N.M. Admin. Code § 8.370.13.8 - GENERAL REQUIREMENTS
A.
Eligibility: The following facilities that were enrolled and
certified to participate in Medicare as of December 27, 2020 are eligible to be
an REH:
(1) CAHs;
(2) A subsection (d) hospital (as defined in
section 1886(d)(1)(B) of the Social Security Act (the Act) with not more than
50 beds located in a county (or equivalent unit of local government) in a rural
area (as defined in section 1886(d)(2)(D) of the Act) (referred to as rural
hospital);
(3) A subsection (d)
hospital (as so defined) with not more than 50 beds that was treated as being
located in a rural area pursuant to section 1886(d)(8)(E) of the Act (referred
to as rural hospital);
(4)
Facilities that were enrolled as CAHs or rural hospitals with not more than 50
beds as of December 27, 2020 and then subsequently closed after that date,
would also be eligible to seek REH designation if they re-enroll in Medicare
and meet all the COPs and requirements for REHs.
B.
Action plan: An action plan
must be submitted to the authority by the applicant facility to initiate REH
services. The action plan outlines the facility's plan for conversion to an REH
and the initiation of REH specific services including the provision of
emergency department services, observation care and other medical and health
services elected by the REH. This should include details regarding staffing
provisions and the number and type of qualified staff for the provision of REH
services, as set forth in the CMS COPs.
(1)
The action plan must include a detailed transition plan that lists the
following:
(a) specific services the facility
will retain;
(b) specific services
the facility will modify;
(c)
specific services the facility will add; and
(d) specific services the facility will
discontinue.
(2) The
facility must include a description of services that the facility intends to
furnish on an outpatient basis if elected by the REH.
(3) The facility must also include
information regarding how the facility intends to use the additional facility
payment. This includes a description of the services that the additional
facility payment would be supporting such as the operation and maintenance of
the facility and furnishing of services (i.e., telehealth services, ambulance
services etc.).
(4) Eligible
facilities may submit the action plan and additional information on letterhead
or use the model template available on the CMS website. The submission should
be signed by the facility's legal representative/ administrator.
(5) The authority will forward the action
plan and information along with its recommendation for approval or denial to
the designated CMS location for review and approval of the action plan
components. The CMS location will make a final determination and notify the MAC
once the enrollment package is complete and has been reviewed and
approved.
(6) The action plan and
information must include all the required elements as specified in Paragraph
(1)-(3) of Subsection B of Section
8.370.13.9 NMAC. Missing or
incomplete information may delay the conversion and enrollment process for
eligible facilities applying to become an REH.
(7) In accordance with section 1861(kkk)
(2)(A) of the Act, action plans will be available to the public and will
eventually be posted on the CMS website.
C.
Transfer Agreement: Pursuant
to section 1861(kkk)(2) of the Act and
42 CFR
485.538 Condition of participation:
Agreements, the REH is required to have a transfer agreement with at least one
medicare-certified hospital that is designated as a level I or level II trauma
center. The agreement is intended to ensure an appropriate referral and
transfer process is in place for patients requiring emergency care and
continued care services beyond the capabilities of the REH. In order to
document compliance, a copy of the transfer agreement should be submitted to
the authority along with the action plan.
D.
Attestation:
(1) An REH is required to meet the COPs for
rural emergency hospitals set forth at Subpart E of 42 CFR Part 485 (485.500 -
485.546). Other than the requirement that the REH submit its agreement with a
nearby trauma center, eligible facilities converting to an REH may self-attest
to meeting the REH COPs and will not require an automatic on-site initial
survey as eligible facilities are expected to be in full compliance with the
existing CAH and hospital requirements at the time of the request for
conversion.
(2) Facilities may
submit the attestation for compliance with the REH COPs along with the action
plan and copy of the transfer agreement to the SA. The attestation may be
completed on facility letterhead or the model template provided on the CMS
website may be used. The attestation should be signed by the facility's legal
representative or administrator.
(3) The authority will review the additional
information for completeness and confirm compliance with any applicable state
licensure requirements. Once complete, the authority will forward the
additional information to the CMS location, along with a recommendation for
certification or denial.
(4) The
CMS location is responsible for making the final determination for
certification of the REH. The effective date will be based upon the date the
application package was determined to be complete and approved by the CMS
location for meeting all REH requirements. For facilities that require an
on-site initial survey, the effective date will be based on current CMS policy,
which is the exit day of survey if no deficiencies are cited, or in the
alternative, if deficiencies are noted, the date an acceptable plan of
correction was approved (see 42 CFR
489.13).
E.
Types of licenses:
(1)
"Annual license": an annual
license is issued for a one-year period to a hospital that has met all
requirements of these requirements.
(2)
"Temporary license": the
licensing authority may, at its sole discretion, issue a temporary license
prior to the initial state survey, or when the licensing authority finds
partial compliance with these requirements. Facilities that were eligible as of
December 27, 2020, which subsequently closed and re-enrolled in Medicare would
require an initial on-site survey by the authority. These facilities do not
have to submit an attestation, as required in Subsection D of
8.370.13.9 NMAC, as an on-site
initial survey will be performed to determine the facility is operational and
in compliance with the REH requirements.
(a)
a temporary license shall cover a period of time, not to exceed 120 days,
during which the facility must correct all specified deficiencies;
(b) in accordance with Subsection D of
Section 24-1-5 NMSA 1978, no more than two
consecutive temporary licenses shall be issued.
(3)
"Amended license": a
licensee must apply to the licensing authority for an amended license when
there is any change of administrator, name, location, capacity, classification
of any unit as listed in these requirements:
(a) the application must be on a form
provided by the licensing authority;
(b) application must be accompanied by the
required fee for an amended license; and
(c) application must be submitted at least 30
calendar days prior to the change.
Notes
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