State Survey and Certification of Health Care Providers and Suppliers

To provide financial assistance to any State which is able and willing to determine through its State health agency or other appropriate State agency that providers and suppliers of health care services are in compliance with Federal regulatory health and safety standards and conditions of participation.
Related Programs

Examples of Funded Projects

Information relating to Federally-funded projects is available to State survey agencies upon request.


Agency - Department of Health and Human Services

The Department of Health and Human Services is the Federal government's principal agency for protecting the health of all Americans and providing essential human services, especially to those who are least able to help themselves.

Office - Contact the Regional Administrator for Centers for Medicare and Medicaid Services.

(See Appendix IV of the Catalog for listing of Regional Offices).


Program Accomplishments

The estimated figure for fiscal year 2007 is approximately 58,000 and for fiscal year 2008 is 58,500. It is estimated that grants will be provided to 53 State/territory survey agencies to conduct inspections in fiscal years 2007 and 2008.

Uses and Use Restrictions

Funds are made available to States for the purpose of inspecting providers and suppliers of health care services, to ensure mandatory adherence to Medicare/Medicaid health and safety standards and conditions.

Funds made available under this program are used to support or reimburse State staff for performing survey activities and for State administration of the program.

Eligibility Requirements

Applicant Eligibility

Under Title XVIII, States enter into Section 1864 agreements with the Secretary of Health and Human Services whereby the designated agency of the State will be supported or reimbursed for on-site inspection of health care providers and suppliers.

The designated State agency is usually that unit performing licensure activities within the State health department.

Under Title XIX, the Federal government reimburses States for the Federal Financial Participation share for costs of inspection.

Such participation is dependent on an approved State activity plan.

Beneficiary Eligibility

Under Title XVIII, States enter into Section 1864 agreements with the Secretary of Health and Human Services whereby the designated agency of the State will be supported or reimbursed for on-site inspection of health care providers and suppliers. The designated State agency is usually that unit performing licensure activities within the State health department. Under Title XIX, the Federal government reimburses States for the Federal Financial Participation share for costs of inspection. Such participation is dependent on an approved State activity plan.

Credentials/Documentation

States must have an approved State Plan for Title XIX and a signed 1864 Agreement for Title XVIII in order to carry out the survey function. Costs will be determined in accordance with OMB Circular No. A-87 for State and local governments.

Aplication and Award Process

Preapplication Coordination

This program is subject to statutory provisions.

States are required to submit an acceptable State Plan for Title XIX, and sign an 1864 Agreement for Title XVIII.

This program is excluded from coverage under E.O.

12372.

Application Procedures

States submit an acceptable State Plan (Title XIX) and sign an 1864 Agreement (Title XVIII) for support of Medicare/Medicaid survey and certification activities. Budget proposals and estimated expenditures must comply with OMB Circular No. A-87 cost principles and regulatory guidelines. This program is excluded from coverage under OMB Circular Nos. A-102 and A-110.

Award Procedures

States are provided a quarterly award based on an approved annual budget under Title XVIII and quarterly formula grants under Title XIX. States are reimbursed for Title XVIII and Title XIX survey activities under Electronic Funds Transfer System procedures. States draw funds through the Department's Payment Management System (PMS).

Deadlines

Annual budget proposals for Title XVIII are requested from the appropriate State agency as negotiated with Regional Office but no later than August 15. In addition, estimates of the amounts to be claimed for reimbursement under Title XIX are required 45 days prior to the applicable quarter. Reports of actual expenditures for both programs are required 30 days after the close of each quarter.

Authorization

Social Security Act, Sections 1863, 1864, 1865, 1902, 1903, and 1919, Title XVIII, as amended.

Range of Approval/Disapproval Time

From 30 to 60 days for initial approval or disapproval.

Appeals

Title XVIII appeals are reviewed by the Armed Services Contracts Appeal Board; Title XIX appeals are reviewed by the Departmental Grants Appeal Board.

Renewals

Ongoing renewals are awarded to States that are willing and able to conduct required survey activities in compliance with statutory mandate.

Assistance Considerations

Formula and Matching Requirements

Funds available for Title XVIII survey costs are not subject to State matching requirements. Awards for Federal Financial Participation reimbursement of Title XIX related survey costs are subject to States certifying their availability of funds as prescribed by Section 1903 (a), (2), and (7), as further defined in 42 CFR, Part 433.15.

Length and Time Phasing of Assistance

Funding authority is provided for a full year to State agencies performing survey and certification activities pertaining to Medicare survey activity. For Medicaid survey activity (State entitlement program), funding authority is indefinite.

Post Assistance Requirements

Reports

States operate under an approved plan (Title XIX) and 1864 Agreement (Title XVIII).

Quarterly expenditure reports are required 30 days after the close of each quarter and monitoring is carried out by the Department of Health and Human Services.

Audits

DHHS Office of Inspector General staff or designated representatives make periodic audits of State survey agencies. In addition, under the Single State Audit Act, States may elect to conduct their own nonpartisan audits and certify the results to the Secretary of Health and Human Services.

Records

States must maintain surveyor time records, line item and expenditure documentation, which substantiate the costs relating to survey activities.

Financial Information

Account Identification

75-0511-0-1-550 (Title XVIII);
75-0512-0-1-551 (Title XIX).

Obigations

(Grants) FY 07 (Title XVIII) $244,008,586, (Title XIX) $200,384,986; FY 08 estimate (Title XVIII) $254,713,742 (Title XIX) $223,000,000; and FY 09 estimate (Title XVIII) $273,700,000 (Title XIX) $228,798,000.

Range and Average of Financial Assistance

(State distributed Title XVIII funds) FY 06 range is from $15,169 to $28,309,623 and an average of $4,734,012; FY 07 range is from $15,366 to $28,637,569 and an average of $4,781,943.

Regulations, Guidelines, and Literature

Title XVIII, Social Security Act as amended Sections 1863, 1864 and 1865. Title XIX, Social Security as amended, Sections 1903, 1904, 1908, 1910, and 1919; 42 CFR, Subparts J, K, L, M, N, O, Q, S, U, and X.

Information Contacts

Regional or Local Office

Contact the Regional Administrator for Centers for Medicare and Medicaid Services. (See Appendix IV of the Catalog for listing of Regional Offices).

Headquarters Office

Thomas Hamilton, Director, Survey & Certification Group, Centers for Medicare and Medicaid Services, 7500 Security Boulevard, Baltimore, MD 21244. Telephone: (410) 786-9493. (Use same number for FTS).

Criteria for Selecting Proposals

Selecting criteria for Federal funding of State certification proposals are available to State survey agencies upon request.



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