skip to content
Thank you for visiting First Coast Service Options' Medicare provider website. This website is intended exclusively for Medicare providers and health care industry professionals to find the latest Medicare news and information affecting the provider community.
To enable us to present you with customized content that focuses on your area of interest, please select your preferences below:
Select which best describes you:
Select your location:
Select your line of business:
This website provides information and news about the Medicare program for health care professionals only. All communication and issues regarding your Medicare benefits are handled directly by Medicare and not through this website. Information for Medicare beneficiaries is only available on the medicare.gov website.
En Español
Text Size:
Send a link to this page
[Multiple email adresses must be separated by a semicolon.]
Last Modified: 10/2/2018 Location: FL, PR, USVI Business: Part A

Determination of provider-based status

Regulations in 42 CFR 413.65 describe the criteria and procedures for determining whether a facility or organization is provider-based. The Medicare hospital Inpatient Prospective Payment System (IPPS) final rule published on August 1, 2002, (67 CFR 50078) revised those regulations that were to become effective on October 1, 2002, for facilities or organizations that were not grandfathered as provider-based and, in the case of grandfathered facilities, effective for main provider cost reporting periods beginning on or after July 1, 2003.
If a potential main provider seeks a determination of provider-based status for a facility that is located on the main campus of the potential main provider, the provider must submit an attestation containing the identifying information described in paragraph (B)(6) above, and stating that its facility meets each of the criteria in 413.65(d). If the potential main provider is a hospital, it must also attest that its facility will fulfill the obligations of hospital outpatient departments and hospital-based entities, as described in proposed 413.65(g). The provider must maintain documentation of the basis for its attestations and make that documentation available to CMS and to its fiscal intermediary (FI) upon request.
If the facility is not located on the main campus of the potential main provider, the provider that wishes to obtain a determination of provider-based status must submit an attestation containing the identifying information described in paragraph B.6 and state that its facility meets each of the criteria in paragraph C.1 through C.4 (corresponding to regulations at 413.65(d)) as well as the additional requirements corresponding to regulations at 413.65(e). If the facility is operated as a joint venture or under a management contract, the potential main provider must also attest to compliance with the requirements in paragraph C.6 and D.5 (corresponding to 413.65(f) and 413.65(h)), as applicable. If the potential main provider is a hospital, the hospital also must attest that it will fulfill the obligations of hospital outpatient departments and hospital-based entities described in to 413.65(g). The provider seeking such a determination must submit documentation of the basis for its attestations to CMS at the time it submits its attestation.
See change request 2411 external pdf file concerning provider-based status.
Source: 42 CFR 413.65 external link
First Coast Service Options (First Coast) strives to ensure that the information available on our provider website is accurate, detailed, and current. Therefore, this is a dynamic site and its content changes daily. It is best to access the site to ensure you have the most current information rather than printing articles or forms that may become obsolete without notice.