On April 18, 2003, CMS published Program Memorandum A-03-030. This transmittal can be found at http://cms.hhs.gov/manuals/pm_trans/A03030.pdf. It largely repeats and summarizes current CMS rules and policy on provider-based status. It also includes a sample attestation form. Although providers are not required to use this form if they opt to seek provider-based approval from CMS, it is probably easier to use CMS' form than to devise one's own form. The attestation form, which is essentially an application for provider-based status, is optional. Providers that submit an attestation and receive CMS approval for provider-based status will have comfort that such status cannot be taken away retrospectively so long as the attestation was accurate and there have been no material changes.

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