Survey Agency, State Medicaid Agency, and PRTF

2832 – Survey Agency, State Medicaid Agency, and PRTF Responsibilities & Obligations (Rev. 132; Issued: 01-16-15, Effective: 01-16-15, Implementation: 01-16-15) 2832A – Attestations State Responsibilities – The SA of the State which is surveying the PRTF inputs the initial attestation information into ASPEN, and continually thereafter. • PRTF Responsibilities – PRTFs must submit attestation statements to each SMA where they have established a provider agreement. • Attestation statements are to be submitted annually and are due on July 21st of each fiscal year. However, if July 21st occurs on a weekend or holiday, the attestation is due on the first business day following the weekend or holiday. • Attestations must include the following information: – Facility General Characteristics: name, address, telephone number of the facility, and a State provider identification number; – Facility Specific Characteristics: + Bed size; + Number of individuals currently served within the PRTF who are provided service based on their eligibility for the Medicaid Inpatient Psychiatric Services for Individuals Under age 21 Benefit (Psych under 21); + Number of individuals, if any, whose Medicaid Inpatient Psychiatric Services Under 21 Benefit is paid for by any State other than the State of the PRTF identified in this attestation letter; and + List all States from which the PRTF has ever received Medicaid payment for the provision of Psych under 21 services. – The signature of the facility director; – The date the attestation was signed; – A statement certifying that the facility currently meets all of the requirements of Part 483, Subpart G governing the use of restraint and seclusion; – A statement acknowledging the right of the SA (or its agents) and, if necessary, CMS to conduct an on site survey at any time to validate the facility’s compliance with the requirements of the rule, to investigate complaints lodged against the facility, or to investigate serious occurrences; – A statement that the facility will submit a new attestation of compliance annually and in the event a new facility director is appointed. 2832B – Plan of Correction (POC) Regulations at 42 CFR 488.28(a) allow recertification of providers with deficiencies at the Standard or Condition level “only if the facility has submitted an acceptable Plan of Correction (POC) for achieving compliance within a reasonable period of time acceptable to the Secretary.” Failure to submit a POC may result in termination of the provider agreement as authorized by §489.53(a)(1). After a POC is submitted, the certifying SMA, or in some cases the CMS Regional Office, makes the determination of the appropriateness of the POC for it to be acceptable. 2832C – Assigning CMS Certification Numbers (CCN) A CCN code is assigned based on where the PRTF is physically located. Processing of requests for payment is usually keyed to the Federal identification number; however this identification number is for Online Survey, Certification, and Reporting System (OSCAR) tracking purposes only. The certification numbers for PRTFs will have five digits and one letter. The first two digits identify the State in which the PRTF facility is located. This number is then followed by the letter L and is then followed by three digits and is numbered according to the order in which a facility was identified as a PRTF in their State. All State codes are listed in SOM §2779. For example, a PRTF located in Maryland would have a State code of “21.” This would then be followed by the letter “L” and identified with a three digit number. For example, if it was the fourth PRTF identified by the State, the PRTF’s CCN would be 21L004. (See SOM §2779B) 2832D – ASPEN Data Input • The surveying SA has the responsibility of entering the survey data into ASPEN. After the CCN is assigned to the PRTF, the SA is to enter information received from the PRTF annual attestation as well as information from recertification or complaint surveys. It is also the responsibility of the SA to update the information as needed. The SA is to input information from Forms CMS- 1539, CMS- 670, CMS-2567 and if applicable, CMS-2567B. • The initial input of information from attestation must be done by the SA of the State surveying the PRTF, even if the State in which the PRTF is located does not include the Inpatient Psychiatric Services for Individuals Under 21 Benefit in its State plan. • Maintaining attestation and survey information is the responsibility of the SA conducting complaint and validation surveys. 2832E – Multi-State Issues & Interagency Relationships 2832E.1 – State-to-State Differences There are several State-to-State differences in the provision of services for individuals who qualify for the Inpatient Psychiatric Services for Individuals Under 21 Benefit. The following factors determine where an individual receives services and who has surveying responsibilities. 1. States may or may not have the Inpatient Psychiatric Services for Individuals Under 21 benefit in their State plan. 2. States may or may not have a PRTF within its borders. 