Waivers

2812.2 - Waivers (Rev. 111, Issued: 04-11-14, Effective: 04-11-14, Implemetation: 04-11-14) A certified hospital/CAH must enter into an agreement only with the OPO designated for the service area in which the hospital/CAH is located, unless CMS has granted the hospital/CAH a waiver under §486.308(e). A hospital/CAH may request and CMS may grant a waiver allowing the hospital to have an agreement with a designated OPO outside of its service area. To qualify for a waiver, the hospital must submit data to CMS as detailed in 42 CFR 486.308(e)(1) and (2). In making a determination on waiver requests, CMS considers the requirement under 42 CFR 486.308 (f)(1)-(4): • Cost effectiveness; • Improvements in quality; • Changes in a hospital’s designated OPO due to changes in the definition of metropolitan statistical areas, if applicable; and • The length and continuity of a hospital’s relationship with an OPO other than the hospital’s designated OPO. A hospital/CAH may continue to operate under its existing agreement with an out-of-area OPO while CMS is processing the waiver request. If the waiver is denied by CMS, the hospital/CAH must enter into an agreement with the OPO designated for its service area within 30 days of notification of the final determination as noted in §486.308(g).