CMS Pub. 100-08, ch. 10, § 10.6.1.3

The CMS Provider Enrollment & Oversight Group (PEOG) and Medicare Administrative

Contractors have assumed a number of enrollment-related functions previously handled by

state agencies (hereafter occasionally referenced as “state”) and CMS Survey & Operations

Group Locations (SOG Locations) concerning certified provider and certified supplier

voluntary terminations. This section 10.6.1.3 instructs the contractor on how to process such

transactions. Unless stated otherwise, these instructions take precedence over those in

section 10.4.3 of this chapter.

Except as stated otherwise in this chapter, this section does not apply to voluntary

terminations pursuant to an HHA change in majority ownership under § 424.550(b)(1).

Instructions concerning the handling of these transactions are in section 10.2.1.6.1 of this

chapter.

A. Background

Consistent with the principles of 42 CFR § 489.52(a) (and except as otherwise required), a

certified provider/supplier that wishes to terminate its agreement with Medicare must send

written notice of its intention to the SOG Location, the state agency, or the contractor within the

timeframes addressed in § 489.52. Under CMS Publication (Pub.) 100-07, chapter 2, section

2005F, the notice is a letter on letterhead with an authorized signature.

Submission of a Form CMS-855 voluntary termination application is not mandatory but is highly

preferred. Providers and suppliers are encouraged to continue to submit this form.

Section 10.6.1.3(B) below discusses various scenarios that the contractor may encounter in

processing certified provider/supplier voluntary terminations. These should be reviewed and

considered in conjunction with the policies in section 10.6.1.3(C) below, particularly those in

subsections (C)(2), (C)(3), (C)(6), and (C)(7).

B. Situations and Scenarios

1. Termination Reported to Contractor Via Form CMS-855 or Letter with No Prior Notice

from State Agency or SOG Location

If the contractor receives a Form CMS-855 voluntary termination application or a voluntary

termination letter (but not both) directly from a certified provider/supplier without having

received any termination notification from the state/SOG Location, the following apply:

(i) The contractor shall: (a) process the application/letter consistent with the timeframes for

voluntary terminations in section 10.4.3 of this chapter; and (b) as applicable, follow the

instructions in section 10.6.1.3(C) below.

(NOTE: If the application/letter is from a skilled nursing facility (SNF), the contractor shall

contact the state agency to determine whether the SNF complies with the requirements of 42

CFR §§ 483.15(c)(8) and 483.70(l). These two provisions address the SNF’s required notice to

the state of an impending closure and patient safety. If the state indicates that the SNF is not

compliant, the contractor shall contact its PEOG Business Function Lead (BFL) for guidance; if

compliance is confirmed, the contractor can proceed as normal.)

(ii) Prior to finalizing its processing of the Form CMS-855 or letter submission, the contractor

shall e-mail a copy of the draft approval letter (see the applicable model letter in section

10.7.5.1) containing the appropriate termination effective date, reason for termination, and

source of the termination notice (i.e., Form CMS-855 or letter) to PEOG at

MedicareProviderEnrollment@cms.hhs.gov, with “S&C Voluntary Termination” in the e-mail’s

subject line.

(iii) PEOG will update the Automated Survey Process Environment (ASPEN) system, notify the

contractor thereof, and, if the provider/supplier is deemed, provide the contractor the name and

e-mail address of the applicable accreditation organization (AO).

(iv) Within 3 business days of receiving of the aforementioned notice from PEOG, the contractor

shall: (1) e-mail a copy of the final signed approval letter to the provider/supplier, SOG

Location, state agency, and AO (if the provider/supplier is deemed); and (2) deactivate the

provider/supplier in the Provider Enrollment, Chain and Ownership System (PECOS) pursuant to

the instructions/guidance in section 10.6.1.3(C)(9) below.

