Health Industry Washington Watch : Washington DC Healthcare Industry Law Firm : Reed Smith : Health Industry Washington Watch : Regulations, Medicare/Medicaid, Governmental Organizations

CMS published a proposed rule on August 3, 2011 that would implement statutory requirements and making technical corrections to various Medicaid and Children's Health Insurance Program (CHIP) regulatory provisions. Among other things, the proposed rule would: implement a new reconsideration process for administrative determinations to disallow Medicaid claims for federal financial participation (FFP); lengthen the time states have to credit the federal government for identified but uncollected Medicaid provider overpayments and provide for interest payment for amounts not credited within that time period; make conforming changes to the Medicaid and CHIP disallowance process to allow states the option to retain disputed federal funds through the new administrative reconsideration process (interest charges may accrue); and revise installment repayment standards and schedules for states that owe significant amounts. The rule also would make a technical correction to reporting requirements for disproportionate share hospital payments, revise internal delegations of authority, remove obsolete language, and correct other technical errors. Comments on the proposed rule will be accepted until September 2, 2011. 

• Email This
• Print
• Comments
• Trackbacks
• Share Link

On March 23, 2011, the Centers for Medicare & Medicaid Services (CMS) published a notice announcing that the 2011 Medicare application fee for institutional providers (excluding physicians and nonphysician practitioners) is $505. Note that CMS has adopted a broad definition of institutional entities subject to the application fee; it applies to “any provider or supplier that submits a paper Medicare enrollment application using the CMS-855A, CMS-855B (not including physician and nonphysician practitioner organizations), CMS-855S or associated Internet-based PECOS enrollment application.” As authorized under CMS’s February 2, 2011 final Medicare/Medicaid/CHIP provider screening rule, institutional providers must pay the application fee when enrolling in Medicare, revalidating their Medicare enrollment, or adding a new Medicare practice location, effective March 25, 2011. Likewise, effective March 25, 2011 prospective or re-enrolling Medicaid or CHIP providers must submit the applicable application fee unless: (1) the provider is an individual physician or nonphysician practitioner; or (2) the provider is enrolled in Medicare or another state’s Medicaid or CHIP program and has already paid an application fee. The application fee will be used to fund new provider screening tools, such as unannounced site visits, background checks, and fingerprinting, and other program integrity efforts. The provider screening rule established a hardship exception process and allows Medicaid to waive the fees in certain circumstances. CMS also has released information on the mechanics of making application fee payments. For more information about the rule, see Reed Smith’s alert.

• Email This
• Print
• Comments
• Trackbacks
• Share Link

On February 2, 2011, the Centers for Medicare & Medicaid Services (CMS) published a final rule with comment period (Final Rule) implementing provisions of the Affordable Care Act (ACA) that strengthen provider and supplier screening provisions under Medicare, Medicaid, and the Children's Health Insurance Program (CHIP). The rule is effective March 25, 2011, as mandated by the ACA (although CMS is delaying the effective date of a provision requiring fingerprint-based criminal history record checks for certain providers until after additional subregulatory guidance is issued).

Among many other things, the Final Rule applies various screening tools, including unannounced site visits, background checks, and fingerprinting, based on the level of risk associated with different provider and supplier types. The Final Rule also: imposes application fees on institutional providers and suppliers; authorizes CMS and states to impose moratoria on new provider enrollment to protect against a high risk of fraud; authorizes the suspension of payments pending an investigation of a credible allegation of fraud; provides guidance to states regarding termination of providers from Medicaid and CHIP if terminated by Medicare or another state program; and addresses termination of providers and suppliers from Medicare if terminated by a Medicaid state agency. The rule also discusses comments regarding an ACA requirement that providers or suppliers in certain industry sectors establish compliance programs; these comments will be considered in a future rulemaking.

CMS notes it has identified specific provisions surrounding implementation of fingerprinting for certain providers and suppliers that may be subject to change based on public comments; comments on the fingerprinting requirements only will be accepted until April 4, 2011.

Our full alert provides an analysis of the major provisions of the extensive Final Rule.

• Email This
• Print
• Comments
• Trackbacks
• Share Link

On February 17, 2011, CMS published a final rule establishing the methodologies and procedures for determining states’ FY 2009 through 2015 allotments for the Children's Health Insurance Program (CHIP). The rule reflects statutory changes included in the Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA), as amended by the ACA.

• Email This
• Print
• Comments
• Trackbacks
• Share Link

On February 2, 2011, the Centers for Medicare & Medicaid Services is publishing a final rule implementing provisions of the Affordable Care Act (ACA) that strengthen provider and supplier screening provisions under the Medicare, Medicaid, and Children's Health Insurance Program (CHIP). The rule is effective March 25, 2011, as mandated by the ACA.  Based on the level of risk associated with different provider and supplier types, CMS will apply three levels of screening tools: (1) “limited risk” providers will have enrollment requirements, license, and database verifications (although CMS has not finalized its proposal to check tax delinquency status); (2) those in the “moderate risk” category will have those verifications plus unscheduled site visits; and (3) high risk providers and suppliers will have verifications, unscheduled site visits, and fingerprint-based criminal history record checks of law enforcement repositories. CMS has modified certain the provider risk assignments in the final rule and specified risk levels for other provider types that were not addressed in the September 23, 2010 proposed rule. CMS also decided not to consider all publicly-traded companies to be in the “limited risk” category, and it eliminated the distinction between government-owned and non-government owned ambulance companies for purposes of the screening level assignments.  Additional details are available after the jump.

