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Federal Certification to Participate in Medicare and Medicaid

Federal Certification to Participate in Medicare and Medicaid

Initial Certification

Complete the Provider Enrollment Application (CMS-855A) and submit it to the Medicare Administrative Contractor (MAC).

  • The MAC will provide you a recommendation letter once the initial review is complete.
  • An email confirming a successful electronic submission of your Civil Rights Clearance for Medicare Provider Certification from the Office for Civil Rights (OCR).
  • A signed "Health Insurance Benefit Agreement" (CMS-1561).
  • A copy of the nursing home’s patient transfer agreement.
  • A letter notifying the Bureau of Survey and Certification (BSC) that the Nursing Home is ready for its federal certification survey.
  • Before the letter is submitted, ensure occupancy has been granted by the Health Facilities Engineering Section and a state license has been issued.
  • To be ready for an initial federal certification survey:
    • The facility must be in full operation and providing services to residents when surveyed.
    • The facility must have opened its doors to admissions, be furnishing all services necessary services, and demonstrate the operational capability of all facets of its operations.
    • To be considered “fully operational,” initial applicants must be serving enough residents so that compliance with all requirements can be determined.
  • Be prepared to provide Policies and Procedures for review, as outlined in the CMS Initial Certification Survey Review Tool, which can be found at the CMS Nursing Home Survey Resource Page in the "Initial Surveys" zip file.

Once all documents have been received and survey has been conducted, BSC will review and forward the application to the MAC for final determination and issuance of Medicare provider number.

Please note: this process can take up to 30-60 days from the date of receipt by the MAC.

 

Change of Ownership (CHOW)

A nursing home will need to complete the following steps and submit the paperwork electronically to LARA-BSCSupport@michigan.gov, unless otherwise noted in the instructions:

  • Ensure all state licensing Change of Ownership requirements have been completed and approved prior to submitting the federal request.
  • Complete Provider Enrollment Application (CMS-855A) and submit to Medicare Administrative Contractor (MAC).
  • The MAC will provide you a recommendation letter once the initial review is complete.
  • An email confirming a successful electronic submission of your Civil Rights Clearance for Medicare Provider Certification from the Office for Civil Rights (OCR).
  • A signed “Health Insurance Benefit Agreement” (CMS-1561)
  • A “Long-Term Care Facility Application for Medicare and Medicaid” (CMS-671).
  • A copy of the nursing home’s patient transfer agreement.
  • A copy of the bill of sale or other legal documentation of change of ownership.
  • Once all documents have been received, the Bureau of Survey and Certification will review and forward the application to the MAC for final determination.
  • Please note: this process can take up to 30-60 days from the date of receipt by the MAC.

Contact Us

Bureau Phone: 517-284-0193

Bureau Fax Number: 517-763-0214

Help for general questions: LARA-BSCHelp@michigan.gov

Certification support email for document submission: LARA-BSCSupport@michigan.gov