Medicare and Medicaid certification for health care facilities
Certification is an optional process that allows providers to bill Medicare or Medicaid for re-imbursement. 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 question about what kinds of services are Medicaid eligible please contact Health Care Policy and Finance.
- Minimum Data Set (MDS) training and resources.
- Outcome and Assessment Information Set (OASIS) training and resources.
General certification information
- Introduction to Licensure and Certification.
- Providers we regulate.
- Guidance regarding initial certification surveys.