2. Termination Reported to Contractor Via Form CMS-855 and Letter with No Prior

Notice from State Agency or SOG Location

If the contractor receives a Form CMS-855 voluntary termination application and a voluntary

termination letter directly from a certified provider/supplier without having received any

termination notification from the state/SOG Location, the following apply:

(i) If the Form CMS-855 and letter arrive either simultaneously or before the contractor begins

processing one of them, the contractor has the discretion to determine which submission to

process unless a Form CMS-855 was submitted via PECOS; in this latter case, the contractor

shall process the Form CMS-855 rather than the letter. It need not process both of them; the

submission that the contractor does not process may be returned (consistent with the instructions

in this chapter) or placed in the provider/supplier file, and the contractor need take no further

action thereon.

(ii) If the contractor receives both submissions and it has begun processing one of them, the

contractor shall continue processing that document. The contractor can return the other

submission (consistent with the instructions in this chapter) or place it in the provider/supplier

file; no further action thereon is required.

(iii) Regardless of whether (2)(i) or (ii) applies, the contractor shall process the submission

consistent with the instructions in section 10.6.1.3(B)(1) above.

3. Notice of Voluntary Termination Received from State Agency and/or SOG Location

without the Contractor Having Received a Form CMS-855 or Letter Directly From the

Provider/Supplier

Although many voluntary termination submissions from certified providers/suppliers are via the

Form CMS-855, there are occasions where the provider/supplier will only notify the state agency

and/or SOG Location. The contractor will typically learn of this when it receives a Form CMS-

1539 (“Medicare/Medicaid Certification and Transmittal”) and/or other written notification from

the state/SOG Location. (The state uses the Form CMS-1539 to communicate findings to the

SOG Location with respect to a facility’s compliance with health and safety requirements.) In

such situations, the following apply:

(i) The contractor may accept from the state/SOG Location written documentation other than the

Form CMS-1539. This includes, for example, a Form CMS-2007 or even a voluntary

termination letter of the type described in sections 10.6.1.3(B)(1) and (B)(2) above; indeed, the

provider/supplier sometimes sends its termination letter directly to the state/SOG Location and

the latter simply forwards it to the contractor.

If the contractor has questions concerning said documentation, it shall contact the state/SOG

Location for clarification. (This could include situations when it is unclear: (1) whether a

termination is involved; (2) which provider/supplier is to be terminated; or (3) if the state

forwards to the contractor a termination request that the state received from the provider,

whether the state considers it to be a valid termination request.).

(ii) Upon receipt of the Form CMS-1539 (or other/additional state/SOG Location document), the

contractor need not develop with the provider/supplier for a Form CMS-855A/B voluntary

termination application or a letter. Instead:

(A) The contractor shall abide by the applicable instructions in section 10.6.1.3(C) below (e.g.,

section (C)(6) regarding effective dates; section (C)(7) concerning cessations of business). If the

notice from the state was a voluntary termination letter from the provider/supplier (as described

in section 10.6.1.3(B)(3)(i) above), the contractor shall pay particular attention to the instructions

in section 10.6.1.3(C)(3) below.

(B) The contractor shall e-mail a copy of the draft approval letter (see section 10.7.5.1 of this

chapter) containing the appropriate termination effective date, reason for termination, and source

of the termination notice to MedicareProviderEnrollment@cms.hhs.gov, with “S&C Voluntary

Termination” in the subject line.

(C) PEOG will update ASPEN, notify the contractor thereof, and, if the provider/supplier is

deemed, provide the contractor the name and e-mail address of the applicable AO.

(D) Within 3 business days of receiving of the aforementioned notice from PEOG, the contractor

shall: (1) e-mail a copy of the final signed letter to the provider/supplier, SOG Location, state

agency, and AO (if the provider/supplier is deemed); and (2) deactivate the provider/supplier in

PECOS pursuant to the instructions/guidance in section 10.6.1.3(C)(9)) below.

