Health Insurance Benefit Program

Health Insurance Benefit (HIB) Program

The Health Insurance Benefit (HIB) Program processes initial applications for Medicare certification, and conducts recertification surveys of Hospitals, Home Health Agencies, Portable X-Ray, Rehabilitation Agencies, Rural Health Clinics, End Stage Renal Disease Facilities, Comprehensive Outpatient Rehabilitation Facilities, Ambulatory Surgery Centers, Hospices, and Swing Bed Units of Hospitals.

The HIB program also processes initial applications for Medicare Certification for Community Mental Health Centers, Prospective Payment System (PPS) exempt status for psychiatric and rehabilitation units in hospitals, PPS exempt status for long term care hospitals and hospital within a hospital.

  • Health Insurance Benefits HOSPITALS Regulations: Conditions of Participation for Hospitals; 42CFR Part 482 Interpretive Guidelines:
  • HOME HEALTH AGENCIES Regulations: Conditions of Participation: Home Health Agencies; 42CFR Part 484
  • PORTABLE X-RAY Regulations: Conditions for Coverage: Portable X-Ray Services; 42CFR Part 486 Subpart C
  • REHABILITATION AGENCIES Regulations: Conditions of Participation for Clinics, Rehabilitation Agencies & Public Health Agencies as Providers of Outpatient Physical Therapy & Speech Language Pathology; 42CFR Part 485, Subpart H
  • RURAL HEALTH CLINICS (RHC) Regulations: Rural Health Clinic: Conditions for Certification; 42 CFR Part 491 Subpart A
  • END STAGE RENAL DISEASE (ESRD) Regulations: Conditions for Coverage of Suppliers of End Stage Renal Disease (ESRD)Services; 42 CFR 405 Subpart U
  • COMPREHENSIVE OUTPATIENT REHABILITATION FACILITIES (CORF) Regulations: Conditions of Participation: Comprehensive Outpatient Rehabilitation Facilities; 42 CFR 485.50 Subpart B
  • AMBULATORY SURGERY CENTERS (ASC) Regulations: Ambulatory Surgical Services; 42CFR Part 416
  • HOSPICES Regulations: Hospice Care; 42CFR Part 418
  • SWING BED UNITS Regulations: Conditions of Participation for Hospitals; 42CFR Part 482; Subpart E: 82.66-Special requirements for hospital providers of long-term care services.
    • Code of Federal Regulations; Social Security Act and Public Health Service Act

Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID)

Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID) Program surveys intermediate care facilities for individuals with intellectual disability. Surveyors meet professional qualifications of the designation Qualified Intellectual Disabilities Professional (QIDP).

ICF/IID Regulations 42 CFR 483 Subpart I Interpretive Guidance: SOM Appendix J (pdf)

Clinical Laboratory Improvement Amendments (CLIA) Program

The Clinical Laboratory Improvement Amendments (CLIA) program oversees laboratories that test human specimens for diagnostic purposes. These include hospital laboratories, stand-alone diagnostic labs, and doctors' offices.

Frequently Asked Questions about the CLIA Program