State Survey and Certification of Health Care Providers and Suppliers
Published on AidPage by
IDILOGIC on Jun 24, 2005
Purpose of this program:
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.
Possible 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.
Who is eligible to apply...
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.
Note:This is a brief description of the credentials or documentation required prior to, or along with, an application for assistance.
About this section:
This section indicates who can apply to the Federal government for assistance and the criteria the potential applicant must satisfy.
For example, individuals may be eligible for research grants, and the criteria to be satisfied may be that they have a professional or scientific degree,
3 years of research experience, and be a citizen of the United States. Universities, medical schools, hospitals, or State and local governments may also be eligible.
Where State governments are eligible, the type of State agency will be indicated (State welfare agency or State agency on aging) and the criteria that they
must satisfy.
Certain federal programs (e.g., the Pell Grant program which provides grants to students) involve intermediate levels of application processing, i.e., applications
are transmitted through colleges or universities that are neither the direct applicant nor the ultimate beneficiary. For these programs,
the criteria that the intermediaries must satisfy are also indicated, along with intermediaries who are not eligible.
How to apply...
Application Procedure:
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.
Note: Each program will indicate whether applications are to be submitted to the Federal headquarters, regional or local office, or to a State or local government office.
Award Procedure:
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).
Note: Grant payments may be made by a letter of credit, advance by Treasury check, or reimbursement by Treasury check.
Awards may be made by the headquarters office directly to the applicant, an agency field office, a regional office,
or by an authorized county office. The assistance may pass through the initial applicant for further distribution by
intermediate level applicants to groups or individuals in the private sector.
Deadlines and process...
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.
Note:
When available, this section indicates the deadlines for applications to the funding agency which will
be stated in terms of the date(s) or between what dates the application should be received.
When not available, applicants should contact the funding agency for deadline information.
Range of Approval/Disapproval Time
From 30 to 60 days for initial approval or disapproval.
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.
Note:
This section indicates whether any prior coordination or approval is required with governmental or nongovernmental units
prior to the submission of a formal application to the federal funding agency.
Appeals
Title XVIII appeals are reviewed by the Armed Services Contracts Appeal Board; Title XIX appeals are reviewed by the Departmental Grants Appeal Board.
Note:
In some cases, there are no provisions for appeal. Where applicable, this section discusses appeal procedures or allowable rework time for resubmission
of applications to be processed by the funding agency. Appeal procedures vary with individual programs and are either listed in this section or
applicants are referred to appeal procedures documented in the relevant Code of Federal Regulations (CFR).
Renewals
Ongoing renewals are awarded to States that are willing and able to conduct required survey activities in compliance with statutory mandate.
Note:
In some instances, renewal procedures may be the same as for the application procedure, e.g., for projects of a non-continuing nature renewals will be treated as new, competing applications; for projects of an ongoing nature, renewals may be given annually.
Who can benefit...
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.
Beneficiaries
About this section:
This section lists the ultimate beneficiaries of a program, the criteria they must satisfy and who specifically is not eligible. The applicant and beneficiary will generally be the same for programs that provide assistance directly from a Federal agency. However, financial assistance that passes through State or local governments will have different applicants and beneficiaries since the assistance is transmitted to private sector beneficiaries who are not obligated to request or apply for the assistance.
What types of assistance...
Formula Grants
Allocations of money to States or their subdivisions in accordance with distribution formulas prescribed by law or administrative regulation, for activities of a continuing nature not confined to a specific project.
How much financial aid...
Range and Average of Financial Assistance
(State distributed funds) FY 03 range is from $15,000 to $26,905,383 and an average of $4,331,321; FY 04 range is from $15,000 to $26,889,131 and an average of $4,335,472.
Note:
This section lists the representative range (smallest to largest) of the amount of financial assistance available. These figures are based upon funds awarded in the past fiscal year and the current fiscal year to date. Also indicated is an approximate average amount of awards which were made in the past and current fiscal years.
Obligations
(Grants) FY 03 (Title XVIII) $230,329,548 (Title XIX) $169,067,609; FY 04 est (Title XVIII) $229,779,997, (Title XIX) $180,000,000; and FY 05 est (Title XVIII) $251,921,500 (Title XIX) $242,820,000.
Note:
The dollar amounts listed in this section represent obligations for the past fiscal year (PY), estimates for the current fiscal year (CY), and estimates for the budget fiscal year (BY) as reported by the Federal agencies. Obligations for non-financial assistance programs indicate the administrative expenses involved in the operation of a program.
