oversight processes, and their comparability to CMS' standards and processes. Furthermore, 42 CFR §489.13 governs how CMS determines the effective date of a provider’s or supplier’s Medicare agreement or approval, including provisions related to certification survey findings. Accordingly, before the AO makes a recommendation to CMS that an applicant seeking initial certification and enrollment in Medicare be “deemed” to meet Medicare’s health and safety standards, the AO must conduct a survey and determine that the applicant meets all requirements for accreditation, including compliance with all applicable Medicare CoPs or CfCs. Applicant in Compliance If the applicant is found to comply with all accreditation requirements, the AO may award deemed status accreditation, effective no earlier than the accreditation survey end date, and recommend the applicant to the RO for Medicare certification via deemed status. The AO must inform the applicant and the RO of the results of the initial accreditation survey and of its recommendation of the applicant for certification via deemed status, including the effective date of the applicant’s accreditation. If the applicant is found to be in substantial compliance, but has lower-level deficiencies, then the AO must receive an acceptable plan of correction (POC) for such deficiencies. (See Section 2008D.) Once the AO receives an acceptable POC from the applicant, the AO may award deemed status accreditation and recommend the applicant for Medicare certification via deemed status. The AO may not make the effective date of the applicant’s deemed status accreditation prior to the date of receipt of a POC that the AO finds acceptable. The AO must inform the applicant and the RO of the results of the initial accreditation survey, the receipt of an acceptable POC, and its recommendation of the applicant for deemed status, including the effective date of accreditation. The AO must also send its survey report to the RO. When the AO notifies CMS of an applicant’s accreditation and the AO’s recommendation of deemed status for that applicant, the RO reviews the AO’s accreditation survey report and other documentation. If the RO accepts the AO’s recommendation of deemed status, it forwards the AO’s notice of accreditation and recommendation of deemed status to the SA. The SA must prepare an initial certification packet for the provider or supplier. The certification packet is sent by the SA to the RO, with the Medicare Health Insurance Agreement (Form CMS-1561, 1561A or 370, depending on provider/supplier type) submitted to the SA by the applicant, along with any other documentation required for initial certification of that provider/supplier type. (See Exhibit 63 for documentation requirements.) In the remarks section of the Form CMS-1539, the SA indicates that it is transmitting an initial certification kit for an accredited, deemed provider/supplier. Once the RO receives the certification packet, it proceeds as described in Section 2005A2. The RO must send to the AO in a timely manner a copy of its approval letter to the applicant. Among other things, the copy of the approval letter advises the AO of the CCN assigned to the new provider’s/supplier’s Medicare agreement, facilitating the AO’s ability to report accurate data to CMS on its deemed status providers/suppliers. If the RO’s review of the accreditation survey suggests a problem, including, but not limited to: • the AO’s survey report describes findings which represent substantial noncompliance with a Medicare condition, but the AO awarded accreditation anyway; or • the AO’s survey report indicated the applicant was required to submit an acceptable POC for lower-level deficiencies, but the AO issued its accreditation effective on a date prior to its receipt of the POC; or • the AO conducted an extension survey but the applicant is a new owner that rejected assignment of the prior owner’s Medicare agreement and must therefore undergo a full accreditation survey; the RO may, consistent with §488.6(c)(2), reject the AO’s recommendation of deemed status. In such cases the RO contacts the AO to discuss its concerns and ways the AO may remedy them, if possible. If the problems are not remedied, the RO may issue a denial of certification to the applicant and provides a copy to the AO in a timely manner. Applicant Not in Compliance If the AO finds the applicant’s failure to meet its CMS-approved Medicare accreditation program requirements represents substantial noncompliance with accreditation standards, including applicable Medicare CoPs or CfCs, the AO may not recommend the applicant for Medicare certification via deemed status. Rather, the AO must inform the applicant and the RO of the results of the initial survey and that it is not recommending the applicant for deemed status. The RO issues a denial of certification based on the AO’s information, and provides a