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 concerning provider-based status.
Source: 42 CFR 413.65
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