Included here are materials and documentation related to the Medicare PPS provider-based designation program.
Off-Campus Emergency Department Attestation
Attention CMS Region V Providers: CMS Region V has developed a special attestation form
for an off-campus Emergency Department and now has a policy that while the provider based attestation process is
voluntary, when a hospital opens an off-campus Emergency Department, this special ED attestation form is required to be completed and submitted.
CMS Program Memorandum Intermediaries, Transmittal A-03-030 (April 18, 2003)
Provider-based Status On or After October 1, 2002.
Final Revisions to the Provider-Based
Regulations
As amended in the August 12, 2005 Federal Register and including the final
EMTALA regulations published in the Federal Register on September 9, 2003.
AdminaStar Federal Attestation Form
Attestation form recommended by AdminaStar Federal. Note that this form or the CMS form below can be used when
working with AdminaStar Federal.
Sample Attestation Form
Sample attestation form prepared by CMS.
Checklist to Determine Eligibility for Provider-Based Status
Obligations
of Hospital Outpatient Departments and Hospital-Based Entities
Chart of the additional obligations imposed on hospital outpatient departments after
January 10, 2001 as required in the provider-based regulations, including the August 12, 2005
amendments.
Revisions
to EMTALA Requirements
EMTALA requirements and their applicability to provider-based entities.
