Hospitals (Participation in Medicare and Medicaid)

Step 1: Enrollment

For information regarding the enrollment process for hospitals please visit the CMS website.

Step 2: Additional Documentation to submit to the State Agency

CMS 1561 Health Insurance Benefits Agreement (3 original signed forms)

Office of Civil Rights forms

Step 3: Initial Certification Surveys  

The Health Standards Section (HSS) of the Department of Health is contracted by the Centers for Medicare/Medicaid Services (CMS) to perform initial and periodic surveys and to certify whether providers of services meet the hospital Medicare Conditions of Participation. Compliance with the hospital Conditions of Participation is a requirement to participate in Medicare. Such Medicare approval, when required, is a prerequisite to qualifying to participate in the State Medicaid program as well.

Due to substantial federal resource limitations, HSS must currently adhere to a priority schedule when responding to requests from new hospital providers seeking to participate in Medicare. CMS now requires HSS to place a higher priority on recertification of existing Medicare certified facilities & complaint investigations than for initial certification surveys of facilities newly seeking Medicare participation.  Please note that initial certification surveys are to be conducted in accordance with the guidelines listed in S&C 08-03, Memorandum to Prospective Providers Seeking Initial Medicare Surveys & Prioritization of Initial Medicare Certification Surveys. Please note that obtaining a certification survey through an approved Accrediting Organization may be your quickest route for certification. 

New providers must be in operation and providing services to patients when surveyed for certification.  This means that at the time of the survey, the institution must have opened its doors to admissions, be furnishing all services necessary to meet the applicable provider definition and demonstrate the operational capability of all facets of its operation.  Please remember that the certification survey for psychiatric hospitals will not be completed earlier than 30 days after you have been licensed and providing patient care (and in accordance with S&C 08-03) due to the fact that active and closed records must be reviewed to determine compliance.  In addition to these guidelines, the state agency must receive notice from the Fiscal Intermediary that the CMS 855 form has been approved.  Please contact your fiscal intermediary for any additional requirements.  

This agency is responsible for determining compliance with Medicare/Medicaid regulations and certifying its findings to the CMS Regional Office, which will make the decision as to whether you qualify for participation in the Medicare/Medicaid program.  A provider participating in the Medicare/Medicaid program under this approval will continue to be eligible to participate until a determination on non-compliance is made.

Current regulations require that the effective date of the provider agreement can be no earlier than the completion date of the certification survey, assuming all requirements are met.  In the event that a deficiency is cited at the initial certification survey, the effective date will be no earlier than the date that the facility provides an acceptable Plan of Correction.

You are cautioned about accepting Medicare/Medicaid beneficiaries prior to confirmation by the Department of Health and Human Services Regional Office, in Dallas, Texas, of the effective date of the Health Insurance Benefits Agreement.  You should notify the beneficiary or his representative, in writing, of beneficiary's financial responsibility in the program.

For information regarding enrolment as a Medicaid Provider or if you need a Provider Enrollment Application, you should contact Provider Enrollment by calling 225-237-3370.