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HCFA Requirements

The Health Care Financing Administration (HCFA) has regulations regarding main health care providers and subordinate care facilities wanting provider-based status. Main providers can shift overhead costs to other operating entities, such as rural clinics or doctor's offices that the main provider acquires and owns under its own name and regulations. With the other operating entities having provider-based status accreditation, the the main provider can shift overhead costs, allowing for greater reimbursement.

  1. License and Ownership

    • For an operating entity seeking provider-based status to operate, it must be under the same license as the main provider. The operating entity has to be controlled entirely by the main provider.

    Reporting Standards

    • An entity seeking provider-based status has to have the same characteristics in a reporting relationship with the main provider as the main provider has with its own departments. The reporting must consist of direct supervision, an integration of administration infrastructures and the same monitoring and oversight.

    Clinical and Financial Services

    • The main health care provider and the operating entity must have an integration of services and medical activities between professional staff. Financial integration involves shared costs and expenses with the operating entity's costs needing to be reported to the main provider's cost center.

    Monitoring Process

    • Under HCFA regulations, health care providers must give information about the monitoring process to the HCFA. Such information would include the frequency of surveys, copies of the survey reports, notification requirements and description of evaluation systems used in surveyor performance.

    Follow-up Activities

    • HCFA requires that the health care providers report information regarding the provider having the required resources in surveying and follow-up activities. The health care provider must proivde data for evaluating the organization's monitoring processes, reports concerning education and experience requirements for surveyors, and information about the sufficiency of funding concerning inspection performance requirements.

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