Medicare, Medicaid, and Children’s Health Insurance Programs

This final rule implements provisions of the Affordable Care Act that establish the following: procedures under which screening is conducted for providers of medical or other services and suppliers in the Medicare and Medicaid programs and Children’s Health Insurance Program (CHIP); an application fee imposed on institutional providers and suppliers; temporary moratoria that may be imposed if necessary to prevent or combat fraud, waste, and abuse under Medicare, Medicaid, and CHIP; guidance for states regarding termination of providers from Medicare, Medicaid, and CHIP; and requirements for suspension of payments pending credible allegations of fraud in the Medicare and Medicaid programs. Public schools deliver Medicaid school-based health services to Medicaid-eligible children and therefore are enrolled as Medicaid providers. Commenters objected to the proposed requirement in § 455.104 that the schools provide the SSNs and DOBs of persons with controlling interests of the provider, which they interpreted to include the SSNs and DOBs of school board members. According to the Department of Health and Human Services (HHS), except to the extent that any public school districts may be organized as corporations, they were not previously required to make disclosures about their boards, nor are they required to under this new rule. Commenters also expressed concern about public school-based providers, for example, speech language therapists, school psychologists, occupational therapists, and physical therapists, employed by public school districts being required to enroll with the Medicaid agency as ordering and referring physicians or other professionals. However, according to HHS, as a way to minimize the administrative burden of enrolling additional providers, state Medicaid agencies may implement a streamlined enrollment process for those providers who only order or refer, that is, who do not bill for services, similar to the CMS–855–O process in the Medicare program. Finally, a number of commenters stated that public school districts should be exempt from having to pay the application fee. However, according to HHS, to the extent that a state determines, consistent with the approved state plan, that a local school district is an institutional provider for purposes of this provision, then it would be subject to the application fee. These regulations are effective on March 25, 2011.

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