4. Notification of Termination Received from the State Agency and/or SOG Location and

Directly from the Provider/Supplier Via the Form CMS-855 and/or Letter

The contractor shall adhere to the instructions in this section (B)(4) in the following situations:

(i) The contractor receives notification of termination (i.e., via Form CMS-1539 or other

documentation) from the state/SOG Location after the provider/supplier has been

deactivated in PECOS pursuant to the latter’s Form CMS-855/letter voluntary termination

submission - Within 10 calendar days of receiving the state/SOG Location notification, the

contractor shall inform the state/SOG Location via e-mail that the provider/supplier has already

been deactivated in PECOS and terminated in ASPEN. No further action by the contractor is

necessary.

(ii) The contractor receives notification of termination from the state/SOG Location while

the contractor is processing a Form CMS-855/letter voluntary termination submission but

before the provider/supplier has been deactivated in PECOS – The contractor shall: (i)

continue processing the application/letter normally and to completion, consistent with the

instructions in this section 10.6.1.3; and (ii) e-mail a copy of the final signed letter to the

provider/supplier, SOG Location, state agency, and AO (if the provider/supplier is deemed) after

the provider/supplier has been deactivated in PECOS.

(iii) The contractor receives notification of termination (i.e., via Form CMS-1539 or other

documentation) from the state/SOG Location before the contractor received or began

processing the provider’s/supplier’s Form CMS-855/letter voluntary termination

submission – The contractor:

(A) Shall follow the instructions in section 10.6.1.3(B)(3) above

(B) Need not contact the provider/supplier about its Form CMS-855/letter submission prior to

the completion of all of the steps in section 10.6.1.3(B)(3)(ii) above

(C) Either in the termination approval letter (which the contractor may modify for the purpose)

sent to the provider/supplier or via a simultaneous or separate e-mail to the provider/supplier, the

contractor shall notify the provider/supplier that its submission to the contractor was not

processed due to the provider/supplier’s prior notification to the state/SOG Location. (If this

communication is sent separately from the approval letter or the e-mail containing the letter, the

contractor shall send the separate e-mail no later than 10 calendar days after sending the letter.)

(iv) The contractor receives notification of termination from the state/SOG Location and a

separate voluntary termination Form CMS-855/letter from the provider/supplier without

having begun the processing of either – The contractor has the discretion to determine which

submission to process unless a Form CMS-855 was submitted via PECOS; in this latter case, the

contractor shall process the Form CMS-855. It need not process both of them; the submission

that the contractor does not process may be returned (consistent with the instructions in this

chapter) or placed in the provider/supplier file, and the contractor need take no further action

thereon.

C. Additional Certified Provider/Supplier Voluntary Termination Policies

1. Completion of Form CMS-1539 – The state completes the Form CMS-1539. In Part II

thereof, the following fields contain: (i) 26-Termination Action “00”; Code for a voluntary

termination; and (ii) 28 –Termination Date; this is the effective date of the voluntary termination.

2. Required Contents of Voluntary Termination Letter Received Directly from Provider/Supplier

– If the contractor is processing a voluntary termination letter it received directly from the

provider/supplier (as opposed to receiving it from the state/SOG Location), the contractor shall

ensure that the letter:

• Is on the provider/supplier’s letterhead

• Contains the provider/supplier’s legal business name, NPI, and CMS Certification Number

(CCN)

• States with sufficient clarity (in the contractor’s judgment) that the provider/supplier wishes

to terminate its Medicare provider/supplier agreement and/or enrollment. (No exact,

uniform, standard language from the provider/supplier is necessary; the letter must merely

furnish adequate notice of the provider/supplier’s intentions).

• Is signed and dated by an authorized representative of the provider/supplier. This person

need not be on file as an authorized or delegated official of the provider/supplier. The

contractor shall accept the individual’s signature if it has no reason to suspect that the

individual lacks the authority to act on the provider/supplier’s behalf. If it has doubts,

however, it may contact its PEOG for guidance.

(The applicable regulations do not require that the letter contain the termination effective date or

the reason for the termination. For purposes of ascertaining the effective date and reason, the

contractor shall follow the instructions in section 10.1.3(C)(6).)

