Volume 22.12
Effective December 5, 2022, certain modifications have been made to Chapter 10 of the Medicare Program Integrity Manual dealing primarily with “Ownership Disclosures”, “Electronic Funds Transfers”, and “Special Payment Addresses”. MM12880 – Provider Enrollment Instructions: Seventh General Update (cms.gov).
Ownership Disclosures:
- The provider or supplier must disclose ALL persons and entities that meet the definition of “owner”.
- Providers must show the applicable ownership percentage for each owner if required by the specific provider enrollment application being completed.
- There cannot be indirect owners without direct owners.
- The combined disclosed ownership percentages for the provider or supplier’s organizational and individual owners cannot be greater than 100%.
Special Instructions for EFT Accounts and Special Payment Addresses
A provider may only have one (1) EFT account and one (1) special payment address (“SPA”) per enrollment. Generally, multiple EFT accounts or SPAs within an existing enrollment will remain in effect only until the provider sends an update to its EFT information or SPA data, respectively, for any of these accounts or addresses. At that time, the EFT account or SPA for which the provider submitted the update will become the lone EFT account or SPA (as applicable) for that enrollment.
Providers or suppliers submitting an initial enrollment application, as well as new owners in a certified provider or supplier Change of Ownership (“CHOW”) will only have one (1) EFT account and one (1) SPA.
Other modifications address HHA capitalization, DMEPOS supplier accreditations, and Opioid Treatment Programs (“OTP”).
The entire Change Request 12880 to Chapter 10 of the Medicare Program Integrity Manual, with markups, is available at R11682PI (cms.gov).
COVID-19 PHE WILL CONTINUE
The COVID-19 PHE will continue in effect until at least mid-January 2023. In October, HHS extended the public health emergency until January 11, 2023; however, HHS has continually committed to providing a sixty (60) day notice to states before any possible termination or expiration. Accordingly, the January 11, 2023 termination date has already passed, assuming the sixty (60) day notification.
Regardless of a continuation of the COVID-19 PHE, providers who received Phase 4 Provider Relief Funding will need to report on the use of these funds on or before March 31, 2023.