Affordable Care Act (ACA) Requirements
To become compliant with the Affordable Care Act (ACA)
requirements, the Indiana Health Coverage Programs (IHCP) announced
in BT201151, dated October 18, 2011, significant
changes to provider enrollment policies and procedures effective
January 1, 2012.
Provider Revalidation
Under the Affordable Care Act (ACA), the Indiana Health Coverage
Programs (IHCP) is required to revalidate all provider enrollments,
applying ACA criteria.
Providers will receive notification letters with instructions
for revalidating 90 and 60 days before their revalidation deadline.
Providers should not take any steps to revalidate until they
receive their notification letters. Providers that fail to submit
revalidation paperwork in a timely manner will be deactivated from
participation in the IHCP as of the deadline date.
Revalidation of enrollment will occur on a regular schedule.
Under the ACA, states are required to revalidate providers at
intervals not to exceed every five years. A more frequent
three-year revalidation requirement applies to durable medical
equipment (DME) and home medical equipment (HME) providers,
including pharmacy providers with DME or HME specialty enrollments.
Providers will be notified every three or five years when it is
time to revalidate their IHCP enrollments.
For more information, see bulletin BT201210.
Note: Revalidation of enrollment is not the same as
recertification of enrollment credentials. See the
Recertify Provider Enrollment Licenses and Other Certifications
web page for details about the recertification process.
Application Fee
Certain providers are subject to an application fee. The Centers
for Medicare & Medicaid Services (CMS) sets the application fee
amount, which may be adjusted annually. The application fee amount
for 2012 is set at $523. The fee is assessed in full for each
service location at initial enrollment, enrollment revalidation,
and if a provider changes ownership. If a provider pays an
application fee to Medicare or to another state Medicaid agency for
a service location, the provider is not required to pay an
additional application fee for that location to the IHCP. The
application fee applies to "institutional" providers, as defined by
CMS. Generally, application fees do not apply to individual
professionals, such as physicians. The Provider Type Application
Fee and Risk Assignment Matrix (for Non-Waiver and
Waiver providers)
provides a full list of provider types, and indicates which are
subject to the application fee.
Payment Options
The application fee can be paid in the following ways:
- By check or money order - Submit a check or money order with
your IHCP Provider Packet.
- By Phone - Contact HP Customer Assistance at (317) 655-3240 in
the Indianapolis local area or toll-free at 1-800-577-1278 and
select the appropriate option. Please have your credit card, debit
card, or checking account information ready. When the transaction
is complete, you will be given a confirmation number to enter in
the appropriate section of your IHCP Provider Packet.
- Online - Go to the IHCP Bill Pay site
and follow the on-screen instructions. You can pay online using a
credit card, debit card, or electronic funds transfer from your
checking account. When the transaction is complete, you will be
given a confirmation number to enter in the appropriate section of
your IHCP Provider Packet.
- The fee payment is made payable to Indiana Health Coverage
Programs
- Providers can download HP's Federal W-9
form from this website for reporting payments on the provider's tax
forms.
In rare instances the CMS may agree to waive the application fee
based on proof it presents a financial hardship for a provider.
Providers requesting a waiver of the fee must submit a letter
with their enrollment packet. The letter must make a compelling
case for the request including a description of the ways in which
the provider attempted to raise the funds. The final decision to
waive the fee is made by the CMS.
Provider Risk Levels
Providers are categorized by risk level - high, moderate, or
limited. This determination is made by the Centers for Medicare
& Medicaid Services (CMS), based on an assessment of potential
for fraud, waste, and abuse for each provider type. The Provider
Type Application Fee and Risk Assignment Matrix (for Non-Waiver and
Waiver providers)
provides a full list of provider types and their CMS-assigned risk
level, both for enrollment and revalidation. Please note that the
risk level assignment may be increased at any time at the
discretion of the State. In these instances, the provider will be
notified by the State, and the new risk level will apply to
processing enrollment-related transactions.
Enrolling and revalidating providers will be screened according
to their assigned risk level. The following table outlines the
general screening activities required for each risk category.
Risk Level
|
Screening Activities |
| High |
- Fingerprinting and criminal background check for all
individuals with ownership in the entity of 5% or more
(implementation pending)
- Unannounced site visits before and after
enrollment/revalidation
- Verification of provider-specific requirements, including but
not limited to the following:
- License verification
- National Provider Identifier (NPI) check
- Office of the Inspector General (OIG) exclusion check
- Ownership/controlling interest information verification
|
Moderate
|
- Unannounced site visits before and after
enrollment/revalidation
- Verification of provider-specific requirements, including but
not limited to the following:
- License verification
- NPI check
- OIG exclusion check
- Ownership/controlling interest information verification
|
| Limited |
- Verification of provider-specific requirements, including but
not limited to the following:
- License verification
- NPI check
- OIG exclusion check
- Ownership/controlling interest information verification
|
Fingerprinting and Criminal Background Check
Implementation Pending