(Medicare General Information, Eligibility, and Entitlement)

10.1.10 - Posting of Signs in Hospital Emergency Departments   Section 6018(a)(2) of the Omnibus Budget Reconciliation Act of 1989 (OBRA 89), effective July 1, 1990, requires hospitals with emergency departments to post signs which specify the rights (under section 1867 of the Social Security Act) of women in labor and individuals with emergency medical conditions to examination and treatment.  To comply with these requirements, hospitals must post signs that meet the following criteria:    At a minimum, the signs must specify the rights of unstable individuals with emergency conditions and women in labor who come to the emergency department for health care services;    It must indicate whether the facility participates in the Medicaid program;   The wording of the sign must be clear and in simple terms understandable by the population serviced;   Print the signs in English and other major languages that are common to the population of the area serviced;   The letters within the signs must be clearly readable at a distance of at least 20 feet or the expected vantage point of the emergency department patrons; and    Post signs in a place or places likely to be noticed by all individuals entering the emergency department, as well as those individuals waiting for examination and treatment (e.g., entrance, admitting area, waiting room, treatment area).   The sample below may be adapted, contains sufficient information to satisfy these requirements, and may be adapted to satisfy the visibility requirement.  IT'S THE LAW!   IF YOU HAVE A MEDICAL EMERGENCY OR ARE IN LABOR   YOU HAVE THE RIGHT TO RECEIVE, WITHIN THE CAPABILITIES OF THIS HOSPITAL'S STAFF AND FACILITIES:   An appropriate medical SCREENING EXAMINATION   Necessary STABILIZING TREATMENT (including treatment for an unborn child)  And if necessary   An appropriate TRANSFER to another facility  Even if  YOU CANNOT PAY OR DO NOT HAVE MEDICAL INSURANCE   OR  YOU ARE NOT ENTITLED TO MEDICARE OR MEDICAID   This hospital (does/does not) participate in the Medicaid program  10.2 - Admission of Medicare Patients for Care and Treatment  (Rev. 120, Issued: 11-02-18, Effective: 12- 04-18, Implementation: 12- 04-18  The participation of a provider of services, which voluntarily files an agreement to participate in the health insurance program, contemplates that such provider will admit Medicare beneficiaries for care and treatment, and upon admission, will provide the m with such services as are ordinarily furnished by the provider to its patients generally.  A provider may have restrictions on the types of services it makes available and/or the types of health conditions it accepts, or may establish other criteria relating to the admission of persons for care and treatment.  However, the law does not contempla te that such restrictions or criteria will apply only to Medicare beneficiaries as a class.  It does contemplate, however, that if such restrictions or criteria apply to Medicare beneficiaries, they will be applied in the same manner in which they are applied to all other persons seeking care and treatment by the provider.  Thus, a provider admission or patient policy or practice which is not consistent with the objective contemplated in the law may be used by CMS as a basis for termination of the agreement for cause (see the regulations at 42 CFR 489.53(a)(2), and also see Pub. 100-04, Medicare Claims Processing Manual, chapter 1, 30.1.3).   10.3 - Under Arrangements  (Rev. 28; Issued:  08-12- 05; Effective/Implementation:  09 -12-05)  A provider may have others furnish certain covered items and services to their patients through arrangements under which receipt of payment by the provider for the services discharges the liability of the beneficiary or any other person to pay for the service. In permitting providers to furnish services under arrangements, it was not intended that the provider merely serve as a billing mechanism for the other party.  Accordingly, for services provided under arrangements to be covered, the provider must exercise professional responsibility over the arranged- for services.   The provider's professional supervision over arranged- for services requires application of many of the same quality controls as are applied to services furnished by salaried employees.  The provider must accept the patient for treatment in accordance with its admission policies, and maintain a complete and timely clinical record on the patient, which includes diagnoses, medical history, physician's orders, and progress NOTEs relating to all services received, and must maintain liaison with the attending physician regarding the progress of the patient and the need for revised orders.  In the case of home health services and outpatient physical therapy or speech- language pathology services, the provider must ensure that the required plan of treatment is periodically reviewed by the physician and secure from the physician the required certifications and recertifications.  Additionally, the provider (other than a SNF) must ensure that the medical necessity of such services is reviewed on a sample basis by the uti lization review (UR) committee if one is in place, the facility's health professional staff, or an outside UR group.  (Effective October 1, 1990, a SNF is no longer required to have a plan for UR.)  The provider, including a SNF that conducts optional UR s ervices, is responsible for medical necessity decisions made under arrangement by an outside group.   10.4 - Term of Agreements  (Rev. 28; Issued:  08- 12-05; Effective/Implementation:  09 -12-05)  An agreement with a hospital, HHA, hospice, and (for the purposes of furnishing outpatient physical therapy, occupational therapy, or speech -language pathology services) a clinic, a rehabilitation agency, or public health agency is not time limited and has  no fixed expiration date.  The agreement remains in effect until such time as there is a voluntary termination, or involuntary termination, or a change of ownership.  10.4.1 - Agreement with a SNF  (Rev. 1, 09- 11-02)  All agreements with SNFs are required to be for a specified term of up to l2 full calendar months with fixed expiration dates.  In appropriate situations, the agreement may also contain a cancellation clause.  Therefore, when it is determined that a SNF is  eligible and that its agreement for participation in the Medicare program will be accepted for filing, the term of the agreement will be determined in the following manner:   A. No Deficiencies -  If a SNF is certified as being in full compliance with all standards contained in the requirements for participation for SNFs, the term of the agreement is, as appropriate to the period of certification for it has been approved, for a ter m of up to 12 full calendar months.  