3. States have an obligation to provide inpatient psychiatric services for individuals under 21 years of age regardless of whether or not the benefit is in their State plan or a PRTF is within its borders. A State will either have the Inpatient Psychiatric Services for Individuals Under 21 Benefit in its State Plan or it will not. However, not all States will have a PRTF within its borders that can meet the needs of its Medicaid beneficiaries and thus will have to transfer beneficiaries to another State to receive the needed service. Occasionally, a SMA may elect to send a patient out of State to receive the Psych Under 21 Benefit, (reference S&C Memo of July 3, 2013: 13-45-PRTF). It is the responsibility of the transferring SMA to ensure that these services are provided in a certified PRTF. In some instances, the facility selected (i.e., receiving facility) is located in a State that does not include PRTF services in its Medicaid State Plan and thus no facilities in that State are certified as PRTFs. If the transferring SMA still wishes to transfer the patient to such a facility, it must make a written agreement for the certification of that facility prior to the patient’s transfer. The initial certification of a PRTF is currently accomplished through an attestation process. The SA, through an agreement with the SMA, conducts surveys (Recertification, Complaint Investigation, and Validation) at least every five (5) years to ensure that the facility remains in compliance with the applicable regulations and the assertions of the attestation. The SA makes a recommendation to the SMA for re-certification or termination. The SMA enters into a written agreement with the PRTF. If the certifying SMA of one State wishes to have a facility in another State certified as a PRTF, there are three options available for the SMA regarding the survey portion of the certification process: • The SMA may make a written agreement with the SA of the State in which the facility is located to conduct the surveys of the facility; • The SMA may make a written agreement with the SA located within their own State to travel to the receiving State to conduct the surveys; or • The SMA may make a written agreement with any other SA to conduct the surveys of the facility. SAs in States where the Medicaid State Plan does not include PRTF services may not have trained personnel or may not have the available resources to conduct these PRTF surveys since this is not a routine part of their workload. If the SMA of one State wishes to certify a PRTF in another State and approaches the other State’s SA to conduct the survey activity, the other SA may agree if they feel they have the necessary resources or may decline if they feel they do not. They are under no obligation to perform the work for the SMA of another State. If the SA from the State where the facility is located is not able to perform the survey activity, the SMA seeking survey of the PRTF may enter into a written agreement with any other State SA (including the SA located within in SMA’s own State) that has the resources and appropriately trained personnel. The SA that conducts the surveys would then be responsible for inputting the survey information into ASPEN. The SMA requesting the survey will ensure that the survey information is entered into ASPEN and ensure that re-certification surveys are conducted at least once every five (5) years. The SMA requesting the survey has the authority to enforce non-compliance actions. 2832E.2 – Action for Non-Compliance and Termination The SMA may take termination action against the PRTF if the SA determines the PRTF is not in compliance with the regulation or fails to appropriately report a death incident. If there are conflicting determinations between the SA and the SMA or there are conflicts that arise based on multi-state issues, then the applicable RO must be informed of the decisions. The RO will settle these conflicts before adverse findings are placed into ASPEN. In the case of multi-state issues, if the SA and the SMA are located in two different Regions, the applicable RO is defined as the RO for the state in which the SMA is located. The facility must submit their plan of correction to the SA of the State that conducted the survey. If the survey findings do not rise to the condition level, but are only standard level deficiencies, it is still the responsibility of the surveying State to send their findings to the certifying SMA and the applicable Regional Office (RO). It is the responsibility of the certifying SMA to review and accept the facility’s plan of correction. 2832E.3 – State Agency – Who Can Survey The SMA identifies which agency is responsible for conducting survey and certification oversight for its PRTFs. Federal regulation requires that the Medicaid “State plan must designate, as the State authority responsible for establishing and maintaining health standards for private or public institutions that provide services to Medicaid beneficiaries, the same State agency that is used by the Secretary to determine qualifications of institutions and suppliers of services to participate in Medicare.” (Emphasis added). (See 42 CFR 431.610(b)). During surveys to determine compliance with the PRTF condition of participation, if findings show that the condition of participation for the PRTF is not met it is the responsibility of the SMA of the State that certified the PRTF to consider termination of the provider agreement. If findings do not rise to the condition level, but are standard level deficiencies, it is still the responsibility of the surveying State to send their findings to the SMA and the applicable RO. Facilities where standard level deficiencies have been found are required to submit a plan of correction to the surveying SA.