The Michigan Department of Community Health (MDCH) has an agreement with the U.S. Department of Health and Human Services (HHS) to assist in determining whether health care programs are operating and remaining in compliance with the federal Medicare Conditions of Participation to qualify for Medicare payments.  This includes the requirements for reimbursement, including financial solvency; and the requirements of Title VI of the Civil Rights Act of 1964.  There are no licensure fees.

Agencies must contact the appropriate Fiscal Intermediary (FI) directly to obtain an Medicare General Enrollment Provider Application (CMS-855A).   The intermediary will also answer any questions about completion of the application and the enrollment process.   You should promptly complete and submit the application to the FI.   The provider must be fulfilling the Conditions of Participation before returning the application and requesting a survey.  The return of the application indicates readiness for a survey.

The approximate processing time for the fiscal intermediary review of your application is 60 days from receipt of your application.   However, this assumes that you promptly provide the fiscal intermediary with any required information that they request.   MDCH will be notified once the Fiscal Intermediary approves the application and a survey will be conducted.   The surveyor will inspect the program, interview staff, review documents, and undertake other procedures necessary to evaluate the extent to which the agency meets the Conditions of Participation. 

MDCH will then recommend to the U.S. Department of Health and Human Services whether the program should participate following the survey.  The federal government will make the final decision on when the program will become eligible.  The date of eligibility can be no earlier than the date the Federal Conditions of Participation are met.  The local CMS regional office will contact you concerning issuance of a formal signed provider agreement once you pass the survey conducted by the State.  A provider number will then be issued and you will be permitted to submit billings upon completion of the agreement.

Providers should promptly complete and return the following forms to MDCH (address shown below) AT THE SAME TIME THE CMS-855A IS RETURNED TO CMS if participation in the Medicare program is desired:

(1)  Hospice Request for Certification in the Medicare Program,

      CMS-417 (one original);

(2)  Hospice Licensure Application (BHS-LC-107b) (one original);

(3)  Civil Rights Packet;

(4)  and the Health Insurance Benefits Agreement, CMS-1561 (two originals).

Please indicate the earliest date the program will be ready for survey in your cover letter when the forms are completed and returned.

The application will be automatically closed when any portion of the material that you provide is more than 90 days old.  It will then be necessary to again notify the DCH, in writing, of the desire to apply.  Second requests for applications will be individually reviewed.

The earliest date of eligibility for previously certified agencies that have been terminated from the Medicaid program is after the second of two surveys at least 60 days apart, demonstrating continuous compliance with the Federal Conditions of Participation.  Provide written documentation indicating how the previous problems causing termination no longer exist.  Once it is determined that all requirements of Medicare and Civil Rights have been met, the Health Insurance Benefits Agreement will be countersigned.  One copy of the federal agreement will be returned to the applicant along with the notification that your program has been approved.  This notice will come from the Centers for Medicare & Medicaid Services (CMS) and serve as the formal notice of approval.

A recommendation for denial must be submitted to CMS if your agency is out of compliance upon initial survey with one or more Conditions of Participation.  CMS will then review all materials and determine if a follow-up will be done or if your application will be denied.  You may appeal this decision to CMS, reapply, or accept the denial if the application is denied.  Those institutions and agencies that are denied certification in the program will be sent notification, together with the reasons for the denial, and information about the right to appeal the decision.

The agreement cannot be transferred unless approved by the CMS if operation of the Agency is later transferred to another owner, ownership group, or to a lessee.   Written notification to MDCH is required at the time a transfer is planned.  MDCH is to be notified in writing as soon as possible if any of the information you provided on your Request for Certification form changes; i.e., address changes, telephone numbers, etc.

Contact MDCH at 517-241-3830 or write to the office below if you have any questions:

Michigan Department of Community Health

Bureau of Health Systems

Hospitals and Specialized Health Services Section

P.O. Box 30664

Lansing, Michigan 48909

123986