Accreditation
If the provider checks “Yes,” the contractor shall ensure that the listed accrediting body is one that CMS recognizes in lieu of a State survey or other certification for the provider type in question. If the accrediting body is not recognized by CMS, the contractor shall advise the provider accordingly. (Note, however, that the provider may not intend to use the listed accreditation in lieu of the State survey and merely furnished the accrediting body in response to the question.)
Section 2 of the Form CMS-855A
A. Home Health Agency (HHA) Branches, Hospital Units, and Outpatient Physical Therapy/Outpatient Speech Pathology (OPT/OSP) Extension Sites
As explained in section 15.4.1.6, a branch is a location or site from which an HHA provides services within a portion of the total geographic area that the parent company serves. The branch is part of the HHA and is located sufficiently close to the parent agency such that it shares administration, supervision, and services with the parent. If an existing HHA wants to add a branch, it is considered a change of information on the Form CMS-855A.
An HHA subunit, meanwhile, is a semi-autonomous organization under the same governing body as the parent HHA and serves patients in a geographic area different from that of the parent. Due to its distance from the subunit, the parent is incapable of sharing administration, supervision and services with the subunit on a daily basis. If the HHA wants to add an HHA subunit, it must complete an initial enrollment application for the subunit. (The subunit also signs a separate provider agreement.)
If an enrolled hospital seeks to add a rehabilitation, psychiatric, or swing-bed unit, it should submit a Form CMS-855 change of information request and not an initial enrollment application. Similarly, if an OPT/OSP provider wants to add an extension site, a change of information request should be submitted.
If the contractor makes a recommendation for approval of the provider’s request to add an HHA
branch or a hospital unit, the contractor shall forward the package to the State agency as described in this chapter. However, the contractor shall emphasize to the provider that a recommendation for approval of the branch or hospital unit addition does not signify CMS’s approval of the new location. Only the RO can approve the addition.
With respect to the Provider Enrollment, Chain and Ownership System, the contractor shall create a separate enrollment record for the hospital unit. However, a separate enrollment record for each HHA branch and OPT/OSP extension site is not required. These locations can simply be listed on the main provider’s enrollment record.
B. Critical Access Hospitals
Critical access hospitals (CAHs) are not considered to be a hospital sub-type for enrollment purposes. Thus, if an existing hospital wishes to convert to a CAH, it must submit a Form CMS-855A as an initial enrollment.
C. Transplant Centers
For purposes of Medicare enrollment, a hospital transplant center is treated similarly to a hospital sub-unit. If the hospital wishes to add a transplant center, it must check the “other” box in section 2A2 of the CMS-855A, write “transplant center” on the space provided, and follow the standard instructions for adding a sub-unit. Unless CMS indicates otherwise, the contractor shall process the application in the same manner it would the addition of a hospital sub-unit; however, no separate enrollment in PECOS need be created for the transplant center.
If the provider checks “Yes,” the contractor shall ensure that the listed accrediting body is one that CMS recognizes in lieu of a State survey or other certification for the provider type in question. If the accrediting body is not recognized by CMS, the contractor shall advise the provider accordingly. (Note, however, that the provider may not intend to use the listed accreditation in lieu of the State survey and merely furnished the accrediting body in response to the question.)
Section 2 of the Form CMS-855A
A. Home Health Agency (HHA) Branches, Hospital Units, and Outpatient Physical Therapy/Outpatient Speech Pathology (OPT/OSP) Extension Sites
As explained in section 15.4.1.6, a branch is a location or site from which an HHA provides services within a portion of the total geographic area that the parent company serves. The branch is part of the HHA and is located sufficiently close to the parent agency such that it shares administration, supervision, and services with the parent. If an existing HHA wants to add a branch, it is considered a change of information on the Form CMS-855A.
An HHA subunit, meanwhile, is a semi-autonomous organization under the same governing body as the parent HHA and serves patients in a geographic area different from that of the parent. Due to its distance from the subunit, the parent is incapable of sharing administration, supervision and services with the subunit on a daily basis. If the HHA wants to add an HHA subunit, it must complete an initial enrollment application for the subunit. (The subunit also signs a separate provider agreement.)
If an enrolled hospital seeks to add a rehabilitation, psychiatric, or swing-bed unit, it should submit a Form CMS-855 change of information request and not an initial enrollment application. Similarly, if an OPT/OSP provider wants to add an extension site, a change of information request should be submitted.
If the contractor makes a recommendation for approval of the provider’s request to add an HHA
branch or a hospital unit, the contractor shall forward the package to the State agency as described in this chapter. However, the contractor shall emphasize to the provider that a recommendation for approval of the branch or hospital unit addition does not signify CMS’s approval of the new location. Only the RO can approve the addition.
With respect to the Provider Enrollment, Chain and Ownership System, the contractor shall create a separate enrollment record for the hospital unit. However, a separate enrollment record for each HHA branch and OPT/OSP extension site is not required. These locations can simply be listed on the main provider’s enrollment record.
B. Critical Access Hospitals
Critical access hospitals (CAHs) are not considered to be a hospital sub-type for enrollment purposes. Thus, if an existing hospital wishes to convert to a CAH, it must submit a Form CMS-855A as an initial enrollment.
C. Transplant Centers
For purposes of Medicare enrollment, a hospital transplant center is treated similarly to a hospital sub-unit. If the hospital wishes to add a transplant center, it must check the “other” box in section 2A2 of the CMS-855A, write “transplant center” on the space provided, and follow the standard instructions for adding a sub-unit. Unless CMS indicates otherwise, the contractor shall process the application in the same manner it would the addition of a hospital sub-unit; however, no separate enrollment in PECOS need be created for the transplant center.
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