Medicare State Operations Manual - Centers for Medicare ...

1 State Operations Manual Chapter 4 - Program Administration and Fiscal Management Table of Contents (Rev. 188, 04-26-19). Transmittals for Chapter 4. Administration 4000 - Federal/ State Relationship for Provider Certification 4000A - Title XVIII - Medicare Regulations 4000B - Title XIX - Medicaid Regulations 4001 - Federal Administrative Responsibilities 4002 - Nature and Source of Payments to states 4002A - Trust Funds for Title XVIII-Related Activities 4002B - Grant Funds for Title XIX-Related Activities 4003 - SA Administrative Responsibilities - SA Responsibility for Records and Reports - SA Responsibility for Staff Training and Development - Staff Training - In-Agency Training - Outside-of-Agency Training 4004 - SA Reporting of Possible Certification

2 Fraud 4005 - Reliance Upon states to Initiate Budget - Coordinated Activity Plans for Carrying Out Program Action 4006 - Interagency Subagreements 4006A - Authority 4006B - Need for Subagreements With Public Entities 4006C - Program Specialization of Tasks Performed by Subagreement Entity - Negotiating Subagreements With Non-Public Entities 4007 - Assistance of CMS in SA Program Administration 4008 - Conflicts of Interest of SA Employees 4008A - Examples of Potential Conflicts of Interest 4008B - Report and Investigation of Improper Acts 4009 - Federal Surveyor Qualifications Standards 4009A - Persons Covered 4009B - Health Professional Qualifications 4009C - Education, Training, and Experience 4009D - Evaluation 4009E - Implementation 4009F - Quality Indicator Survey (QIS) Training Process - Orientation and Training of Newly Employed Surveyors in a State Implementing the QIS.

3 - Training Process: Registered QIS Surveyor - Training Process: CMS-Certified QIS Trainer - Documentation of Successful Completion of Training - CMS Regional Office Staff Participation in QIS. Training - Federal Minimum Qualification Standards for LTC Facility Surveyors - Purpose - Prerequisites - Test Composition - Successful Performance - Unsuccessful Performance - Test Administration/Registration - State Agency (SA) Registration Responsibilities - Regional Office (RO) Registration Responsibilities - Contractor Registration Responsibilities Testing Center Registration Responsibilities - Additional Responsibilities - Additional State Agency (SA) Responsibilities - Additional Regional Office (RO)

4 Responsibilities Surveyor Responsibilities Test Related Activities Recordkeeping Training of Surveyors That Do Not Pass The SMQT. 4010 - SA Annual Activity Plan 4011 - SA Planning Annual Workload 4018 - Regulatory Role of Surveyor and Consultant 4055 - Ordering CMS Forms and Literature Office of Management and Budget (OMB) Approval of Information Collected from the Public 4060 - Approval of Information Collected From Public by SAs - General 4062 - Information That Does Not Require OMB Approval -Verification or Correction Information - Certifications Survey and Certification Related Activities 4100 - Basis for Determining Health Insurance Relatedness of Activity Costs 4101 - Survey-Related Activities - General 4102 - Activities With Accredited Entities Deemed to Meet Participation Requirements 4111 - Higher Than National Standards 4115 - Non-Facility-Related Activities 4116 - SA Promotional and Public Informational Activities.

5 Medical Societies 4117 - Relations with Other Programs 4131 - Deeming and Waiver of Nurse Aide Training and Competency Evaluation (NATCEP) Requirements 4132 - NATCEPs and CEPs - Approval of NATCEPs and CEPs - Requirements for Program Approval - Time Frames for Review - Prohibition of Program Approval - Withdrawal of Program Approval - Waiver of Program Prohibition - Conflicts of Interest - Requirements for NATCEPs - Hours of Training - Restrictions on Activities of Students in a NATCEP. - Instructor Qualifications - Minimum Curriculum Requirements - Competency Evaluation Component - Prohibition of Charges - Requirements for CEP.

