CMS Pub. 100-08, ch. 10, § 10.4.3

A. Voluntary Terminations of Certified Providers and Certified Suppliers

For information regarding certified provider/supplier voluntary terminations, see section 10.6.1.3

of this chapter.

B. Voluntary Terminations of Non-Certified Suppliers

The contractor shall adhere to the following when processing voluntary terminations of non-certified suppliers.

1. Timeframes – The contractor shall process such voluntary terminations in accordance with

the timeframes in section 10.5 et seq. of this chapter.

2. Submission – Non-certified suppliers may only submit voluntary termination requests via the

paper application process or PECOS. They cannot do so via letter.

3. Reassignments/PTANs - When processing a voluntary termination of a reassignment, the

contractor shall contact the group to confirm that: (1) the group member PTAN is being

terminated from all locations; and (2) if multiple group member PTANs exist for multiple group

locations, each PTAN is terminated. However, if a group has one PTAN with multiple

addresses, the contractor need not contact the group to confirm the termination.

4. PECOS and Deactivations - The contractor shall identify the voluntary termination action in

PECOS as a deactivation with a status reason of “Voluntarily Withdrawal from the Medicare

Program.” Per 42 CFR § 424.540(a)(7), and unless stated otherwise in this chapter or in another

CMS directive, the effective date of the deactivation (for system purposes) shall be the day after

the date on which the supplier voluntarily withdrew from Medicare

5. Reassignments - When processing a voluntary termination of a reassignment, the contractor

shall terminate non-certified suppliers effective the day after that which the supplier requested on

its termination application. (Note that this is different from a voluntary termination of the

provider/supplier itself as addressed in subsection (B)(4) above.)

6. Special Payments - Upon receipt of a non-certified supplier voluntary termination request, the

contractor may ask the supplier to complete the “Special Payments” portion of Section 4 of the

Form CMS-855/20134 so that future payments can be sent thereto. If the supplier has no special

payments address already on file, the addition should be included in the same transaction as the

termination (i.e., one transaction incorporating both items). If the supplier wants to change its

existing special payments address, the transaction should be treated as a separate change request

(i.e., one termination and one change request). The supplier is not required to submit a Form

CMS-588 in conjunction with a termination.

C. Involuntary Terminations – Certified Providers/Suppliers

In the event an instruction in section 10.6.1 et seq. of this chapter contradicts guidance in this

section 10.4.3(C), the section 10.6.1 et seq. guidance takes precedence.

1. Notification from State or SOG Location

If the contractor receives a notice from the state or SOG Location that involuntarily terminates a

certified provider/supplier’s Medicare participation because the provider/supplier no longer

meets the conditions of participation, the contractor need not send a letter to the

provider/supplier stating that its Medicare participation has been terminated. The state or SOG

Location will issue such a letter and afford appeal rights. The contractor shall follow the

applicable instructions in section 10.4.7 et seq. of this chapter with respect to revoking the

provider/supplier’s enrollment, since the provider/supplier is no longer compliant with Medicare

enrollment regulations. (NOTE: The contractor must identify in its revocation letter the exact

provision within said statute(s)/regulation(s) with which the provider/supplier is non-compliant.)

The contractor shall record the revocation in PECOS using the status reason of “Non-Compliance: Provider/Supplier Type Requirements Not Met.” The contractor shall not identify

the involuntary termination action in PECOS as a Deactivation with a status reason of

“Voluntarily Withdrawal from the Medicare Program.” In addition, the contractor shall end-date

the entity’s enrollment record in PECOS in the same manner as it would upon receipt of a

termination notice from the SOG Location.

2. Revocation Letter

Per subsection (C)(1) above, the contractor shall issue a revocation letter to the certified

provider/supplier using 42 CFR § 424.535(a)(1) as the legal basis for the revocation. The letter

shall also contain the effective date of the revocation, appeal rights, and the length of the

reenrollment bar as determined by CMS and indicated to the contractor. (See section 10.7 et seq.

of this chapter for the applicable revocation letter.) The contractor shall e-mail a copy of the

letter to the SOG Location using the same e-mail address it normally uses when communicating

with the SOG Location’s survey and certification staff.

3. Additional Information

For more information on voluntary terminations, refer to:

• Section 1866(b)(1) of the Social Security Act

• 42 CFR § 489.52(b)

• Pub. 100-07, chapter 3, section 3046 (SOM)