copy to the AO in a timely manner. The applicant may, at the AO’s discretion, continue to work with the AO to correct the deficiencies and again seek initial certification through deemed status. If the applicant is surveyed again by the AO the survey must be a new survey which is a full, standard survey, except: • If on the first survey an applicant subject to the Life Safety Code (LSC) requirements was in substantial compliance with the LSC, the AO has the discretion to not resurvey for LSC compliance (although it must receive an acceptable Plan of Correction for any lower-level deficiencies before it may recommend deemed status); and • In the case of an applicant seeking to participate as a hospital, the AO has the discretion to conduct a new survey of only those conditions for which the applicant was found non-compliant during the prior survey. If the AO chooses to conduct such a focused subsequent survey, the hospital applicant must submit an acceptable plan of correction for all noncompliance identified in the prior survey, including for conditions where there were only lower-level deficiencies cited, before the AO may conduct the subsequent survey. NOTE: It is not possible for an initial applicant to seek CAH status; the applicant must first be certified as a hospital, and then subsequently the hospital may apply to convert to CAH status. This is technically a conversion, not an initial application. If the AO advises CMS that it is not recommending the applicant for CAH deemed status or if the RO determines that the applicant does not satisfy the CAH location requirements, then the RO sends a letter denying the hospital’s request to convert to CAH status. Unless the denial was based on the applicant not satisfying the CAH location requirements, the applicant may, at the AO’s discretion, continue to work with the AO to correct the deficiencies and again seek CAH certification through deemed status. As with initial hospital applicants, the AO has the discretion to conduct a new survey of only those conditions for which the CAH applicant was found non-compliant during the prior survey. If the AO chooses to conduct such a focused subsequent survey, the CAH applicant must submit an acceptable plan of correction for all noncompliance identified in the prior survey for all noncompliance identified in the prior survey, including for conditions where there were only lower-level deficiencies cited, before the AO may conduct the subsequent survey. In all cases the RO retains the authority to require a new full survey if it has concerns about a deemed status recommendation based on a focused survey after a prior survey identified substantial noncompliance. In cases where the RO anticipates that it will require a new full survey, it should notify the AO of this as soon as possible, to facilitate planning for the full survey by the AO. If the AO continues to find substantial noncompliance on the subsequent survey, the above process may be repeated. However: • The applicant may submit no more than two reapplications for certification in connection with one enrollment application; and • No more than six months may elapse between the date of the RO’s first denial of certification and receipt by the RO of a second reapplication for certification (for a total of three certification applications). If the applicant fails to demonstrate compliance by the end of this six month period, the RO not only issues a final denial of certification, but also sends a written recommendation to the MAC that the enrollment application be closed out as denied. If the applicant continues to seek enrollment and certification, the RO must receive a new MAC recommendation for approval before it may process a new certification application. 2005B - Deemed Providers/Suppliers Except CLIA – Additional Information (Rev. 123, Issued: 10-03-14, Effective: 10-03-14, Implementation: 10-03-14) AO renewal of deemed provider/supplier accreditation: AOs conduct re-accreditation surveys of Medicare-deemed providers and suppliers on a triennial basis. Upon awarding re-accreditation, the AO also makes a recommendation for the provider’s or supplier’s continued Medicare deemed status. The provider’s or supplier’s deemed status continues without interruption. When the AO notifies CMS of its renewal of accreditation and recommendation of continued deemed status, the RO forwards the notice to the SA and the SA must prepare a recertification kit for the provider or supplier. The recertification packet is sent by the SA to the RO, with the Form CMS-1539 and any other documentation required for that provider/supplier type. (See Exhibit 63 for documentation requirements.) In the remarks section of the Form CMS-1539, the SA indicates it is transmitting an accredited, deemed provider/supplier update. Termination/Withdrawal; Removal of Deemed Status The AO must notify CMS whenever a provider’s or supplier’s