Deadline Fast-Approaching for Medicaid Managed Care Participating Providers

November 7, 2017 | Geoffrey R. Kaiser | Ashley S. Osadon | Compliance Investigations & White Collar | Health Services

The deadline for required enrollment with Medicaid under the Federal 21st Century Cures Act (Cures Act) is fast approaching. Currently, Medicaid Managed Care providers are sending mass mailings to their participating providers with notices of required compliance.

By December 1, 2017 certain participating healthcare providers of New York State Medicaid Managed Care plans or the Children’s Health Insurance Program are required to enroll with the Medicaid program. Those affected include, but are not limited to, physicians, chiropractors, adult day healthcare facilities and clinical social workers. The New York State Department of Health has issued information regarding which types of providers are required to enroll with Medicaid, and those who need not enroll under the new rule. This information can be found here.

In New York, Medicaid Managed Care participating providers must submit their enrollment applications to CSRA, the New York State Medicaid Program’s fiscal agent, by the December 1 deadline in order to comply with the Cures Act. The New York State Medicaid program provides a convenient online enrollment process at eMedNY.org.

Although providers are required to enroll with Medicaid if they participate with a Medicaid Managed Care plan, they are not required to provide services to straight Medicaid beneficiaries or to beneficiaries of other Medicaid managed care plans in which the provider does not participate, so long as the provider specifically enrolls as a non-billing Ordering/Prescribing/Referring/ Attending (OPRA) provider. Providers must check the appropriate box on the top of the Medicaid enrollment application if they do not wish to provide services to patients with Medicaid, but wish to continue to provide services to their Medicaid Managed Care beneficiaries.

Providers should be diligent and swift in ensuring compliance with all federal and state requirements, as non-compliance may lead to overpayment or other administrative and legal obstacles, including termination from participation with all Medicaid Managed Care plans to which the provider is currently enrolled.

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