If the letter does not meet all of the above requirements, the contractor shall develop with the

provider/supplier for the missing or deficient information. Development shall be consistent with

the general developmental instructions in this chapter (e.g., 30 days for provider/supplier to

respond) except as follows:

• The contractor may develop for the missing or clarifying information via any means, even by

telephone. No application development letter is required.

• Except as stated in sections 10.6.1.3(C)(3) and (C)(6) below, all missing or clarifying data

must be furnished via a new letter signed by an authorized representative (who need not be

the same person who signed the original letter).

If the provider/supplier fails to respond fully and completely to the aforementioned request

within the required timeframe, the contractor shall contact its PEOG BFL for guidance and

include a copy of the initial provider/supplier letter in the e-mail to PEOG.

(See section 10.6.1.3(C)(3) below for instances where the guidance in this section 10.6.1.3(C)(2)

may apply to voluntary termination letters submitted to the state/SOG Location rather than to the

contractor.)

1. Provider/Supplier’s Voluntary Termination Letter Received Directly from the state/SOG

Location Without the Contractor Having Received a Termination Notification from the

Provider/Supplier – As explained in section 10.6.1.3(B)(3) above, the contractor may receive a

provider/supplier’s voluntary termination letter directly from the state/SOG Location without

having received any termination notification (i.e., letter or Form CMS-855) from the

provider/supplier. If the contractor encounters this situation, the contractor shall adhere to the

following:

(i) Provider/Supplier Voluntary Termination Letter Received from State/SOG Location Without

Other Confirming Documentation - If the letter is unaccompanied by a Form CMS-1539 or other

documentation signifying that the state/SOG Location (1) considers the termination letter as

valid or (2) otherwise accepts the termination request, the contractor shall contact the state via e-mail for clarification on these issues. If the state indicates that it considers the provider/supplier

as having terminated its provider/supplier agreement, the contractor shall process the termination

consistent with the instructions in section 10.6.1.3(B)(3); any missing or unclear information

(e.g., reason for the termination, effective date, CCN) shall be obtained from the state and/or

SOG Location. If the state is merely forwarding the provider/supplier letter to the contractor for

processing without making any determination as to whether the termination is valid, the

contractor shall process the letter consistent with the instructions in section 10.6.1.3(B)(1) and

(C)(2).

(ii) Provider/Supplier Voluntary Termination Letter Received from State/SOG Location With

Additional Documentation Confirming that the State Considers the Provider/Supplier As Having

Terminated Its Agreement - The contractor shall process the termination consistent with the

instructions in section 10.6.1.3(B)(3).

4. Tie-Out Notices – SOG Locations no longer issue tie-out notices (Form CMS-2007) for

voluntary terminations.

5. Special Payments - Upon receipt of a Form CMS-855 voluntary termination application or a

voluntary termination letter directly from the provider/supplier per the instructions in this section

10.6.1.3, the contractor may (but is not required to) ask the provider/supplier to complete or

update the “Special Payments” portion of Section 4 of the Form CMS-855 so that future

payments can be sent thereto. If the provider/supplier is adding a special payment address, it

should be included in the same transaction as the voluntary termination action (i.e., one

transaction incorporating both items). If the provider/supplier is changing its existing special

payments address, the transaction constitutes a separate change request (i.e., one termination and

one change request). The provider/supplier is not required to submit a Form CMS-588 in

conjunction with a termination.