accredited status is not renewed, as well as the reason for the loss of accreditation. If the AO notifies CMS that the AO has terminated a provider’s or supplier’s accreditation, or that the provider or supplier has voluntarily withdrawn from the AO’s CMS-approved Medicare accreditation program, the RO must remove the provider’s or supplier’s deemed status, unless there is evidence of accreditation under another CMS-approved Medicare accreditation program. For example, if the provider or supplier was accredited simultaneously under two CMS- approved programs, and one AO notifies CMS of a termination or withdrawal, the provider/supplier would continue to have deemed status based on the other accreditation. However, if the notice of termination by the first AO indicates that the reason for termination was the provider’s/supplier’s failure to meet accreditation standards, the RO must consider this a substantial allegation of noncompliance with Medicare standards and must authorize the SA to conduct a complaint investigation. If one AO provides notice of termination or withdrawal and concurrently another AO recommends deemed status, a recertification packet including the new AO recommendation must be submitted by the SA to the RO. (See also Section 3258.) If the RO removes the provider’s or supplier’s deemed status, it places the provider/supplier under the jurisdiction of the SA and must advise the SA of the change in the provider’s/supplier’s status. The SA surveys the facility in order to provide assurance that the facility is in compliance with the applicable Medicare conditions. The timing of the SA survey depends on the reason for the provider’s/supplier’s loss of accreditation: • If the AO terminates accreditation due to failure of the provider/supplier to meet accreditation standards, then the SA must conduct a standard survey within 45 calendar days of notification by the RO that deemed status has been removed. If the AO’s reason for termination appears to be related to an immediate jeopardy, then the RO instructs the SA to conduct the standard survey as soon as possible. • If the AO terminates accreditation due to voluntary withdrawal or failure to pay fees by the provider/supplier, the SA prioritizes the provider’s/supplier’s survey on the basis of the current CMS policy concerning survey frequencies and SA workload priorities, using the date of the most recent accreditation survey to calculate the survey interval, unless: • The facility is a home health agency (HHA). Then the SA must conduct the survey no later than 3 years after the last accreditation survey; or • The RO exercises its discretion to request the SA to conduct the survey by a specified date. CMS may also temporarily remove deemed status (and therefore AO jurisdiction) when a SA or Federal survey team identifies condition-level non-compliance in a deemed provider or supplier during either a representative sample or substantial allegation validation survey. The RO advises the provider or supplier that its deemed status is removed and that it is being placed under SA jurisdiction. However, no change is made to the provider’s or supplier’s deemed status in the Automated Survey Process Environment (ASPEN). Instead, the placement of the provider or supplier under SA jurisdiction is noted under the Deeming tab within the certification kit in ACO. The provider/supplier remains under SA jurisdiction until it either demonstrates substantial compliance or CMS terminates its Medicare participation. If the provider/supplier demonstrates substantial compliance to the SA, CMS restores its deemed status. Note that there is no prohibition against an AO also conducting its own survey of a provider/supplier that is temporarily under SA jurisdiction. Other AO adverse actions The AO is required to inform CMS of significant adverse actions it takes against the accreditation status of a provider/supplier participating through deemed status. However, as long as the accreditation under the AO’s CMS-approved Medicare accreditation program is not terminated, the provider/supplier's participation in Medicare is not affected. See Section 3258 for information on actions to take when an AO terminates the accreditation of a deemed provider or supplier. The AO is also required to inform CMS by close of business the next day when it identifies an immediate jeopardy situation on a survey. In such cases, the RO generally triages this as an immediate jeopardy complaint and directs the SA to conduct a substantial allegation validation survey, based on the information provided by the AO. 2005C - Clinical Laboratory Improvement Amendments of 1988 (CLIA) Laboratories (Rev. 1, 05-21-04) The procedures for initial certification basically apply to CLIA laboratories with a few exceptions. The enrollment procedures for CLIA laboratories are outlined as follows. CLIA laboratories will be surveyed (if applicable) and