Effective Date of Provider Agreement, Form CMS-1561, and

2780 - Effective Date of Provider Agreement, Form CMS-1561, and Supplier Approval (Rev. 123, Issued: 10-03-14, Effective: 10-03-14, Implementation: 10-03-14) The effective date of participation in the Medicare program, i.e., of the provider agreement or supplier approval issued by the RO, may not be earlier than the date on which the provider or supplier meets all Federal requirements. See Section 2008D for discussion of Federal requirements. While the on-site initial certification survey is often the final Federal requirement that is met, this is not always the case. For example, when the applicant has not submitted required Office of Civil Rights documentation prior to the survey, the determination of compliance with the requirements of the Office of Civil Rights may be the final requirement that is met and thus be the effective date of the provider agreement or supplier approval. Another example may be if the MAC verification inadvertently occurred after the onsite survey was conducted or, for HHAs, when the second MAC review requires additional information for verification of the information, then the effective date would be on that date. 2780A - Compliance with All Federal Requirements (Rev. 123, Issued: 10-03-14, Effective: 10-03-14, Implementation: 10-03-14) The agreement is effective on the date the onsite survey is completed if, on the date of the survey the entity not only meets all Federal health and safety standards, i.e., the CoPs, CfCs or Requirements (for SNFs), but also has met all other applicable Federal requirements for Medicare participation. 2780B - All Health and Safety Standards Are Not Met on the Day of the Survey (Rev. 123, Issued: 10-03-14, Effective: 10-03-14, Implementation: 10-03-14) If on the initial certification survey the provider or supplier does not meet all applicable health and safety standards, then, assuming all other Federal requirements have been met, the effective date of the Medicare agreement would be: • For SNFs, the date the SNF has been found to be in substantial compliance with the requirements for participation, and, if applicable, has submitted an approvable waiver request. (See 42 CFR 488.301.) • For non-long term care providers/suppliers, the date when the provider/supplier has: • Met all applicable conditions, i.e., has no deficiency citations; or • Has been found to be in substantial compliance, but has standard-level deficiencies and the SA or AO has received an acceptable plan of correction (POC) and/or CMS receives an approvable waiver request. If a provider or supplier submits both a POC and an approvable waiver request, the later of the dates of the two submissions would be the effective date. • Effective dates of Medicare participation for NFs requesting to participate in the Medicare program as SNFs can be any date during the certification period as long as the provider is in substantial compliance with all requirements and if applicable, have an approved waiver. • For Medicaid-only facilities, the SA determines whether the PoC is acceptable and whether waiver requests for ICFs/IID are approvable. LSC waivers for Medicaid NFs require the RO’s approval. Retroactive SA certifications of compliance with health and safety standards or AO accreditation decisions prior to the survey end date are not permitted under any circumstances.