Basis for Determining Health Insurance Relatedness of Activity

4100 - Basis for Determining Health Insurance Relatedness of Activity Costs (Rev. 1, 05-21-04) Sections 1864 and 1902 of the Social Security Act (the Act) provide the basis for agreements and plans with States under which CMS pays States for costs incurred in performing survey and certification functions The primary State function may be characterized as “certification” of health facilities, and the costs of SA activities that are an integral part of this process are appropriate for survey and certification funding. This manual discusses the procedures involved in the certification function. The criteria contained in §§4100-4109 are controlling in terms of the nature and extent of activity that may be charged to the survey and certification program within the limits of the approved budget. The operating procedures contained in Part Two outline activities that are required to support an initial certification that a facility does or does not qualify to participate in, or have their services covered under the survey and certification program, or a certification recommending continuing participation, coverage, or termination. Such activities are certification-related and are funded under the survey and certification program In those agencies where activities are performed for survey and certification only, the survey and certification program pays the entire costs. In many States, these activities serve other programs in addition to survey and certification (e.g., certification as well as licensure). When this situation exists, the SA establishes a method of determining the survey and certification share of the cost. (See §§4500-4544.) Where the SA has responsibility for performing survey-related activities under title XVIII and title XIX, establish appropriate safeguards to ensure that proper charges are made to each program and that duplicate charges are avoided.