RO Review of SA Certifications

2777 - RO Review of SA Certifications (Rev. 1, 05-21-04) 2777A - Medicaid-Only Certifications (Rev. 123, Issued: 10-03-14, Effective: 10-03-14, Implementation: 10-03-14) With the exception of State-operated NFs, which are certified by CMS, the SA completes all Medicaid-only certifications and forwards them to the State Medicaid agency (SMA) within 45 days after the survey. The SMA initiates appropriate action based on the SA’s certification of the Medicaid-only provider. After this action is completed, the SMA forwards the case (with the exception of Form HHS-441, Assurance of Compliance with the Department of Health and Human Services Regulations under Title V of the Civil Rights Act of 1964, or a comparable form, which is submitted to the applicable Regional Office of Civil Rights) to the SA for entry into the ASPEN system. Before the initial certification is entered into the ASPEN system, the SA assigns a CCN to the NF, hospital or ICF/IID. The ASPEN system screens the facility’s current compliance record for Conditions of Participation (CoPs), Requirements (for NFs), and other RO flags. 2777B - State-Operated Medicaid NFs (Rev. 1, 05-21-04) These facilities are certified by the CMS RO. 2777C - Medicare Certifications (Rev. 1, 05-21-04) The SA must certify participating providers and suppliers of services and forward the certification to the RO within 45 days after the survey. The RO reviews all initial SA certifications when received. The SA enters routine recertification cases into the OSCAR system. The OSCAR system screens the facilities’ current certification compliance records for CoPs, Requirements for SNFs, and other RO flags that are out of compliance. If there is a deficiency in one or more of these requirements, the OSCAR system may notify the SA to forward the case to the RO for additional review. The SA retains unflagged certification documents. Exhibit 164 is a suggested checklist that the RO certification specialist may use as a guide to review certification kits received from the SA. The RO modifies the checklist to suit changing needs or variances. 2777D - Change in Certification (Rev. 123, Issued: 10-03-14, Effective: 10-03-14, Implementation: 10-03-14) 2777D1 - Medicaid NF and Medicaid Distinct Part NF Providers Seeking to Participate as Medicare SNF providers (Rev. 123, Issued: 10-03-14, Effective: 10-03-14, Implementation: 10-03-14) When Medicaid NF and Medicaid distinct part NF providers wish to participate as Medicare SNF providers, the SA sends the most recent survey information obtained during the latest Medicaid survey along with other documentation required for an initial Medicare certification of a SNF (Exhibit 63) to the RO for official determination of whether to approve the facility and enter into a provider agreement. If these documents provide adequate evidence that the facility is in compliance with the requirements governing program participation, the RO notifies the provider of the effective date of Medicare participation. The effective date is the date requested by the provider, but cannot be earlier than the date the request is filed with the RO or the SA. The requesting facility must sign a Medicare provider agreement, which will be in effect concurrently with its present Medicaid agreement. The facility will be surveyed for both programs at the end of the current period of Medicaid certification. A facility may increase its Medicare distinct part by converting Medicaid NF beds to Medicaid/Medicare SNF/NF beds without a survey. In expanding a distinct part, providers must adhere to distinct part organizational requirements and accounting principles. 2777D2 – Medicare- and Medicaid-Participating Hospitals Seeking to Become Medicaid-Only Hospitals (Rev. 123, Issued: 10-03-14, Effective: 10-03-14, Implementation: 10-03-14) When a hospital that dually participates in Medicare and Medicaid wishes to voluntarily terminate its Medicare provider agreement, but continue to participate in Medicaid only, it must provide written notification to the SA and submit a completed Form CMS-855A to the MAC as required in Chapter 15, Section 10 of the Program Integrity Manual, Publication 100-08. In terms of survey and certification, voluntary terminations of the Medicare provider agreement will be processed in accordance with SOM Section 3046. A Non-deemed hospital will be surveyed at the time it ordinarily would have been subject to a recertification survey had it continued to participate in Medicare. In the case of a deemed hospital, it will be surveyed by its CMS-approved AO when its current accreditation is due for renewal. 2777D3 - Medicaid-Only Hospitals Seeking to Participate in Medicare and Medicaid (Rev. 123, Issued: 10-03-14, Effective: 10-03-14, Implementation: 10-03-14) When a Medicaid-only hospital wishes to participate in both Medicare and Medicaid, it must submit a Form CMS-855A to the MAC. After receipt of the MAC’s recommendation to approve the hospital’s enrollment in Medicare, the SA sends the survey findings from the most recent Medicaid survey and its certification of Medicare CoP compliance or noncompliance based on that survey, along with other documentation required for an initial Medicare certification (see Exhibit 63), to the RO. The RO determines whether or not to approve the hospital for Medicare participation and enter into a provider agreement. In the case of a Medicaid-only deemed hospital, after receipt of the MAC’s recommendation for approval, the hospital must notify its CMS-approved AO of its application to change its status from a Medicaid-only hospital to a Medicare- and Medicaid (dually)–participating hospital. The hospital must request the AO to send the most recent survey report to the RO. The RO determines whether or not to approve the hospital for Medicare participation and enter into a provider agreement. The RO has the option of requiring a new full, standard survey if it has concerns based on the most recent Medicaid survey findings. • If the RO determines there is substantial compliance with Medicare participation requirements based on the most recent Medicaid survey, it determines the effective date in accordance with 42 CFR 489.13, retires the previously issued Medicaid-only hospital CCN number and issues a Medicare CCN along with the signed Medicare provider agreement. The Medicare participation effective date may be the date requested by the provider, but cannot be earlier than the date the CMS 855A was approved by the Medicare Administrative Contractor (MAC) or, if there are other applicable federal requirements, the date on which all federal requirements were met. See Section 2780 concerning the effective date of the Medicare agreement. The Medicare provider agreement is in effect concurrently with the Medicaid agreement. The facility will be surveyed for both programs at the end of the current period of Medicaid certification. In the case of Medicaid-only deemed hospitals, when the AO surveys the hospital when the accreditation is due for renewal, it follows the standard process for notifying CMS of accreditation and recommendation of continued Medicare deemed status. • If the RO requires a new full, standard survey and that survey indicates substantial compliance, the RO determines the effective date in accordance with 42 CFR 489.13. The Medicare participation effective date cannot be earlier than the date the survey was completed or, if applicable, the date an acceptable plan of correction was received. See Section 2780 concerning the effective date of the Medicare agreement. If the survey indicates noncompliance, the RO denies the hospital’s Medicare certification application. See Section 2005A2 for the process related to a denial. The SA must also advise the State Medicaid Agency of the substantial noncompliance.