The Centers for Medicare and Medicaid Services (CMS) received over 100 public comments on its proposed rule CMS 6028-P to improve the program integrity of Medicare, Medicaid and the Children’s Health Insurance Program (CHIP).  Among other things, the proposed rule included new provisions for Medicaid/CHIP provider suspensions, disclosures, screening and enrollment.  The proposed rule was published on September 23, 2010 and public comments were due by November 16th. Comments were submitted by state and national provider organizations and advocates, state agencies, managed care organizations and service providers such as home health agencies and local education agencies (LEA).

Comments were submitted on behalf of hundreds of LEAs across the country by national organizations including the National School Boards Association, the American Association of School Administrators and LEAnet.  At least ten comments were submitted by individual LEAs, six of which were from Minnesota.  All requested that LEAs be specifically exempted from the proposed rule in its entirety or from specific provisions of the proposed rule such as the suspension of payments to providers based on “credible allegations of fraud”, screening of providers and Medicaid enrollment of ordering and referring physicians and other professionals.  Approximately 30 state Medicaid agencies also individually or jointly submitted comments on CMS 6028-P.  Most agencies expressed concerns about potential administrative and financial burdens that would be caused by the proposed rule at a time when state human and financial resources are strained.

It is possible that CMS will complete its review of and responses to all comments and issue a final rule, as may be amended, within the next few weeks.  Implementation of the new screening requirements is scheduled to begin on March 23, 2011 for newly enrolling providers and on March 23, 2012 for existing providers.

About Patsy Crawford

Patsy Crawford, Director of Legal Services, PCG Education, has over 30 years of legal experience and is responsible for providing legal and regulatory compliance support to the PCG Education management team. Since joining the firm in 1997, Patsy has worked closely with school district administrators and PCG Education managers and consultants to coordinate with state and federal Medicaid agencies to protect and improve billing programs for school districts. She has provided direct legal support to PCG Education projects in multiple states across the country.

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