CMS Revisions to Hospital State Operations Manual Appendix A

PUBLISHED: Sep 12, 2017
Relevant to: Hospitals

The Centers for Medicare and Medicaid Services recently issued a memorandum clarifying guidance under Appendix A of the State Operations Manual (SOM) about how it determines when a facility qualifies as a hospital.

According to the memorandum:

  • The Social Security Act, (the Act) Section 1861(e) defines the statutory definition of a hospital.
  • A hospital is primarily engaged in providing inpatient services under section 1861(e)(1) of the Act when it is directly providing services to inpatients.
  • In order to qualify for a provider agreement as a hospital under Medicare and Medicaid, an entity must meet and continue to meet all of the statutory provisions of §1861(e) of the Act.
  • A hospital must have inpatients at the time of survey in order for surveyors to directly observe the actual provision of care and services to patients, and the effects of that care.
  • The use of benchmarks for average daily census (ADC) and average length of stay (ALOS) data for the hospital will be two factors, in addition to other factors, utilized to determine if the hospital is primarily engaged

CMS has the final authority to determine whether or not a facility has met the statutory definition of a hospital after considering the facility’s entire situation, the recommendations of the State Agency surveyors as well as the evidence submitted by the State Agencies and Accreditation Organizations. A facility that meets State requirements for obtaining State status as a hospital is not automatically considered a hospital for federal survey and certification purposes without further evaluation and consideration of all relevant CMS requirements. In addition, approval by the Medicare administrative contractor of an enrollment application does not convey hospital status for CMS purposes. Hospital status is only conveyed and approved by the CMS Regional Offices after a survey has been completed and the results clearly demonstrate that the facility has met all the federal requirements, including the statutory definition.

Please see the memorandum, link provided below, for additional information.

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