6 - Notification to Individual - Content of CEP. - Administration of NACEP. - Proctoring - Successful Completion of CEP. - Unsuccessful Completion of Competency Evaluation 4140 - Guidance to states for Medicaid NF Remedies 4140A - Background 4140B - Required State Remedies 4140C - Alternative Remedies 4140D - Incentives for High Quality Care 4140E - Federal Financial Participation (FFP). 4141 Nurse Aide Registry (NAR). 4141A - Registry Function 4141B - Registry Information 4141C - Responsibility for NAR. 4145 - Specification of Resident Assessment Instruments (RAIs) for Use in Long Term Care Facilities - Statutory Requirements - Definitions - RAI by CMS.

7 - Specification of a State RAI. - Variations in Formatting the State -Specified RAI. - Approval Process 4146 - Minimum Data Set (MDS) System - System Description - Administration Requirements - Validation and Editing Process - Reports - Correction of Errors in MDS Records That Have Been Accepted by the Standard MDS System at the State - Replication to the CMS Repository - Privacy and Confidentiality - System of Records - Procedures for Disclosure of Information Pursuant to Data Use Agreement - Routine Uses - Access by an Individual to His or Her Own Records - Criminal Penalties for Improper Disclosure - System Security - RO Roles and Responsibilities - Provider Relations SA Analysis Activity 4149 - OSCAR System 4149A - Summary 4149B.

8 Availability of OSCAR Data 4149C - Review of Certification Data 4149D - OSCAR Input Considerations 4149E - Suggested Output Utilization 4150 - RO Oversight of SA Surveyor Training 4151 -RO Program Analysis Activity 4151A - Analysis of Administrative Factors 4151B - Analysis of SA Reviews 4151C - Analysis of Individual Special Programs 4152 State Performance Measures for All Providers and Suppliers 4157 - Federal Monitoring Surveys - Definition and Purpose 4157A - Definition 4157B - Purpose 4157C - Scope of Survey 4157D - Survey Definitions 4158 - Federal Oversight Support Survey (FOSS) Expectations and Responsibility 4158A - SA Responsibility 4158B - RO Responsibility 4159 - Selecting and Scheduling Facilities for Monitoring Surveys 4160 - Conduct of Monitoring Surveys Provider Certification Files and Program Reporting 4200 - SA Provider Certification Files 4205 - Materials Forwarded to RO.

9 4210 - SA Files Used for Case Control and Reporting 4225 - Establishment of SA Case Folders and Controls Necessary SA Expenses 4500 - General 4502 - SA Cost of Studies of Distribution of Staff Time 4504 - Pro Rata Costs - General Rule 4508 - SA Goods, Facilities, Services from Other State Agencies or From Local Agencies 4508A - Definition 4508B - Centralized State Services 4510 - SA Personnel Services 4510A - Selection of Personnel 4510B - Charges for Director and Secretary of State Survey Activities Determined by Pro Rata Method 4514 - SA Determination of Necessary Staff 4514A - Full-Time 4514B - Limitation of Full-Time Identifiable Positions 4514C - Part-Time and Temporary 4514D - Charging for Multi-Program Staff - Program Activities Readily Identifiable 4514E - Charging for Multi-Program Staff - Program Activities Not Separate 4518 - Use of Overtime in SAs - Payment

10 For Overtime 4530 - SA Non-Personnel Services 4531 - Travel by SA Personnel 4531A - Certification and Administrative Travel 4531B - Training and Conference Travel 4532 - SA Communications and Supplies 4532A - Communications 4532B - Supplies 4532C - Basis for Charges 4534 - SA Office Space - Standard of Comparable Rental 4535 - Rent in Privately-Owned Space 4535A - Cancellation Clause 4535B - Lease Not Exceeding One Year 4535C - Consulting RO. 4536 - Space in Publicly-Owned Buildings 4537 - SA Repairs and Alterations 4537A - Maintenance Repairs 4537B - Major Repairs and Replacements 4537C - Alterations 4538 - SA Identifiable (Direct)