Enforcement of Medicaid Provider Enrollment Proposed for Jan. 1

Posted on October 10, 2018

The 21st Century Cures Act was signed into law in December 2016, requiring Medicaid enrollment of providers that render services to Medicaid beneficiaries, regardless of whether services are provided through Medicaid fee-for-service or Medicaid managed care organizations (MCOs). The Medical Services Administration (MSA) recently released a proposed policy to begin enforcing the Medicaid provider enrollment requirement for Medicaid health plan (MHP) and dental health plan (DHP) providers, effective Jan. 1. Enforcement of this requirement was delayed from its initially scheduled effective date of March 1, 2018.

Enrollment in the Community Health Automated Medicaid Processing System (CHAMPS) does not require or mandate managed care providers to provide services to Medicaid FFS beneficiaries. However, if the proposed rule takes effect Jan. 1, the MSA will prohibit MCOs from making payment to Medicaid providers that are not enrolled in CHAMPS and will begin to phase in provider enrollment enforcement for those Medicaid providers.

In addition, in early 2019, the MSA will begin to enforce the plan for prescribers that will prohibit Medicaid payment for prescription drug claims written by any prescriber not enrolled in CHAMPS. Teaching hospitals are encouraged to enroll all new medical residents in CHAMPS prior to the beginning of their residency programs July 1, 2019, since they must be enrolled in CHAMPS as a provider.

While compliance will be enforced in phases, all providers not yet enrolled in CHAMPS are encouraged to do so as soon as possible. Assistance is available via the provider resources reflected on page 5 of the proposed policy. Comments regarding the proposal are due to the MSA Nov. 8. Members with questions should contact Vickie Kunz at the MHA.

Tags: Medicaid, CHAMPS, 21st Century Cures Act, Enrollment

Posted in: Member News

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