SA Evaluation of Compliance

2734 - SA Evaluation of Compliance (Rev. 1, 05-21-04) A qualified surveyor (see §4009) who participated on the survey is expected to coordinate the survey team’s compilation of all information required to complete the certification and is responsible for completing all official reports of survey findings. Survey findings, per se, are not certifications. However, they determine the type of the certification recommendation made. The SA director or his/her designee makes certifications. Thus, compliance with program requirements is an official finding made by or for the SA director. 2734A - Conditions for Certifying Compliance (Rev. 1, 05-21-04) 1 - Medicare, Medicaid and CLIA Participants A participating provider cannot participate in a program, and a supplier’s service cannot be covered, unless it is in compliance with each of the applicable CoPs, Conditions of Coverage, or substantially in compliance with the requirements for SNFs/NFs. 2 - Certifying Compliance Based on Acceptable PoC Certifying compliance based on an acceptable PoC indicates that the CoPs, or Conditions of Coverage are substantially met, the provider has submitted an acceptable PoC and/or request for an approvable waiver, if needed, and is able to furnish adequate care which does not jeopardize the health and safety of patients and residents during the time period that the corrections are taking place. (See §7300 for SNFs/NFs.) If the provider/supplier submits a PoC and/or a request for an approvable waiver, the SA evaluates whether the corrective action will result in compliance within a timeframe acceptable to CMS or the SA, which is usually 60 calendar days. (See §2728 for acceptable PoCs.) The PoC may include the provider’s/supplier’s objections to the cited deficiencies. A health or LSC waiver is granted only in accordance with the regulations on the premise that patient/resident health and safety are adequately safeguarded. 2734B - Certifying Noncompliance (Rev. 1, 05-21-04) The SA certifies noncompliance based on a provider or supplier’s: • Failure to meet the CoPs, Conditions of Coverage, or substantially meet the Requirements for SNFs and NFs; or • Inability or refusal to submit an acceptable PoC for any other unmet requirement. Following a certification of noncompliance, the SA follows the procedures for denial, termination, or denial of payment in §§3000-3040 or Chapter VII for SNFs/NFs.