On September 23, 2010, the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule that would implement various provisions of the Patient Protection and Affordable Care Act (PPACA). Specifically, the proposed rule implements sections 6401, 6402, 6501, 10603 and 1304 of PPACA. Most notably the proposed rule establishes:
1.Procedures under which screening is conducted for providers of medical or other services and suppliers in the Medicare program, providers in the Medicaid program, and providers in the Children's Health Insurance Program (CHIP);
2.An application fee to be imposed on providers and suppliers;
3.Temporary moratoria that may be imposed if necessary to prevent or combat fraud, waste, and abuse under the Medicare and Medicaid programs, and CHIP;
4.Guidance for States regarding termination of providers from Medicaid and CHIP if terminated by Medicare or another Medicaid State plan or CHIP;
5.Guidance regarding the termination of providers and suppliers from Medicare if terminated by a Medicaid State agency; and
6.Requirements for suspension of payments pending credible allegations of fraud in the Medicare and Medicaid programs.
Additionally, the proposed rule presents an approach and requests comments on the provisions of PPACA that require providers of medical or other items or services or suppliers within a particular industry sector or category to establish compliance programs. The comments are due by November 16, 2010.
Changes to Medicare and Medicaid Provider and Supplier Enrollment Process
Suspension of Medicare and Medicaid Payments Pending Investigation of Credible Allegations of Fraud