CHA News Article

CMS Clarifies Guidance Under Appendix A of State Operations Manual
Includes definition of hospital

The Centers for Medicare & Medicaid Services (CMS) has released Survey & Certification Memo 17-44, which revises guidance released in September on the definition of a hospital under the Social Security Act and requirements for qualifying as a hospital under Medicare and Medicaid provider agreements. Hospitals with a low average daily census are encouraged to carefully review this guidance. CMS’ changes apply to its Conditions of Participation surveyor guidance under State Operations Manual, Appendix A (Hospital Interpretive Guidelines) and are intended to help providers determine whether they meet key requirements. The revised guidance addresses questions the agency received since the memo’s first release.

According to CMS:

  • 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.
  • 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 Section 1861(e) of the Act, including the Conditions of Participation requirements.
  • 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 and average length of stay data for the hospital, in addition to other factors, will be utilized to determine if the hospital is primarily engaged in providing inpatient services.

CMS recently held a provider call addressing this information; resources from that call, including a recording and presentation, are available online