July 2012

Information Bulletin 12-05
NH-160

Process for Decertifying from the Medicare program while maintaining Medicaid certification

Purpose

The purpose of this informational bulletin is to inform Medicare/Medicaid certified Nursing Homes of the process for decertifying from the Medicare program while maintaining Medicaid certification.

Background

The 2012 state legislature repealed the legislation requiring all Medicaid Nursing Homes to participate in the Medicare program. In its place is a new requirement that any nursing facility that is not certified to participate in the Medicare program must refer and document the referral of dual eligible recipients for whom placement is requested and for whom the stay would be qualified for Medicare coverage to a facility that is certified for Medicare. The Department of Human Services will audit this activity and in cases of non-compliance will deny Medicaid payment for the first 20 days of the resident’s stay. This provision was effective July 1, 2012.

If a facility drops its Medicare certification, it may take advantage of some additional federal nursing staff waivers; however, all other federal regulations would still apply. Any facilities that elect to terminate their Medicare certification should be aware that if they wish to resume Medicare certification at a later date, they will need to reapply for this portion of their certification. The Minnesota Department of Health (MDH) cannot guarantee whether or not the Centers for Medicare and Medicaid Services (CMS) will consider a facility returning to the Medicare program to be a new facility or an existing facility as far as issues such as Life Safety Code are concerned.

Steps to Take in Order to Terminate Medicare Certification

A nursing facility wishing to exercise this option should take the following steps:

• A letter must be sent to the Minnesota Department of Health.  This letter needs to include:

• A statement that the facility wishes to terminate its Medicare certification.  The letter needs to clearly state that the facility is only dropping Medicare certification and still wants to retain its Medicaid certification if that is what they want to do.  If this is not clearly stated, it is possible that MDH could inform CMS that the facility is terminating its participation in both programs.

• The date that the facility wants the termination to be effective.

• The letter must be sent to:

• Mary Henderson, Program Assurance Supervisor
  Minnesota Department of Health
  Health Regulation Division
  P.O. Box 64900
  St. Paul, Minnesota  55164-0900

• The facility needs to contact the fiscal intermediary to inform them of their intent to terminate Medicare participation.  The necessary paperwork required by the fiscal intermediary to terminate Medicare certification (the CMS-855) will need to be submitted to the fiscal intermediary.  When the CMS-855 has been approved a copy will be forwarded to MDH.

• MDH will then forward the required paperwork to CMS, including the CMS-855 form.  CMS will send the provider a letter acknowledging the termination when the processing is complete.

• The facility needs to provide notice to residents and families of their intent to terminate participation in the Medicare program 60 days prior to the Medicare termination. 

• Any questions about this process should be directed to Mary Henderson at Mary.Henderson@state.mn.us or 651-201-4115.

Statutory Reference

MN Statute 256B.48 Subd. 6a. Referrals to Medicare providers required. Notwithstanding subdivision 1, nursing facility providers that do not participate in or accept Medicare assignment must refer and document the referral of dual eligible recipients for whom placement is requested and for whom the resident would be qualified for a Medicare-covered stay to Medicare providers. The commissioner shall audit nursing facilities that do not accept Medicare and determine if dual eligible individuals with Medicare qualifying stays have been admitted. If such a determination is made, the commissioner shall deny Medicaid payment for the first 20 days of that resident's stay.

REPEALER:

Minnesota Statute 256B.48, subdivision 6, are repealed.