RO Procedures for Exclusion from PPS for Hospitals and Units

3112 - RO Procedures for Exclusion from PPS for Hospitals and Units (Rev. 1, 05-21-04) For initial exclusion from PPS, hospitals (except those now certified as psychiatric hospitals) and hospital units that meet the criteria of this section have been instructed in the Provider Reimbursement Manual to notify the RO of their eligibility for exclusion. Notification should be in writing and include the following: name of hospital, type of hospital/units, address, current provider identification number, name of contact person, FI, and a statement that the hospital/units(s) meets the criteria for exclusion. Notification should be made, where possible, no later than 5 months before the date the hospital becomes subject to PPS. Hospitals and units that have already been excluded from PPS need not reapply for exclusion. These facilities will be reevaluated based on the criteria described in §3112.2 to determine if they still meet the PPS exclusion criteria. If the RO does not receive notification of a hospital/unit meeting the criteria of this section but has knowledge that it should be excluded, the RO identifies the hospital/unit for exclusion. Except for currently certified psychiatric hospitals, the RO notifies the hospital and the FI, in writing, 45 days prior to the start of the cost reporting period, of the excluded status of the hospital or unit(s) and of any new provider number(s). The RO coordinates these activities very closely with the servicing intermediary of the hospital. Prior to making a decision on hospital/unit exclusion, the RO determines whether the hospital/unit meets all exclusion criteria including those criteria that are the responsibility of the servicing intermediary. PPS excluded or nonexcluded status for a hospital or hospital unit remains in effect for the entire cost-reporting period for which the determination is made. If a change in meeting applicable criteria occurs during a cost reporting period or the hospital requests exclusion after the start of its cost reporting period, the status already determined for that period will remain for the duration of the period. However, any change in status resulting from the beginning or end of a hospital’s participation in an approved demonstration project or State reimbursement control program will be effective on the date the change occurs, whether or not the date coincides with the start of a cost reporting period. A hospital may increase or decrease the space (square footage or number of beds) assigned to an excluded unit only at the start of the hospital’s next cost reporting period.