CHOW of Providers and Suppliers

3210 - CHOW of Providers and Suppliers (Rev. 1, 05-21-04) Regulations covering CHOWs are at 42 CFR 489.18(ff). The initial development of facts concerning a CHOW is made by the FI via the 855 process (see §2005.E). The FI sends the SA its recommendations and a final 855. After the SA concludes its fact-finding, it forwards the findings, with supporting documentation, to the RO with its recommendations for determination. When a provider undergoes a CHOW, the provider agreement is automatically assigned to the new owner unless the new owner rejects assignment of the provider agreement. If the new owner rejects this assignment, the provider organization will not be able to participate in the Medicare program without going through the same process as any new provider, i.e., enrolling with the FI, applying for participation, undergoing Office of Civil Rights (OCR) clearance and an initial survey, having an effective date of participation assigned based upon regulation, etc. Automatic assignment of the existing provider agreement to the new owner means the new owner is subject to all the terms and conditions under which the existing agreement was issued. Terms and conditions include, but are not limited to: 3210A - Existing PoC (Rev. 1, 05-21-04) The new owner must meet the timeframes for correcting deficiencies cited in the existing PoC. A CHOW is not a basis for extending the time given for correction. Documented evidence of effort and progress, and the absence of jeopardy to patient health and safety remain the only acceptable reasons for giving additional time for correction of deficiencies. 3210B - Compliance With Health and Safety Standards (Rev. 1, 05-21-04) Assignment of an existing provider agreement assumes that a CHOW will have no adverse effect on patient health and safety. Consequently, a survey may not be required. If, however, there is any indication that patient care has deteriorated following a CHOW, the State must conduct a survey. If such a survey indicates noncompliance, the RO applies the enforcement action that is applicable to the provider/supplier type and appropriate to the level of noncompliance. 3210C - Compliance With Ownership and Financial Interest Disclosure Requirement (Rev. 1, 05-21-04) Follow the guidance provided in §2005.F concerning enrollment and completion of the Form CMS-855. 3210D - Compliance With Civil Rights Requirements (Rev. 1, 05-21-04) The RO notifies the OCR-RO of CHOWs of providers. Assignment of the existing provider agreement is not withheld pending civil rights clearance, and a new agreement can be issued before clearance by the OCR-RO is obtained. However, under these circumstances, a restricted provider agreement is issued with a contingency clause that states that if OCR clearance is not obtained, any payments made during the period will be recouped from the facility as of the effective date of the CHOW. 3210E - All Medicare Sanctions and Penalties (Rev. 1, 05-21-04) Medicare sanctions and penalties are assigned to the new owner with the following exceptions: 1 - NATCEP The restrictions preclude a State from approving (and requiring a State to withdraw from) Nurse Aide Training and Competency Evaluation Programs (NATCEPs/CEPs) offered by or in facilities that, within the previous two years, have been found to be out of compliance with certain CoPs. If there is a CHOW before such a 2-year restriction has run its course, whatever remains of the 2-year period will not be transferred to the new owner. 2 - Money Owed in Fraud Cases The new owner is not responsible for money owed the Federal Government due to a determination that the previous owner is personally guilty of fraud. (However, if a determination of fraud is made against the corporation, and if the corporation is purchased and not incorporated as a new and separate corporation by the new owner, the new owner is subject to all Medicare penalties, sanctions, and liabilities.)