registered for CLIA participation whether or not the laboratory enrolls in Medicare. The enrollment Form CMS-855A or CMS-855B process applies to all CLIA laboratories that participate in Medicare. This includes laboratories that have a certificate of waiver, certificate for physician performed microscopy procedures, certificate of accreditation, certificate of compliance, certificate of registration, or are state exempt. However laboratories that bill through the fiscal intermediary (are part of a Part A institutional provider, such as a hospital or SNF) will not need to complete the Form CMS-855A or CMS-855B. The Form CMS- 855A or CMS-855B will be downloaded from the CMS Web site - http://www.cms.hhs.gov/forms/ and completed by the CLIA laboratory. The SA will mail out Form CMS-116, and any other form needed for CLIA registration to the laboratory. A CLIA laboratory is only required to complete a Form CMS-855A or CMS-855B if it decides to enroll in Medicare. At the time a laboratory initially applies for CLIA registration, inquire as to whether the laboratory intends to bill Medicare. If the laboratory intends to bill Medicare, send the laboratory Form CMS-116 and Form CMS-855A or CMS-855B. Questions on the Form CMS-855A or CMS-855B, form should be addressed to the intermediary/carrier. The SA will send the laboratory the Form CMS-116. The laboratory will complete and return the Form CMS-116 to the SA and the Form CMS-855A or CMS-855B to the FI or Carrier. The SA will enter the Form CMS- 116 into the CLIA data system, and the system will assign a CLIA number to the laboratory. For CLIA laboratories, the intermediary/carrier will be responsible for all aspects of the Form CMS-855A or CMS-855B and Medicare enrollment processing. After the intermediary/carrier has reviewed and verified the Form CMS-855A or CMS-855B, it will send a completed copy of the Form CMS-855A or CMS-855B to the RO and State survey agency along with its recommendation for approval or denial. (See §2005.A) for instructions regarding approvals, denials and appeals.) Processing of the Form CMS- 855A or CMS-855B will not affect the scheduling of CLIA surveys since CLIA registration must occur regardless of Medicare enrollment. If a laboratory is denied for Medicare, follow the instructions for denials and take all appropriate CLIA-related actions. If the laboratory does not plan to bill Medicare, it should complete Forms CMS-116 and return it to the State survey agency. 2005D - Supplementary Applications (Rev. 1, 05-21-04) An additional application used for supplementary purposes to support the Form CMS- 855A or the CMS-855B is The Medicare Individual Reassignment of Benefits Health Care Provider/Supplier Application (Form CMS-855R). The Medicare Change of Information Health Care Provider/Supplier Application (Form CMS-855C) is no longer used. The CMS-855A or the CMS-855 B is used to report changes to enrollment (see also §2003). The fiscal intermediary/carrier will send a copy of the Form CMS-855A or CMS-855B with the updated/changed information to the appropriate State Agency and RO. 2005D1 - Forms CMS-855A or the CMS-855B for Changes in Provider/Supplier Information (Rev. 1, 05-21-04) Application changes are changes to any items on the Form CMS-855A or CMS-855B. These changes require the submission of the appropriate updated sections of the Form CMS-855A or CMS-855B with a signed certification statement. The changes will be reviewed by the fiscal intermediary/carrier. The review will result in a recommendation for approval, denial, or return for additional information. The fiscal intermediary/carrier will send a copy of the Form CMS-855A or CMS-855B with the updated/changed information to the State agency or RO that distributed the initial application. When a provider experiences a change of ownership the current owner will check the box marked “potential termination of current ownership” on the Form CMS-855A or CMS- 855B. Voluntary use of the Form CMS-855A or CMS-855B is encouraged for providers/suppliers that were previously certified without completing the Form CMS- 855A or CMS-855B. However, these providers/suppliers may submit these changes in writing on letterhead with an authorized signature. 2005D2 - Form CMS-855R (Rev. 1, 05-21-04) In general, Medicare only makes payments to the individual or entity that directly provides services. However, an individual may reassign benefits to an eligible entity as defined in 42 CFR 424.80. This application must be completed when an individual practitioner is reassigning his/her benefits to an eligible entity. An eligible entity is a business organization that is eligible to receive reassigned benefits (e.g., employer, facility, health care delivery system or agent). Not every provider/supplier will need to complete the Form CMS-855R. Organizations that are likely to receive reassigned benefits are: hospitals, hospices, SNF, ESRD, RHC, CORF, FQHC, and CMHC. The Form CMS-855R is available to applicants for downloading via the CMS Web site at http://www.cms.hhs.gov/forms/. The State survey agency should inform the applicant that any questions concerning the Form CMS-855R should be directed to the intermediary or carrier. If the State agency receives the Form CMS-855R, it will forward the Form CMS- 855R to the intermediary. After reviewing the application and making a recommendation, the intermediary will forward the package to the carrier for the carrier’s review of the reassignment of benefits. 