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This page provides basic information about being certified as a Medicare and/or Medicaid hospital provider and includes links to applicable laws, regulations, and compliance information. A hospital is an institution primarily engaged in providing, by or under the supervision of physicians, inpatient diagnostic and therapeutic services or rehabilitation services. The State Survey Agency evaluates each general hospital as a whole for compliance with the Medicare requirements and certifies it as a single provider institution including all components: - Under the legal control of the hospital governing body and part of the same corporation or governmental administrative entity; and
- Subject to the direction of the hospital administrator and medical staff organization.
The State Survey Agency evaluates and certifies the whole hospital even when the components are separately housed. It is not permissible to certify only part of a general hospital. However, the following are not considered parts of the hospital and are not to be included in the evaluation of the hospital's compliance: - Components appropriately certified as other kinds of providers or suppliers. i.e., a distinct part Skilled Nursing Facility and/or distinct part Nursing Facility, Home Health Agency, Rural Health Clinic, or Hospice; and
- Excluded residential, custodial, and non-service units not meeting certain definitions in the Social Security Act.
Accredited Hospitals - A hospital accredited by the Joint Commission or AOA is deemed to meet all Medicare requirements for hospitals (except the requirements for Utilization Review, the special conditions for psychiatric hospitals, the Skilled Nursing Facility Requirements for swing-bed designation, and any higher-than-national standards approved by the Secretary. When notified that a participating hospital has been accredited, the State Survey Agency verifies the accreditation, removes the hospital from future resurvey schedules, and discontinues any follow-up on deficiencies. If Condition-level deficiencies still exist, the State refers the matter to the CMS Regional Office. Surveyors assess the hospital's compliance with the Medicare Conditions of Participation (CoP) for all services, areas and locations in which the provider receives reimbursement for patient care services billed under its provider number. Although the survey generally occurs during daytime working hours (Monday through Friday), surveyors may conduct the survey at other times. This may include weekends and times outside of normal daytime (Monday through Friday) working hours. When the survey begins at times outside of normal work times, the survey team modifies the survey, if needed, in recognition of patients' activities and the staff available. All hospital surveys are unannounced. - Should an individual or entity (hospital) refuse to allow immediate access upon reasonable request to either a State Agency or CMS surveyor, the Office of the Inspector General (OIG) may exclude the hospital from participation in all Federal healthcare programs.
- The CMS State Operations Manual (SOM) provides CMS policy regarding survey and certification activities.
Death Reporting Requirements - Previously, hospitals were required to report to CMS only those patient deaths that occurred while the patient was restrained or in seclusion for behavior management, or where it was reasonable to assume that a patient's death was the result of restraint or seclusion used for behavior management. Now, key reporting provisions at 42 CFR 482.13(g) of the Patients' Rights Final Rule, published December 8, 2006 (71 FR 71378) specify that: 1. Hospitals must report the following information to CMS: - Each death that occurs while a patient is in restraint or seclusion.
- Each death that occurs within 24 hours after the patient has been removed from restraint or seclusion.
- Each death known to the hospital that occurs within one week after restraint or seclusion where it is reasonable to assume that use of restraint or placement in seclusion contributed directly or indirectly to a patient's death. "Reasonable to assume" in this context includes, but is not limited to, deaths related to restrictions of movement for prolonged periods of time, or death related to chest compression, restriction of breathing, or asphyxiation.
2. Each death must be reported to CMS by telephone no later than the close of business the next CMS business day following knowledge of the patient's death. 3. Hospital staff must document in the patient's medical record the date and time the death was reported to CMS. See the downloads section below for the Patient's Rights Final Rule that includes more information on the hospital death reporting requirements related to restraint and seclusion.
Page Last Modified: 10/06/2008 3:13:39 PM
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