California Implements Provider Enrollment Fingerprinting Requirements Effective October 2
September 12 2014
On September 10, 2104, the California Department of Health Care Services (“DHCS”) announced that it will implement federal requirements for fingerprinting in the Medi-Cal provider enrollment process starting October 2, 2014. This new process implements a portion of the federal Patient Protection and Affordable Care Act that requires DHCS to establish categorical risk levels for certain providers determined to have a high risk of program abuse. Provider types that are categorically determined to be “high risk” are newly enrolling home health agencies, newly enrolling durable medical equipment suppliers, and newly enrolling and revalidating Drug Medi-Cal Clinics. In addition, providers not considered high risk by enrollment category may also be subject to fingerprinting if they are currently experiencing a Medi-Cal payment suspension based on a credible allegation of fraud, the applicant has an existing Medicaid overpayment based on fraud, the applicant has been excluded from participation in federal healthcare programs by the federal Office of Inspector General or another State’s Medicaid program within the previous 10 years, or CMS has lifted a temporary enrollment moratorium in the enrollment category sought within the past six months.
If the applicant is subject to fingerprinting, fingerprints must be supplied by any person with a five-percent or greater direct or indirect ownership. Such individuals must submit proof of fingerprint submission to an authorized State Identification Bureau (Bureau of Criminal Information and Analysis, Department of Justice), and providers must attach a copy of a complete DOJ form Request for Live Scan Service, with their enrollment application. Applications not containing this documentation will be returned with a Notice of Deficiency, with the applicant having 30 calendar days to supply the missing information. Failure to do so will result in the denial of the application.
A copy of the DHCS release is available, here.