Provider-Based Criteria
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Related Resources
AAMC Documents
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Only a high level of integration with the "main provider"
will qualify an entity as being provider-based. The regulations
set forth seven criteria, all of which must be met in order
for an entity to qualify as "provider-based." These
criteria focus on the following areas: licensure; ownership
and control; administration and supervision; clinical services;
financial integration; public awareness; and location in immediate
vicinity of the main provider.
The AAMC spearheaded efforts with other hospital organizations
to request a delay in the October 10, 2000 effective date
of the rule because of a number of ambiguities contained in
the April 2000 regulations. CMS granted the delay, making
the requirements effective for cost reporting periods beginning
on or after January 10, 2001.
On December 21, 2000, the Benefits Improvement and Protection
Act (BIPA) of 2000 was signed into law. BIPA includes: (1)
a grandfathering provision for facilities that were treated
as provider-based on October 1, 2000; (2) alternative criteria
for meeting the geographic location requirement; and (3) criteria
for temporary treatment as a provider-based entity. CMS published
the final regulation implementing these provisions on November
30, 2001. |