2005E - Changes of Ownership (Rev. 1, 05-21-04) See §3210 for a full discussion of change of ownership (CHOW). The following procedures apply to all provider/supplier types that are subject to survey and/or certification. 2005E1 - CHOW Occurs (Rev. 1, 05-21-04) For a CHOW, the current owners will submit a Form CMS-855A or CMS-855B citing the termination of current ownership. The current owner will check the box marked “potential termination of current ownership” on the Form CMS-855A or CMS-855B and complete Section 1 (Provider/Supplier Information), Section 8 (Potential Termination of Current Ownership), and Section 10 (Attestation Statement). The new owners will complete and submit a new Form CMS-855A or CMS-855B. The current and new owners will submit the Form CMS-855A or Form CMS-855B along with any supporting documents to the FI or carrier. The RO has the delegated authority for making the determination if a CHOW actually exists. [However, the RO may delegate this responsibility to the State agency.] For complex or questionable situations, the FI/carrier will forward all documents to the RO for review. Upon review of all documents, the RO will make the decision as to whether or not a CHOW has occurred. The intermediary/carrier will verify the Forms CMS-855A or CMS-855B and may take one of three actions on a CHOW: ● Recommendation for approval; ● Recommend for denial; or ● Request for additional information. Verification of Information From Intermediary/Carrier - After a complete review and verification of the application, if no additional information is needed, and there is no need to issue a denial, the intermediary/carrier notifies the RO/SA of its verification of information provided about the CHOW within 30 calendar days (absent extenuating circumstances) of the receipt of the completed enrollment applications. The notification will be written and accompanied by a copy of the completed Forms CMS-855A or CMS-855B, if any changes were made to the forms. RO Determines CHOW Has Occurred - If the RO determines that a CHOW has occurred, the RO waits until it receives the intermediary/carrier’s verification of information about the CHOW before completing the process. When the process is completed, the RO will notify the provider/supplier, State agency and intermediary/carrier that a CHOW has occurred. RO Determines CHOW Has Not Occurred - The RO makes the final decision whether a CHOW has actually occurred. If the RO determines that a CHOW has not occurred, the RO notifies the provider/supplier, the State survey agency, and the intermediary/carrier that a CHOW has not taken place. The notification should explain the reason(s) why a CHOW has not occurred. Recommendation for Denial from Intermediary/Carrier - After a complete review and verification of the application, the intermediary/carrier may recommend a denial of the Form CMS-855A or Form CMS-855B based on one or more of the reasons for denial stated in §2005.A.3. The intermediary/carrier will send the recommendation of denial to the RO/SA. For a CHOW, the provider agreement may be automatically assigned to the new owner. However, the new owner could choose to come into Medicare as a new applicant and should be advised of this option. In such a case if the new owner accepts the assignment it also assumes the former owners liabilities. (The new owner could also receive an outstanding underpayment under this scenario). The new owner must enroll the same as any other new applicant (see §3210), undergo the survey and certification process, and be issued a new provider agreement/number. The RO/SA processes a voluntary termination of the provider agreement of the former owner. 2005E2 - Change in Intermediary as Result of CHOW (Rev. 1, 05-21-04) Providers who are changing their intermediary as a result of a CHOW, acquisition, merger, or consolidation should submit the information to the new intermediary of preference. This information, which is required to be submitted by Form CMS-855A, should be promptly processed by the new intermediary. However, the provider should also request a change of intermediary from the RO. If an FI receives a Form CMS-855A for a CHOW that requires a change of intermediary, it should contact the provider and advise it to contact the current RO for a change of intermediary. The new intermediary shall contact the outgoing intermediary and provide it with the submitted information. If the provider mistakenly submits the CHOW information to the old intermediary, the old intermediary shall contact the new preferred intermediary and forward the submitted information to it. The new intermediary shall note on any recommendation for approval if a required change of intermediary request has not yet been approved by the RO. NOTE: CHOW determinations are the responsibility of the RO unless otherwise delegated. 