CMS Issues Proposed Rule Enhancing Medicare Provider Enrollment Process.

Date posted: April 6, 2016

The Centers for Medicare & Medicaid Services (CMS) recently released a proposed rule addressing Medicare, Medicaid, and Children’s Health Insurance Program (CHIP) enrollment and revalidation requirements.  The proposed rule will expand CMS’ ability to deny or revoke provider or supplier Medicare enrollment.  Under the proposed rule, providers and suppliers seeking enrollment will be required to reveal any current or previous affiliations involving a “disclosable event.”  CMS will then determine whether the disclosable event poses an undue risk of fraud, waste, or abuse.

Disclosable events include:

Key provisions of the proposed rule include:

  • Physicians and eligible professionals ordering, certifying, referring, or prescribing under Part A or B must be enrolled or have validly opted-out of Medicare.
  • Expansion of CMS ability to deny or revoke enrollment when:
    • A physician or eligible professional repeatedly endangers Medicare beneficiary health or safety;
    • A provider or supplier has been revoked under a different name, identifier, or business identity; or
    • Other federal health care programs or others states have terminated a provider or supplier.

CMS will accept public comment on the proposed rule until May 1, 2016.

The proposed rule is available at:

Medicare, Medicaid, and Children’s Health Insurance Programs; Program Integrity Enhancements to the Provider Enrollment Process; Proposed Rule, 81 Fed. Reg. 10719, 10719-10753 (March 1, 2016).

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