6. Termination Effective Dates and Termination Reasons – As noted previously, § 489.52(b)

outlines the applicable effective dates for voluntary terminations. The contractor shall adhere to

the following instructions regarding these dates as well as certain situations pertaining to

termination reasons:

(i) The contractor receives a Form CMS-855 or voluntary termination letter per section

10.6.1.3(B)(1) or (B)(2) (i.e., the contractor receives a termination submission from the

provider/supplier before receiving notification from the state/SOG Location):

(A) If the provider/supplier’s submission is missing either the effective date of termination or the

reason for the termination (or if either data element is not sufficiently clear to the contractor), the

contractor shall develop with the provider/supplier for the missing/unclear data. The contractor

may develop for the information via any means, even by telephone; no development letter is

required. The provider/supplier must furnish the data via e-mail or other written format, but a

new letter is not required. If the provider/supplier fails to submit the requested data within 30

days, the contractor shall contact its PEOG BFL for guidance. If the provider/supplier submits

the data, the following effective dates apply:

(1) The termination reason is that the provider/supplier has ceased business (which includes non-operational status) – The termination effective date in ASPEN is that on which the

provider/supplier stopped providing services to the community. (See section 10.6.1.3(C)(6)(i)(C)

below for additional instructions concerning cessations of business.)

(2) The termination reason does not involve a cessation of business or non-operational status

(e.g., the provider simply wishes to depart Medicare without closing its business; the provider

elects not to renew its state license) – The contractor shall include on the draft approval letter the

termination effective date the provider/supplier furnished. However, the contractor shall include

in its e-mail to PEOG (see section 10.6.1.3(B)(1)(ii) above) notification as to whether this

effective date is less than 6 months from the date on which the contractor first received the

provider/supplier’s Form CMS-855/letter. If it is less than 6 months, PEOG will determine

whether this termination effective date is acceptable.

(B) If the provider/supplier’s initial submission contains the termination effective date and

reason, and no development on these issues is needed, the contractor shall proceed as instructed

per, as applicable, sections 10.6.1.3(B)(1), (B)(2), and (C)(6)(i)(A) above.

(C) In cases where a cessation of business (including non-operational status) is involved, a

retroactive termination effective date is permissible if there were no Medicare beneficiaries

receiving services from the facility on or after the requested termination date. The contractor

shall confirm this via a claims review prior to forwarding the e-mail and approval letter to PEOG

per section 10.6.1.3(B)(1)(ii). If claims were submitted, the contractor shall contact the

provider/supplier via e-mail to confirm that services were indeed rendered and adjust the

termination date with the provider/supplier; if no adjustment is made or contact cannot be made,

an overpayment request must be issued.

(ii) The contractor is processing a Form CMS-1539 or other documentation received from the

state/SOG Location other than the provider/supplier’s voluntary termination letter – The

contractor shall use the termination date listed on the Form CMS-1539 or other documentation as

the termination effective date, even if a subsequent submission from the provider/supplier (e.g.,

Form CMS-855) uses a different date. If no termination date is listed on the submission from the

state/SOG Location, the contractor shall contact the state agency for guidance.

Except as otherwise stated in this section 10.6.1.3 or unless directed otherwise by PEOG, the

contractor: (1) shall use/apply the termination effective date listed on whichever submission it is

processing (e.g., the contractor is processing the provider’s Form CMS-855 voluntary

termination application before receiving any documentation from the state); and (2) need not

alter this termination effective date based on a subsequent submission from provider/supplier or

the state/SOG Location.

7. State Agency Performs Survey Based on Cessation of Business

(i) Solicitation of Information

Situations may arise where the state (i) performs a survey of a certified provider/supplier based

on a compliant or a cessation of business and (ii) finds that the provider/supplier is no longer

operational and/or has vacated the practice location. The state will notify the contractor of its

findings via the Form CMS-1539 or other documentation. Upon receipt of this documentation,

the contractor shall send to the provider/supplier the applicable notice in section 10.7.2 of this

chapter requesting that the provider/supplier: (1) provide evidence to the contractor (with a copy

to the state) that it is still operational; (2) submit a request to the contractor (either via letter or a

Form CMS-855) to voluntarily terminate its enrollment; or (3) submit a Form CMS-855 change

of information application to report a changed practice location address (and any other changed

data). The contractor shall copy the state and SOG Location on the notice and give the

provider/supplier 10 calendar days from the date the notice is sent to respond to the request.

