CHOWS Involving Multi-Regional Chain Organizations

3210.3 - CHOWS Involving Multi-Regional Chain Organizations (Rev. 24, Issued: 01-26-07; Effective: 10-01-05; Implementation: 01-26-07) When a CHOW involves a multi-regional chain organization, a lead or coordinating RO is designated. For certification purposes, this will typically be the RO serving the State in which the headquarters of the chain is located. The coordinating RO will notify all affected ROs of its lead role, make a CHOW determination that is uniform for all regions, and notify all affected ROs of the determination. Exceptions to the lead RO procedure can occur. In an example involving 100 commonly- owned hospitals in eight regions, not all of the transactions met the definition of a CHOW under the regulations. Many of the transactions required individual, detailed analysis. In this case, no coordinating RO was designated because no uniform circumstances existed. In any situation in which the RO believes a coordinating RO may need to be designated, CO must be contacted for guidance. New providers that belong to CMS-recognized chains have the option of being assigned to the local designated FI or to the FI that serves the chain home office. The CORFs, CMHCs, OPT facilities, rehabilitation facilities, and ESRD facilities will be assigned to the local designated FI. This group of providers will also not be able to become chain organizations or receive single FI status. However, some exceptions have been made for ESRD facilities. Exceptions are made on a case-by-case basis where the ESRD provider makes a compelling argument that to become a chain organization or have single FI status would be in the best interests of the Medicare program.