Program Integrity Provisions of the Affordable Care Act Provider Enrollment and Screening: Are You Ready?
The Department of Public Welfare is in the midst of implementing the Provider Enrollment and Screening Provisions of the Affordable Care Act (42 CFR 455 Subpart E). This Act contains many changes for MA providers:
Implementation Activities In Progress:
- Enrollment of Prescribing, Ordering, and Referring Providers
- Collection of Institutional Application Fees
- Risk Level Assessments (site visits, fingerprinting, criminal background checks) (on hold pending guidance from CMS)
- Enhanced Post Enrollment Provider Screening
Completed Implementation Activities:
- Revalidation Announcement to all providers who have not completed new enrollment applications for their service locations prior to March 24, 2016 (Issued March 2, 2014, MAB 99-14-06)
- Enhanced Pre Enrollment Provider Screening (Completed prior to ACA)
- Federally Imposed Enrollment Moratoria Procedures
- Collection of Additional Information (including SSN) for all Board Members (including voluntary), Managing Employees and Agents with >5% Controlling Interest (Completed August 22, 2011)
- NPI on all Media: Electronic, Paper, and Internet (edits were set to deny on claims submission dates January 1, 2013)
We will be posting details for each aspect as implementation dates are scheduled. They will be announced on this website, so check back frequently.
REVALIDATION OF ALL PROVIDERS REQUIRED BY MARCH 24, 2016
- The Affordable Care Act (§ 455.414) requires the Department to validate ALL new providers and revalidate ALL existing providers by March 24, 2016.
- Medical Assistance Bulletin 99-14-06, issued on March 2, 2014 contains additional information regarding this requirement. This bulletin can be found at: http://www.dpw.state.pa.us/cs/groups/webcontent/documents/bulletin_admin/c_074003.pdf
- Providers will need to complete a full new enrollment application for their provider type for each site of service (service location) in sufficient time for the Department to screen and approve by March 24, 2016, including prescribing, ordering and referring providers.
- If you have not already done so, please plan on submitting your provider application prior to this date, and plan for additional time for processing.
- If this is not completed, all service locations that are not revalidated will automatically expire.
- The Department expects longer wait times for approvals and heavier volumes close to the March 24, 2016 deadline. Please plan to submit your renewed applications in sufficient time for a continuous enrollment period to avoid disruptions in service and claims.
- You may have already revalidated! Beginning October 2013, all provider letters and portal login screens will contain your next revalidation due date. Look for changes on the provider portal for each 13-digit logon to check your service location. QuickTip 155 describes in detail where this information is accessible on the Provider Portal: http://www.dpw.state.pa.us/cs/groups/webcontent/documents/communication/p_034770.pdf
The Race is On!
See your provider type below to chart revalidation progress!
PRESCRIBING, ORDERING, and REFERRING PROVIDERS
The Affordable Care Act (§ 455.440) requires the Department to deny claims that require prescribing, ordering, and referring providers if they are not enrolled in PA Medical Assistance.
Claims will not pay once the Department sets edit dispositions to deny for this requirement.
The Department will issue an MAB and other communication materials announcing a target date.
Helpful Contacts and Links
For specific questions about these provisions, how PA MA will be implementing, and how these provisions may apply to you, please submit questions to: RA-FFS_ACA@pa.gov
Look for future MABs on the above topics for more information on these implementations
Thank you for your service to our Medical Assistance recipients. We value your participation!