Certification is an optional process that allows providers to bill Medicare or Medicaid for reimbursement. Most types of facilities are eligible for Medicare and Medicaid. Some are eligible for Medicaid only. The process can be confusing, and we are here to help. Certification starts with a letter of intent.
CMS Medicare/Medicaid certification requirements for health care facilities
Facilities subject to Medicare/Medicaid certification must meet requirements established by the Centers for Medicare and Medicaid Services (CMS).
CMS delegates the inspection/survey functions to us.
Below is a list of CMS resources, including links to federal regulations:
- General compliance requirements.
- Guidance to laws and regulations for certified facilities, including State Operation Manuals (SOMs).
- Guidance regarding Initial Certification Surveys.
- CMS policy memos (includes S&C Letters).
HCPF Medicaid certification requirements
Facilities subject to Medicaid certification through the state’s Department of Health Care Policy and Financing (HCPF) must meet that department's Volume 8 regulations.
HCPF reimburses providers for Medicaid client services, but delegates the inspection/survey functions to us.
For questions about what kinds of services are Medicaid eligible please contact Health Care Policy and Finance.
Training
- Minimum Data Set (MDS) training and resources.
- Outcome and Assessment Information Set (OASIS) training and resources.
General certification information