(ii) Potential Outcomes

(A) The provider/supplier timely furnishes evidence to the contractor and the state that it is still

operational at the same location – The contractor need take no additional action on the matter

until it receives confirmation from the state concerning the latter’s review. (If the contractor

receives evidence from the provider/supplier more than 10 days after the request was made, it

shall contact the state for guidance.)

While the contractor may forward the provider/supplier’s evidence to the state to ensure that the

latter received it, the contractor is not required to do so. It is ultimately (1) the

provider/supplier’s responsibility to copy the state on its submission to the contractor and (2) up

to the state to determine whether the evidence of operational status the provider/supplier

submitted is sufficient.

Upon receiving notice from the state as to the review’s results, the contractor shall follow the

applicable instructions in this section 10.6.1.3 if the provider/supplier is to be terminated (e.g.,

the state sends a Form CMS-1539 to the contractor). If the provider/supplier was indeed found

operational, the contractor need take no further action.

(B) The provider/supplier submits a Form CMS-855 voluntary termination and/or a voluntary

termination letter in response to the contractor’s aforementioned solicitation - The contractor

shall process the submission consistent with the instructions in section 10.6.1.3(B)(1) and/or

(B)(2), as applicable. Notwithstanding any instruction to the contrary in this section 10.6.1.3, the

contractor shall use the termination effective date listed on the Form CMS-1539 or other

documentation from the state (rather than the date on the Form CMS-855/letter) as the

termination effective date.

(C) The provider/supplier timely submits a Form CMS-855 to change its address – The

contractor shall process the change request to completion, notify the provider/supplier thereof via

the applicable instructions in this chapter 10, and forward a copy of the change request via e-mail

to the state and SOG Location via e-mail. In this e-mail, the contractor shall: (1) notify the

state/SOG Location of the new address; (2) reference the Form CMS-1539 (or other

documentation) that the state had sent to the contractor; and (3) notify the state if PECOS

indicated any addresses other than the “old” or “new” address at which the provider/supplier

might be located.

(D) The provider/supplier fails to respond to the contractor’s solicitation - The contractor shall

process the voluntary termination consistent with the instructions in section 10.6.1.3(B)(3)

above.

8. Clock Stoppages – In any circumstance where the contractor is required under section

10.6.1.3 to contact PEOG (including sending a termination to PEOG for approval) or the

state/SOG Location for a determination, approval, or guidance of some type, the application

processing time clock is stopped. It resumes on the date on which the contractor receives

PEOG/state/SOG Location’s decision, resolution, determination, or final guidance, as applicable.

Interim communication between the contractor and PEOG/state/SOG Location during such

“waiting periods” (e.g., PEOG request for additional information from the contractor) does not

restart the clock. Optional communications---that is, communications with PEOG/state/SOG

Location that are not specifically directed under this section 10.6.1.3---do not stop the processing

clock.

9. PECOS Deactivation Date

a. Matching Dates - As indicated previously, the termination effective date will be entered into

ASPEN. The date of deactivation in PECOS (and except if PEOG instructs otherwise) should

match the termination effective date with the exception of certified suppliers paid via MCS, in

which case the PECOS deactivation date shall be the day after the termination date.

b. Already Deactivated – If the provider/supplier is already deactivated in PECOS pursuant to

42 CFR § 424.540(a)(1) through (a)(6) (i.e., the provider/supplier’s billing privileges are merely

stopped) and the provider/supplier is now voluntarily terminating enrollment, no change in the

deactivation effective date in PECOS is needed (notwithstanding any contrary instruction in this

chapter).

c. Seller CHOW - Notwithstanding paragraph (9)(b) above, the deactivation effective date in

PECOS---as well as the voluntary termination date---is the day before the date of the sale. For

certified suppliers paid via MCS, however, the deactivation effective date shall be the date of the

sale. (Note that this paragraph (9)(c) does not apply to HHA changes in majority ownership for

which no exception applies; see section 10.2.1.6.1(B) of this chapter for more information.)