Get Section 5506 Cms Application Form - Centers For Medicare ... - Cms

Filling out the Section 5506 CMS Application Form is an essential step for hospitals seeking to increase their full-time equivalent (FTE) caps as per the Affordable Care Act. This guide will provide a straightforward approach to completing the form accurately and efficiently.

Follow the steps to successfully complete the CMS Application Form.

1. Click ‘Get Form’ button to acquire the application form and open it in your preferred editor.
2. Begin by filling in the Round Number you are applying for. If you have multiple applications for different rounds, a separate form must be completed for each round.
3. Provide the name of your hospital and enter the Medicare Provider Number (CCN) assigned to your hospital.
4. Identify the Medicare Contractor associated with your hospital by entering their name.
5. Fill in the Core-Based Statistical Area (CBSA) code where your hospital is physically located, using the five-digit format.
6. Enter the name of the county where your hospital is located.
7. For each residency program, describe the Name of Specialty Training Program and select the Medicare GME Affiliated Group by checking the appropriate box for Allopathic or Osteopathic Program.
8. Indicate the Number of FTE Slots Requested for the specific program and overall if applicable. Document both Direct GME and IME slots requested.
9. Proceed to Section A and provide documentation that supports the likelihood of filling the requested slots based on the Demonstrated Likelihood Criteria (DLC).
10. Complete Section B by indicating your hospital's priority category by placing an 'X' in the appropriate box.
11. Fill out Section C with the relevant ranking criteria applicable to your application, ensuring to check each appropriate box.
12. Gather and compile all required documentation as specified in the application process, including the necessary attestations.
13. After completing the form, ensure you save your changes, and then choose to download it for printing or sharing.

Complete your application online today to ensure timely submission and compliance with CMS requirements.