2005E3 - CHOWs Involving Multi-Regional Chain Organizations (Rev. 1, 05-21-04) When a CHOW involves a multi-regional chain organization, a lead or coordinating RO is designated. This will typically be the RO serving the State in which the headquarters of the chain doing the acquiring is located. The coordinating RO will notify all other affected ROs and intermediaries involved in the CHOW determination and processing of enrollment activities. The lead RO may decide which intermediary(ies) will process the new CHOW applications. A separate Form CMS-855A is still required for each separately surveyed provider/supplier. However, they all may be processed simultaneously by the receiving intermediary when the incoming chain requests one intermediary for all the units. Each intermediary shall follow the instructions of the lead RO for CHOWs involving multi-regional chains. For a CHOW which involves multiple incoming or multiple outgoing intermediaries handled by the same RO, the RO shall also direct where and how the new application should be reviewed, and serve as the coordinator for the CHOW in a manner similar to being the lead RO for a multi-regional CHOW. 2005E4 - Change of Owners, but Not CHOW (Rev. 1, 05-21-04) A partnership provider sometimes experiences an addition or deletion of personnel, but a CHOW does not occur. For example, a provider may add or delete owners without experiencing a CHOW. In these situations, the provider should complete section 10 (Ownership Information) on the Form CMS-855A or CMS-855B. It should also complete identifying information in section 1 (Applicant Information) and section 19 (Certification Statement). The rest of the form does not need to be completed. Advise the provider/supplier to submit the Form CMS-855A or CMS-855B directly to the intermediary/carrier. The intermediary/carrier will send a copy of the Form CMS-855A or CMS-855B to the SA/RO when it has completed its verification. In certain situations, based on the review of a submitted Form CMS-855A or CMS-855B, the intermediary/carrier may suspect that a CHOW has occurred that the RO may not be aware of. In these cases, the intermediary/carrier may notify the State survey agency and RO and request a determination. The intermediary/carrier will send a letter to the State survey agency and RO, along with a copy of the Form CMS-855 or CMS-855B and any supporting documentation. The RO will determine whether a CHOW has actually occurred and report its findings to the intermediary and the State survey agency. 2005F - Voluntary Terminations (Rev. 201, Issued: 06-19-20, Effective: 06-19-20, Implementation: 07-27-20) A provider agreement may be voluntarily terminated in accordance with the regulations at 42 CFR §489.52. The provider must send written notice of its intention, a letter on letterhead with an authorized signature, to its RO or SA within the timeframes addressed in §489.52. Suppliers must provide notice in accordance with the regulatory requirements specific for the supplier type. Additionally, a provider/supplier must properly complete and submit the applicable Form CMS-855A or CMS-855B to the MAC. If the provider/supplier sends the Form CMS- 855A or CMS-855B for voluntary termination directly to the MAC, then the MAC will notify the RO and SA via email within three days from the receipt of the completed form. NOTE: In a change of ownership situation, the rejection of automatic assignment of the existing provider/supplier agreement (by the new owner) is a voluntary termination of the agreement/approval, including its associated CCNs, in accordance with 42 CFR 489.52. Further, if the new owner rejects automatic assignment of the acquired facility’s existing provider/supplier agreement, and that facility previously was deemed to meet the applicable conditions based on its accreditation under a CMS-approved Medicare accreditation program, the accrediting organization (AO) may not “extend” the facility’s prior deemed status to the new owner. Instead, the AO must conduct a full initial accreditation survey of the facility under its new ownership after the acquisition date. The effective date of the new owner’s Medicare provider agreement or supplier approval is established in accordance with the provisions of 42 CFR 489.13. For complete information on CHOWs, see SOM 3210. NOTE: A cessation of business is a voluntary termination under 42 CFR 489.52(b)(3).