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Catalog of Federal Domestic Assistance

Program Descriptions

93.777:  State Survey and Certification of Health Care Providers and Suppliers

Objectives:  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.

PROGRAM AND AWARD	FINANCIAL AND INFORMATION CONTACTS
ELIGIBILITY REQUIREMENTS	FINANCIAL AND ADMINISTRATIVE INFO.
APPLICATION AND AWARD PROCESS	INFORMATION CONTACTS
RELATED PROGRAMS	ASSISTANCE CONSIDERATIONS
PROGRAM ACCOMPLISHMENTS	POST ASSISTANCE REQUIREMENTS

93.777 ELIGIBILITY REQUIREMENTS:

Applicant Eligibility:  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.

Beneficiary Eligibility:  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.

93.777 APPLICATION AND AWARD PROCESS:

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.

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.

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).

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.

Range of Approval/Disapproval Time:  From 30 to 60 days for initial approval or disapproval.

Appeals:  Title XVIII appeals are reviewed by the Armed Services Contracts Appeal Board; Title XIX appeals are reviewed by the Departmental Grants Appeal Board.

Renewals:  Ongoing renewals are awarded to States that are willing and able to conduct required survey activities in compliance with statutory mandate.

Criteria for Selecting Proposals:  Selecting criteria for Federal funding of State certification proposals are available to State survey agencies upon request.

Examples of Funded Projects:  Information relating to federally-funded projects is available to State survey agencies upon request.

Range and Average of Financial Assistance:  Title XVIII: $15,500 to $20,600,000. Title XIX: $233,000 to $22,300,000.

93.777 RELATED PROGRAMS:

• 93.773 Medicare: Hospital Insurance;
• 93.774 Medicare: Supplementary Medical Insurance;
• 93.778 Medical Assistance Program (Medicaid).

93.777 PROGRAM ACCOMPLISHMENTS:

In fiscal year 1999, the Department had oversight of about 48,000 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.

93.777 FINANCIAL AND ADMINISTRATIVE INFO:

Federal Agency:  HEALTH CARE FINANCING ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES

Type of Assistance:  Formula Grants.

Obligations:  (Grants): FY 99 (Title XVIII) $167,985,510 (Title XIX) $134,549,000; FY 00 est (Title XVIII) $179,247,000, (Title XIX) $182,100,000; and FY 01 est (Title (XVIII) $182,347,000, (Title XIX) $192,000,000.

Budget Account Number:  75-0511-0-1-550 (Title XVIII) and 75-0512-0-1-551 (Title XIX).

Authorization:  Social Security Act, Sections 1863, 1864, 1865, 1902, 1903, and 1919, Title XVIII, as amended.

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.

93.777 INFO CONTACTS:

Regional or Local Office:  Contact the Regional Administrator for Health Care Financing Administration. (See Appendix IV of the Catalog for listing of Regional Offices.)

Headquarters Office:  Director, Disabled and Elderly Health Program Group, Health Care Financing Administration, 7500 Security Blvd., Baltimore, MD 21244. Phone: (410) 786-3160. (Use same number for FTS.)

(See Appendix IV for more contact info.)

93.777 ASSISTANCE CONSIDERATIONS:

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.

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.

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.

93.777 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, HCFA.

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.

Records:  States must maintain surveyor time records, line item and expenditure documentation, which substantiate the costs relating to survey activities.