Account Identification
75-0511-0-1-550 (Title XVIII); 75-0512-0-1-551 (Title XIX).
Note:
Note: This 11-digit budget account identification code represents the account which funds a particular program.
This code should be consistent with the code given for the program area as specified in Appendix III of the Budget of the United States Government.
Examples of funded projects...
Information relating to federally-funded projects is available to State survey agencies upon request.
About this section
This section indicates the different types of projects which have been funded in the past. Only projects funded under Project Grants or Direct Payments for Specified Use should be listed here. The examples give potential applicants an idea of the types of projects that may be accepted for funding. The agency should list at least five examples of the most recently funded projects.
Program accomplishments...
In fiscal year 2002, the Department had oversight of approximately 49,000 certified Medicare and Medicaid health care providers and suppliers to ensure they met prescribed regulatory standards and conditions, which allowed beneficiaries to receive quality care within a safe and sanitary environment. The estimated figure for fiscal year 2003 is approximately 47,000 and for fiscal year 2004 is 48,000. Grants were provided to 53 State/territory survey agencies to conduct inspections in fiscal year 2002. It is estimated that grants will be provided to 53 State/territory survey agencies to conduct inspections in fiscal years 2003 and 2004.
Criteria for selecting proposals...
Selecting criteria for Federal funding of State certification proposals are available to State survey agencies upon request.
Assistance considerations...
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.
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.
Note:
A formula may be based on population, per capita income, and other statistical factors. Applicants are informed whether there are any matching requirements to be met when participating in the cost of a project. In general, the matching share represents that portion of the project costs not borne by the Federal government. Attachment F of OMB Circular No. A-102 (Office of Management and Budget) sets forth the criteria and procedures for the evaluation of matching share requirements which may be cash or in-kind contributions made by State and local governments or other agencies, institutions, private organizations, or individuals to satisfy matching requirements of Federal grants or loans.
Cash contributions represent the grantees' cash outlay, including the outlay of money contributed to the grantee by other public agencies, institutions, private organizations, or individuals. When authorized by Federal regulation, Federal funds received from other grants may be considered as the grantees' cash contribution.
In-kind contributions represent the value of noncash contributions provided by the grantee, other public agencies and institutions, private organizations or individuals. In-kind contributions may consist of charges for real property and equipment, and value of goods and services directly benefiting and specifically identifiable to the grant program. When authorized by Federal legislation, property purchased with Federal funds may be considered as grantees' in-kind contribution.
Maintenance of effort (MOE) is a requirement contained in certain legislation, regulations, or administrative policies stating that a grantee must maintain a specified level of financial effort in a specific area in order to receive Federal grant funds, and that the Federal grant funds may be used only to supplement, not supplant, the level of grantee funds.
Post assistance requirements...
Reports
States operate under an approved plan (Title XIX) and 1864 Agreement (Title XVIII). Quarterly expenditure reports are required days after the close of each quarter and monitoring is carried out by the Department of Health and Human Services.
Note:
This section indicates whether program reports, expenditure reports, cash reports or performance monitoring are required by the Federal funding agency, and specifies at what time intervals (monthly, annually, etc.) this must be accomplished.
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 for Health and Human Services.
Note:
This section discusses audits required by the Federal agency.
The procedures and requirements for State and local governments and nonprofit entities are set forth in OMB Circular No. A-133.
These requirements pertain to awards made within the respective State's fiscal year - not the Federal fiscal year,
as some State and local governments may use the calendar year or other variation of time span designated as the fiscal year period,
rather than that commonly known as the Federal fiscal year (from October 1st through September 30th).
Records
States must maintain surveyor time records, line item and expenditure documentation, which substantiate the costs relating to survey activities.
Note:
This section indicates the record retention requirements and the type of records the Federal agency may require.
Not included are the normally imposed requirements of the General Accounting Office.
For programs falling under the purview of OMB Circular No. A-102, record retention is set forth in Attachment C.
For other programs, record retention is governed by the funding agency's requirements.
Regulations...
Authorization
Social Security Act, Sections 1863, 1864, 1865, 1902, 1903, and 1919, Title XVIII, as amended.
Note:
This section lists the legal authority upon which a program is based (acts, amendments to acts, Public Law numbers, titles, sections, Statute Codes, citations to the U.S. Code, Executive Orders, Presidential Reorganization Plans, and Memoranda from an agency head).
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.