Administrative Review/Offsite Investigation (for Nursing

5075.5 - Administrative Review/Offsite Investigation (for Nursing Homes and Deemed and Non-Deemed Non-Long Term Care Providers/Suppliers) (Rev. 243; Issued: 06-12-26; Effective: 06-12-26; Implementation: 06-12-26) Nursing Homes The SA conducts the review/offsite investigation and may confirm the findings at the next on-site survey. Offsite investigations are rare and are not permitted unless approved in advance by CMS. For example, if a complaint is received related to arbitration agreements, prohibition on third party guarantee of payment, or prohibition on charges for services covered under Medicaid, CMS may approve an offsite review of these or other documents to assess compliance and cite noncompliance and require corrections, as necessary. Non-long Term Care Providers/Suppliers For non-long term care providers/suppliers, both deemed and non-deemed, administrative review or offsite investigation is generally not permitted. Exceptions are usually limited to the following types of cases: • CMS location review of alleged noncompliance with provider agreement requirements found in 42 CFR Part 489, such as: • Alleged discrimination against Medicare beneficiaries, or • Failure of a hospital to accept Medicare-like payment rates for treatment provided to a patient referred by an Indian Health Service or tribal facility. • CMS location review in the case of a CAH: • Of a notice by the MAC of failure of a CAH to maintain an average annual per patient length of stay not exceeding 96 hours, or • Whether a relocating CAH or an existing hospital seeking to convert to CAH status satisfies the CAH location requirements. The CMS location documents in the provider/supplier file the results of such administrative review or offsite investigation. Note: depending on CMS location practice, such administrative review cases may or may not be entered into iQIES.