RO Verifying Continued Compliance With Exclusion Criteria

3112.2 - RO Verifying Continued Compliance With Exclusion Criteria by Currently Excluded Hospitals or Units (Rev. 1, 05-21-04) 3112.2A - Self-Attestation Procedures for PPS-Excluded Hospitals and Units (Rev. 1, 05-21-04) 1. Rehabilitation Hospitals/Units and Psychiatric Units - Annual verification surveys for all previously excluded rehabilitation hospitals and units, and psychiatric units are no longer required. The new procedures is as follows: o At least 120 days prior to the beginning of the next cost reporting period, SAs provide (see Exhibit 126) excluded rehabilitation hospitals/units and psychiatric units with the attestation statement (Exhibit 127) and the appropriate Criteria Worksheet, Form CMS-437, 437A, or 437B; o Hospital/unit officials complete and sign the attestation statement and the appropriate Worksheet and return them to the SA no later than 90 days before the beginning of the next cost reporting period; and o After receiving the hospital/unit’s self-attestation materials from the SA, the RO notifies the hospital/unit (see Exhibit 193) that recertification has been approved. • Previously excluded hospitals/units are required to report any change in operations (e.g., expansion or downsizing) to the appropriate CMS RO and to provide the SA with a copy of the report within 10 days after the change occurs; • The SA conducts annual validation compliance surveys at excluded hospitals/units; • SAs continue to conduct complaint surveys at excluded hospitals/units; • SAs continue to conduct first-time verification surveys in connection with a hospital/unit’s first exclusion from PPS; and • FIs continue to verify, on an annual basis, compliance with the 75 percent rule (see 42 CFR 412.23 through 412.30) for rehabilitation hospitals and units. 3112.2B - RO Verifying Exclusion Eligibility of Other Facilities (Rev. 1, 05-21-04) 1. Currently Certified Psychiatric Hospital - A hospital currently participating in Medicare and identified by its provider number as a psychiatric hospital is excluded from PPS and is not required to make any special requests for exclusion. 2. Children’s Hospital - A hospital is an excluded children’s hospital if it has in effect an agreement to participate as a hospital, and if the majority of its inpatients are individuals under the age of 18. The determination is based on the hospital’s most recently filed cost report. If there is an indication that the age of the patient population has changed since the close of the period covered by the report, the RO uses data for the prior 6-month period, asking the servicing intermediary to verify whether the age criterion has been met (i.e., whether the majority of the hospital’s inpatients are individuals under the age of 18). This may be based on the intermediary’s knowledge of the provider, or based on a separate contact. 3. Long-term Hospitals - A hospital is an excluded long-term hospital if it has in effect an agreement to participate as a hospital and if the average inpatient length of stay is greater than 25 days. The RO bases its determination on the hospital’s most recently filed cost report. If there is an indication that the length of stay has changed since the close of the period covered by the report, use data for the prior 6-month period, asking the servicing intermediary to verify whether the length of stay criterion has been met (i.e., whether the average length of stay is in excess of 25 days). Rehabilitation hospitals meeting the length of stay criterion as a long- term hospital are eligible for a long-term hospital exclusion from PPS and do not have to meet the special criteria established for these categories of facilities. 4. The “hospital-within-hospital” criteria described in §3112.1 apply to all long-term hospitals with cost reporting periods beginning on or after October 1, 1995. If the RO becomes aware of any long-term hospital operated in a building or campus occupied by another hospital, the hospital must be in compliance with the criteria. 5. Cancer Hospitals - The RO verifies through contact with the Center for Medicare Management, that the hospital continues to be designated as a cancer hospital.