Health Center Regulatory Issues

Provider Enrollment Requirements for Writing Prescriptions for Medicare Part D Drugs

By: Alyssa Shinto, NACHC Intern 

The Centers for Medicare and Medicaid Services’ (CMS) Medicare Learning Network (MLN) released an article regarding the authorization of CMS’s final rule on 2015 policy and technical changes to the Medicare Advantage and Part D programs. This final regulation requires physicians and other eligible professionals who write prescriptions for Part D drugs to be enrolled in an approved status or to have a valid opt-out affidavit on file for their prescription to be covered under Part D.  CMS will begin enforcing this final rule beginning December 1, 2015, however, prescribers of Part D drugs must submit their Medicare enrollment applications or opt-out affidavits to their Part B Medicare Administrative Contractors (MACs) by June 1, 2015 to allow sufficient time to process applications. CMS has released an enrollment file that recognizes physicians and eligible professionals who are enrolled in Medicare in an approved or opt out status. The enrollment file contains data subsequent to November 2014 and will be updated every two weeks until the enforcement date.  For the health center community, we believe that the vast majority of providers are appropriately enrolled and thus will not be impacted by this new regulation, but we encourage you all to check the data file to ensure your providers are appropriately approved.

Any questions on the data file? Submit them to providerenrollment@cms.hhs.gov. For more information on the Part D enrollment, please visit CMS Part D Enrollment site.

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