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From Health Law Daily, February 17, 2016

Revised Medicare recertification checklist issued to state agencies

By Harold Bishop, J.D.

CMS has revised its Critical Access Hospital (CAH) Recertification Checklist: Rural and Distance or Necessary Provider Verification to include: (1) procedures for determining whether a CAH that was Medicare-certified by CMS prior to January 1, 2006, had been designated by the state agency (SA) as a necessary provider; and (2) examples of documentary evidence demonstrating necessary provider designation prior to January 1, 2006. The revised checklist is effective immediately and should be used by CMS Regional Office (RO) staff when processing CAH recertifications (CMS Letters, S&C: 16-08-CAH, February 12, 2016).

Authority. Section 1820(c)(2)(B) of the Soc. Sec. Act and CMS regulations at 42 CFR 485.610(b) and 485.610(c) require CAHs to be located in a rural area, more than a 35-mile drive, or within15 miles in areas with only secondary roads or mountainous terrain, from another hospital or CAH.

OIG recommendations. An August 19, 2013, HHS Office of Inspector General (OIG) report (OEI-05-12-00080) recommended that CMS periodically reassess CAHs’ compliance with all location-related requirements under 42 CFR 485.610. In addition, the OIG called on CMS to maintain evidence that it is routinely reevaluating the compliance of currently Medicare-certified CAHs with these status and location requirements. CMS concurred with the OIG’s recommendations and developed the checklist to facilitate these reevaluations.

Procedures. The revised procedures for verifying that a CAH that was certified prior to January 1, 2006, had been designated by the SA as a necessary provider are as follows:

  • Annually, the RO will request from each SA a list of all deemed and non-deemed CAHs expected to undergo a recertification survey over the next 12 months.
  • For deemed CAHs, the SA reviews the deemed status tab in the Automated Survey Processing Environment (ASPEN) for accreditation dates of CAHs.
  • Prior to the date of an SA or Accrediting Organization (AO) CAH recertification survey, the RO must determine whether the CAH meets the status and location requirements.
  • The RO must evaluate, determine, and document compliance with the CAH location-related Conditions of Participation by using the checklist.
  • Once the RO has made the determination that a particular CAH is in current compliance with the rural status and distance requirements, it must contact the SA/AO to advise them that a recertification or reaccreditation survey may be conducted.
  • The SA and AO may not conduct a recertification/reaccreditation survey of a CAH that does not meet the rural status and location requirements.

A CAH may request review of a CMS’ determination that the CAH is not a necessary provider if it submits supplementary evidence to the RO for CMS’ consideration within 60 days of receiving CMS notice that its CAH distance requirements have not been met. If the CAH is ultimately found to be not compliant with the rural status and distance requirements, the RO will send the CAH a letter notifying the CAH that it will be allowed time to attempt to reclassify as rural, convert to hospital status, or have its Medicare participation terminated.

Documentary evidence. Two examples of potentially qualifying evidence include, but are not limited to: (1) a letter, issued before January 1, 2006, from the appropriate state authority designating the CAH by name as a necessary provider; or (2) an edition of the State’s Rural Health Plan, published in 2005 or earlier, identifying the CAH by name as a necessary provider.

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