DHS Updates Medicaid Enrollment Process for Co-Located Providers

Pennsylvania's Department of Human Services (DHS) announced a new enrollment/revalidation process for Medical Assistance (MA) providers that are in co-location agreements. The notification was made via a Medical Assistance Bulletin published on May 31, 2016.

MA regulations—55 Pa.Code § 1101.51(c)(3)—prohibit providers from leasing or renting space, shelves or equipment within a provider's office to another provider or allowing the placement of paid or unpaid staff of another provider in a provider's office. This regulation does not preclude a provider from owning or investing in a building in which space is leased for adequate and fair consideration.

Since the regulation was issued, the health care industry has shifted toward integrated patient care, resulting in the growth of things like multi-disciplinary co-location arrangements between separate providers. DHS supports these changes provided the Medicaid beneficiary retains freedom of choice and that providers do not engage in prohibited acts such as improper referrals or kickbacks.

One consequence of the regulation is that when a provider submits an application to enroll in the MA Program—and the provider is attempting to enroll with the same distinct address as another currently-enrolled provider—DHS' Provider Enrollment system identifies the address match. DHS then asks the providers to submit additional information and documentation related to the arrangement between the providers. This may cause a delay in processing the provider's enrollment application(s).

To prevent such delays in the future, DHS has created a Co-Location Attestation form that providers can use to attest to their compliance with state and federal anti-kickback laws as well as the MA regulations noted above.

What Does this Mean for Physicians and Practices?

Moving forward, when a co-located provider submits an enrollment or revalidation application and DHS identifies an address match, DHS will forward the attestation form to both the applicant and the currently enrolled provider(s) along with a request for proposed language for signage. This signage advises beneficiaries that they may receive services from any enrolled provider and must be displayed in a prominent place in the provider's office, such as a waiting room or at the point of check-in.

A co-located provider seeking to enroll in the MA Program can also proactively request a copy of the attestation form and submit it as well as the proposed language for signage to the Department prior to the Department identifying the co-location arrangement. Access the DHS Medical Assistance Bulletin and Co-Location Attestation form.

The completed attestation form and proposed language for signage must be submitted by both providers at the service location via one of the following methods:

  1. Email: RA-ProvApp@pa.gov.
  2. Fax: (717) 265-8284.
  3. Mail: DHS Enrollment Unit, PO Box 8045, Harrisburg, PA, 17105-8045.

Pennsylvania Medical Society members with questions can also contact our Knowledge Center at 855-PAMED4U (855-726-3348) or KnowledgeCenter@pamedsoc.org.

Leave a comment

676_Website Box_MACRA

norcal mutual opioids advertisement
Norcal Mutual

Learn More 
nm5001-PA-MedSocietyMag-SRPatientSafetyOpioids-970x90