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State Operations Manual (SOM) Chapters 1, 2 & 3 Selected Updates: Medicare Effective Date Determination for Initial Applicants; Survey & Certification Process for Initial Medicare Applicants; Medicaid-only Hospitals; & Deemed Providers/Suppliers
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Medicare Agreement Effective Date: Section 2008D is being revised to conform more clearly to the governing regulation at 42 CFR 489.13. (See also SC-11-04 and SC-13-60). Survey Process after Denial of Initial Application: Section 2005 has been revised to reflect the following: an applicant who is denied certification by the Centers for Medicare & Medicaid Services (CMS), based on a finding of substantial noncompliance from the initial survey, may reapply for certification. However, the applicant may submit no more than two reapplications for certification in connection with one enrollment application, and no more than six months may elapse between the date of the CMS Regional Office’s (RO’s) first denial and the RO’s receipt of the second reapplication. Applicants who reapply for certification must undergo a subsequent survey. •Hospital Initial Applicant - at State Survey Agency (SA) or accrediting organization (AO) discretion, the subsequent survey may be focused survey. This same approach may also be used for initial Critical Access Hospital (CAH) conversion surveys. •Applicants subject to the Life Safety Code (LSC) – if the applicant was in substantial compliance with the LSC on the initial survey, at SA or AO discretion compliance with the LSC does not have to be reassessed. The RO retains the authority in the above types of cases to require another full survey and should promptly notify the SA or AO if it intends to require a full survey. For all other cases a survey subsequent to a reapplication for certification must always be a full survey. Medicaid-Only Hospitals are not required to enroll in Medicare but must meet Medicare participation requirements: Most hospitals choose to participate in both the Medicare and Medicaid programs, but a small number participate in Medicaid only. Various SOM sections, including Sections 2053, 2777, 2779, 3005 and 3008 have been revised to update provisions concerning Medicaid. New procedures for handling a Medicaid-only hospital include: •SA role in determining if the hospital meets Medicare requirements; •Assigning Medicaid-only CMS Certification numbers (CCNs) within the classification system, including in the Automated Survey Process Environment (ASPEN). •The role of State Medicaid Agencies (SMAs) and ROs. Multiple provisions of the SOM related to accreditation have been clarified.