42 U.S.C. § 1395aa : US Code - Section 1395AA: Agreements with States

Search 42 U.S.C. § 1395aa : US Code - Section 1395AA: Agreements with States

(a) Use of State agencies to determine compliance by providers of
services with conditions of participation
The Secretary shall make an agreement with any State which is
able and willing to do so under which the services of the State
health agency or other appropriate State agency (or the appropriate
local agencies) will be utilized by him for the purpose of
determining whether an institution therein is a hospital or skilled
nursing facility, or whether an agency therein is a home health
agency, or whether an agency is a hospice program or whether a
facility therein is a rural health clinic as defined in section
1395x(aa)(2) of this title, a critical access hospital, as defined
in section 1395x(mm)(1) of this title, or a comprehensive
outpatient rehabilitation facility as defined in section
1395x(cc)(2) of this title, or whether a laboratory meets the
requirements of paragraphs (16) and (17) of section 1395x(s) of
this title, or whether a clinic, rehabilitation agency or public
health agency meets the requirements of subparagraph (A) or (B), as
the case may be, of section 1395x(p)(4) of this title, or whether
an ambulatory surgical center meets the standards specified under
section 1395k(a)(2)(F)(i) of this title. To the extent that the
Secretary finds it appropriate, an institution or agency which such
a State (or local) agency certifies is a hospital, skilled nursing
facility, rural health clinic, comprehensive outpatient
rehabilitation facility, home health agency, or hospice program (as
those terms are defined in section 1395x of this title) may be
treated as such by the Secretary. Any State agency which has such
an agreement may (subject to approval of the Secretary) furnish to
a skilled nursing facility, after proper request by such facility,
such specialized consultative services (which such agency is able
and willing to furnish in a manner satisfactory to the Secretary)
as such facility may need to meet one or more of the conditions
specified in section 1395i-3(a) of this title. Any such services
furnished by a State agency shall be deemed to have been furnished
pursuant to such agreement. Within 90 days following the completion
of each survey of any health care facility, ambulatory surgical
center, rural health clinic, comprehensive outpatient
rehabilitation facility, laboratory, clinic, agency, or
organization by the appropriate State or local agency described in
the first sentence of this subsection, the Secretary shall make
public in readily available form and place, and require (in the
case of skilled nursing facilities) the posting in a place readily
accessible to patients (and patients' representatives), the
pertinent findings of each such survey relating to the compliance
of each such health care facility, ambulatory surgical center,
rural health clinic, comprehensive outpatient rehabilitation
facility, laboratory, clinic, agency, or organization with (1) the
statutory conditions of participation imposed under this subchapter
and (2) the major additional conditions which the Secretary finds
necessary in the interest of health and safety of individuals who
are furnished care or services by any such health care facility,
ambulatory surgical center, rural health clinic, comprehensive
outpatient rehabilitation facility, laboratory, clinic, agency, or
organization. Any agreement under this subsection shall provide for
the appropriate State or local agency to maintain a toll-free
hotline (1) to collect, maintain, and continually update
information on home health agencies located in the State or
locality that are certified to participate in the program
established under this subchapter (which information shall include
any significant deficiencies found with respect to patient care in
the most recent certification survey conducted by a State agency or
accreditation survey conducted by a private accreditation agency
under section 1395bb of this title with respect to the home health
agency, when that survey was completed, whether corrective actions
have been taken or are planned, and the sanctions, if any, imposed
under this subchapter with respect to the agency) and (2) to
receive complaints (and answer questions) with respect to home
health agencies in the State or locality. Any such agreement shall
provide for such State or local agency to maintain a unit for
investigating such complaints that possesses enforcement authority
and has access to survey and certification reports, information
gathered by any private accreditation agency utilized by the
Secretary under section 1395bb of this title, and consumer medical
records (but only with the consent of the consumer or his or her
legal representative).
(b) Payment in advance or by way of reimbursement to State for
performance of functions of subsection (a)
The Secretary shall pay any such State, in advance or by way of
reimbursement, as may be provided in the agreement with it (and may
make adjustments in such payments on account of overpayments or
underpayments previously made), for the reasonable cost of
performing the functions specified in subsection (a) of this
section, and for the Federal Hospital Insurance Trust Fund's fair
share of the costs attributable to the planning and other efforts
directed toward coordination of activities in carrying out its
agreement and other activities related to the provision of services
similar to those for which payment may be made under part A of this
subchapter, or related to the facilities and personnel required for
the provision of such services, or related to improving the quality
of such services.
(c) Use of State or local agencies to survey hospitals
The Secretary is authorized to enter into an agreement with any
State under which the appropriate State or local agency which
performs the certification function described in subsection (a) of
this section will survey, on a selective sample basis (or where the
Secretary finds that a survey is appropriate because of substantial
allegations of the existence of a significant deficiency or
deficiencies which would, if found to be present, adversely affect
health and safety of patients), provider entities that, pursuant to
subsection (a) or (b)(1) of section 1395bb of this title, are
treated as meeting the conditions or requirements of this
subchapter. The Secretary shall pay for such services in the manner
prescribed in subsection (b) of this section.
(d) Fulfillment of requirements by States
The Secretary may not enter an agreement under this section with
a State with respect to determining whether an institution therein
is a skilled nursing facility unless the State meets the
requirements specified in section 1395i-3(e) of this title and
section 1395i-3(g) of this title and the establishment of remedies
under sections 1395i-3(h)(2)(B) and 1395i-3(h)(2)(C) of this title
(relating to establishment and application of remedies).
(e) Prohibition of user fees for survey and certification
Notwithstanding any other provision of law, the Secretary may not
impose, or require a State to impose, any fee on any facility or
entity subject to a determination under subsection (a) of this
section, or any renal dialysis facility subject to the requirements
of section 1395rr(b)(1) of this title, for any such determination
or any survey relating to determining the compliance of such
facility or entity with any requirement of this subchapter (other
than any fee relating to section 263a of this title).