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Provider-Based Status Background Information
Delay in the Expiration Date for Grand-fathered Entities
The April 7, 2000, Federal Register established that any facilities or organizations that were "treated" as provider-based in relation to any hospital or critical access hospital (CAH) on October 1, 2000, would continue to be treated as such until October 1, 2002. "Treated" includes those entities with formal Centers for Medicare and Medicaid Services (CMS) determinations and those without formal CMS determinations that were billing and being paid as provider-based as of October 1, 2000. This means that those facilities and organizations that were considered "grand-fathered" could retain that provider-based status without meeting the criteria in the existing regulations until October 1, 2002.
On October 1, 2002, the statutory moratorium regarding the application of these criteria to the grand-fathered facilities, was to expire. However, CMS issued an additional delay in the effective date. The delay was to allow hospitals and other facilities the time they need to make contractual and organizational changes to comply with the new rules. This delay means these grand-fathered facilities continued to be considered provider-based in relation to the parent hospital or critical access hospital until the start of the hospital's first cost reporting period that began on or after July 1, 2003.
Implementation Date for "Non-Grand-fathered" Facilities
Note that if an entity was not a "grand-fathered" facility or organization, the responsibilities of the existing regulations became effective on the first day of the hospital's cost reporting period that began on or after January 10, 2001. The above delay did not apply to providers that did not meet the grandfather clause. These facilities could however follow the regulations pertaining to the voluntary attestation process that became effective October 1, 2002. Providers that were not included in this grandfather provision had to comply with the "immediate vicinity" requirements of the existing regulations or the alternative 75/75 test, as well as the other requirements identified in the April 7, 2000, Federal Register. These requirements varied based on whether the facility was located on campus or off campus.
General Information
The provider-based rules do not apply to specific services; rather these rules apply to facilities as a whole. That is, the facility in its entirety must be a subordinate and integrated part of the main provider. A provider may attest in a single application package, that each one of its facilities in which it intends to bill for services as if the facility is provider-based, meets the applicable provider-based rules under Section 413.65. For those facilities that are located on campus, documentation is not required to be submitted with the attestation, unless subsequently requested by the Fiscal Intermediary or CMS. However, for those facilities located off campus, if the provider chooses to submit an attestation, supporting documentation must be submitted. The Cahaba Provider-Based Attestation Statement contains a listing of the required documentation.
As stated above, the voluntary attestation process became effective October 1, 2002. In the case of grand-fathered facilities, this process was effective at the start of the provider's first cost reporting period that began on or after July 1, 2003.
Additional Section Links
- Provider Enrollment Introduction
- About Medicare Provider Enrollment
- Provider Enrollment Packet
- Provider Enrollment Frequently Asked Questions
- Provider-Based Status Determinations
- Provider-Based Status Background
- Electronic Funds Transfer (EFT)
Page last updated: May 7, 2008