B. Deficiencies -  If a SNF is certified as not being in full compliance, the term of the agreement is, as appropriate to the period of certification or conditional period of certification for which it has been approved:   1. For a term which expires no later than the close of the 60th day following the last day of the time period specified in the written plan providing for the correction of deficiencies in meeting the requirements for participation, provided that such term doe s not exceed 12 full calendar months or   2. Provide a conditional term of up to 12 full calendar months, subject to a cancellation clause that the agreement may be canceled on a predetermined date (no later than the close of the 60th day following the last day of the time period specified in the written plan providing for the correction of deficiencies in meeting the requirements for participation), provided that date will occur within the 12- month term.   If the health and safety of Medicare patients are not jeopardized, the term of an agreement may be extended for 2 full calendar months when necessary to prevent irreparable harm to the facility, to prevent hardship to Medicare beneficiaries furnished care,  or if it is impracticable within the term of the agreement to determine whether the SNF is complying with the provisions of the Act and regulations issued thereunder.   10.4.2 - Agreement with Rurhal Health Clinic (RHC)/Federally Qualified Health Clinic (FQHC)  (Rev. 1, 09- 11-02)  Agreements between RHCs/FQHCs and CMS are generally for a term of 1 year.  They may be annually renewed by mutual agreement of the RHC/FQHC and CMS, i.e., a new agreement need not be signed each year.  Special circumstances may result in a term of less tha n 1 year for an initial agreement, e.g., a clinic or center may wish the agreement year to run concurrently with the RHC/FQHC's fiscal year or have some other technical considerations.   10.5 - Responsibilities of Participating Provider  (Rev. 1, 09- 11-02)  Upon acceptance for participation, a provider becomes responsible for remaining in compliance with the terms of the agreement and the provisions of title XVIII and regulations issued thereunder.  Where the agreement is made retroactive, the provider must comply with its responsibilities as of the retroactive date.  Payment to the provider for covered items and services it furnishes on or after the effective date of the agreement will require that the provider have a recordkeeping capability sufficient for determining the cost of services furnished Medicare beneficiaries.   The termination of participation (see 10.6  of this chapter) does not immediately abrogate all of the provider's responsibilities and in specific matters a responsibility may extend beyond the effective date of termination.  For example, the provider continues to be responsible (as applicable) for those provisions of the law and regulations which provide for program coverage to remain in effect for specified periods of time beyond the effective termination date, for those beneficiaries who were accepted for care and treatment by the provider before such date.  The provider also continues to be responsible for filing a final cost report and/or the repayment of any overpayment, as these actions relate to final program cost settlement after termination.   10.6 - Termination of Provider Participation  (Rev. 1, 09-11-02)  A provider may voluntarily terminate its participation in the program or have it terminated by the Secretary for cause.    10.6.1 - Voluntary Termination  (Rev. 1, 09-11-02)  A provider may terminate its agreement (and in the case of a SNF, it may terminate its agreement prior to the close of the specified term of its agreement) by filing with the Secretary a written notice of its intention to terminate the agreement.  The Secr etary may accept the termination date stated in the notice (the date must be the first day of a month and, in the case of a SNF, must occur within the specified term of such facility's agreement) or set a different date.  However, the termination date set by the Secretary may not be more than 6 months from the date the provider's notice is filed.  10.6.2 - Involuntary Termination, Including SNF Agreement Cancellations  (Rev. 1, 09-11-02)  The Secretary may terminate an agreement (and in the case of a SNF, he/she may terminate its agreement prior to the close of the specified term of the agreement) with a provider if it is determined that the provider:   Is not complying substantially with the provisions of the agreement or with the applicable provisions of title XVIII of the Act and regulations;   No longer meets the appropriate requirements for participation;   Has failed to supply information which is necessary to determine whether payments are due or were due and the amounts of such payments; or    Refuses to permit examinations of fiscal and other records, including medical records.   The cancellation of a SNF agreement at the close of the predetermined date stated in the cancellation clause contained in such agreement (see 10.6.2 of this chapter) is viewed as an involuntary termination of the agreement by the Secretary for cause.  Such actions involve a finding that the SNF has not satisfactorily completed its written plan providing for the correction of deficiencies with respect to one or more of the standards in the applicable requirements for participation, or that the facility has not made substantial effort and progress in correcting such deficiencies.  A provider which is dissatisfied with the Secretary's determination terminating its agreement is entitled to request a hearing thereon in accordance with the appeals procedures contained in 42 CFR Part 498.  There is no reconsideration step before the opportunity for a hearing.  NOTE:   The involuntary termination of a hospital's approval authorizing it to provide extended care services, i.e., to be a swing bed facility, does not automatically result in the involuntary termination of the hospital's agreement relating to the provision of hospital services.   10.6.3 - Expiration and Renewal - Nonrenewal of SNF Term Agreements  (Rev. 1, 09-11-02)  All agreements with skilled nursing facilities are required to be for a specified term of up to 12 full calendar months with fixed expiration dates.  The agreement expires at the close of the last day of its specified term and is not automatically renewable from term to term.  When the term of an agreement is extended (see 10.6.3 of this chapter), the close of the last day of its specified term is the close of the day of the extension of the agreement.  Thus, when the term of an agreement is extended, the provider's participation in the program continues, and the agreement does not expire until the close of the last day to which it has been extended.