Certifications of Additional Services

3220 - Certifications of Additional Services (Rev. 1, 05-21-04) Several categories of providers/suppliers require specific approval prior to becoming eligible to receive Medicare and Medicaid payment for certain services beyond those for which they were initially approved. The specific provider/supplier types affected by this requirement are: • HHAs; • RHCs; and • ESRD facilities. During the initial survey and resurveys, the SA advises the provider/supplier to inform it and the appropriate FI or carrier promptly in writing when an additional service is contemplated, so that it can evaluate compliance with the pertinent CoPs or Conditions for Coverage. Do not accept oral requests. When the SA is notified by the provider or supplier or the FI or carrier of the addition by the provider/supplier or learns that a service has been added, it reviews applicable documentation and, as necessary, performs a survey of the new service promptly. The SA records the results on the appropriate survey report. The only services of an HHA that when added would require a survey are OPT and speech language pathology services are when these services are provided by the HHA as a provider of outpatient physical therapy services (See 42 CFR 484.38 and §3222.) This usually does not require an immediate survey, but can be surveyed at the time of the next standard survey. 3220A - Services in Compliance (Rev. 1, 05-21-04) If a new survey is performed and the service meets the applicable Conditions, the SA recertifies the provider/supplier as continuing to meet the CoPs or Conditions for Coverage and complete Form CMS-1539. It includes an explanation in Item 17 concerning the added service and an evaluation of the new service. 3220B - Services Not In Compliance (HHAs, RHCs, and ESRD Facilities) (Rev. 1, 05-21-04) If a new service does not meet the applicable Condition(s), the SA informs the provider/supplier that it must either come into compliance or stop providing the service to avoid termination action. If the provider/supplier agrees to stop providing a service, the SA notes this action in its files and follows up within 60 calendar days to ascertain whether the service has been discontinued. If the provider/supplier is unwilling to correct or stop providing the service, the SA initiates termination action.