• Email This
• Print
• Comments
• Trackbacks
• Share Link

On October 15, 2010, HHS published a final notice to implement a Children’s Health Insurance Program Reauthorization Act of 2009 provision that requires recalculation of the Federal Medical Assistance Percentage (FMAP) for Medicaid federal matching funds in certain instances. Specifically, the notice sets forth the methodology HHS will use to determine the need for, and amount of, recalculation of a state’s FMAP to disregard identifiable significantly disproportionate employer pension or insurance fund contributions for a state. As HHS notes, when these contributions are counted, it increases state personal income and consequently decreases the FMAP for the state.

• Email This
• Print
• Comments
• Trackbacks
• Share Link

On October 1, 2010, CMS informed state Medicaid directors that it is instituting changes in the state plan amendment (SPA) review process to enable more efficient reviews of modifications to Medicaid state plans. As described in detail in the memo to states, CMS is providing states with the option to resolve issues related to state plan provisions that are not integral to the SPA through a separate process. CMS also intends to use this new approach in review of SPAs related to the Children’s Health Insurance Program (CHIP). 

• Email This
• Print
• Comments
• Trackbacks
• Share Link

This post was written by Daniel A. Cody, Scot T. Hasselman, Carol C. Loepere and Debra A. McCurdy.

On September 23, 2010, the Centers for Medicare & Medicaid Services (CMS) published a proposed rule that would implement provisions of the Affordable Care Act (ACA) designed to strengthen provider and supplier screening requirements under the Medicare, Medicaid, and Children’s Health Insurance Program (CHIP). According to CMS, the Proposed Rule is intended to ensure "that only legitimate providers and suppliers are enrolled in Medicare, Medicaid, and CHIP, and that only legitimate claims will be paid."

Among many other things, the Proposed Rule would: apply screening tools, including unannounced site visits, background checks, and fingerprinting, based on the level of risk associated with different provider and supplier types; impose a $500 application fee on certain providers and suppliers; authorize temporary moratoria on enrollment of certain types of new providers and suppliers; require Medicare and Medicaid payments to be suspended upon credible allegations of fraud; and update various Medicaid screening requirements. Comments on the proposed rule will be accepted until November 16, 2010.

Our full alert provides an analysis of the proposed rule.

• Email This
• Print
• Comments
• Trackbacks
• Share Link

On September 17, 2010, CMS published a proposed rule that would implement an Affordable Care Act of 2010 (ACA) provision establishing transparency and public notice procedures for experimental, pilot, and demonstration projects approved under section 1115 of the Social Security Act relating to Medicaid and the Children’s Health Insurance Program (CHIP). Comments on the proposed rule will be accepted until November 16, 2010.

• Email This
• Print
• Comments
• Trackbacks
• Share Link

On August 10, 2010, CMS published a final rule designed to reduce the rate of errors in Medicaid and the Children’s Health Insurance Program (CHIP). The rule implements provisions from the Children’s Health Insurance Program Reauthorization Act of 2009 with regard to the Medicaid Eligibility Quality Control and Payment Error Rate Measurement programs, and it codifies several procedural aspects of the process for estimating Medicaid and CHIP improper payments. The rule is effective September 10, 2010. CMS has posted additional background materials regarding the rule here. 

• Email This
• Print
• Comments
• Trackbacks
• Share Link

CMS is seeking public input as it develops recommendations for legislative changes to improve the quality of care provided to children under Medicaid and CHIP, including recommendations for quality reporting by the states, as mandated by the Children's Health Insurance Program Reauthorization Act of 2009. Comments are due August 30, 2010. 

• Email This
• Print
• Comments
• Trackbacks
• Share Link

On September 16, 2009, CMS published a proposed rule regarding the methodology and procedures for determining state Children's Health Insurance Program (CHIP) allotments, as provided under the Children's Health Insurance Program Reauthorization Act of 2009 and other related legislation. CMS will accept comments on the proposed rule until November 16, 2009.

• Email This
• Print
• Comments
• Trackbacks
• Share Link

The Centers for Medicare & Medicaid Services (CMS) has issued a proposed rule to implement provisions from the Children's Health Insurance Program Reauthorization Act of 2009 with regard to the Medicaid Eligibility Quality Control (MEQC) and Payment Error Rate Measurement (PERM) programs. The rule also would also codify several procedural aspects of the process for estimating improper payments in Medicaid and the Children's Health Insurance Program (CHIP). CMS is accepting comments on the proposed rule until August 14, 2009. 

• Email This
• Print
• Comments
• Trackbacks
• Share Link