By: Roger Schwartz
Beginning March 25, 2011, Medicare institutional providers and suppliers, including FQHCs, will have to pay Medicare an “application” fee of $505 for each site (including a pharmacy) either when the FQHC applies for a new site location or when there is revalidation of existing sites. This requirement is part of a 110 page final rule published in February 2011 by the Centers for Medicare and Medicaid Services (CMS). 76 Fed. Reg. 5862-5971 (February 2, 2011) at 5907-5917. The fee will be adjusted each year based on changes in the consumer price index. The new regulation provides (in 42 CFR 424.514(f)) that a provider or supplier can request an exemption from the fee by submitting “a letter that describes the hardship [imposed by the fee] and why the hardship justifies an exception.”
CMS rejected NACHC’s November 2010 comment and request that FQHCs get a blanket exemption from the fee because FQHCs have multiple sites and a significant portion of a center’s budget includes section 330 grant funds. CMS said (at 5911 and 5914) that the statute did not exempt FQHCs, that a fee must be paid whenever a form CMS-855 is submitted for each site, and that a FQHC can request a hardship exception to the fee. CMS stated (at 5911) that it will make available by March 25, 2011 more detailed information on this fee in connection with submitting form CMS-855.
This new fee is required by the Affordable Care Act (ACA) to help cover the costs to the government of implementing the Act’s antifraud provisions (CMS estimates – at 5956 — that over the next five years the new fee will yield about $304 million to CMS.). The new antifraud rules– also effective March 25, 2011 — have several elements relevant to FQHCs including: (1) enhanced screening of providers and suppliers participating in Medicare, Medicaid or the Children’s Health Insurance Program (CHIP); (2) periodic revalidation of credentials; (3) ongoing monitoring of databases; (4) required reporting and information sharing among Medicare, Medicaid, and CHIP agencies; (5) suspension of payments to providers based on a “credible allegation of fraud;” and (6) the imposition of a temporary moratorium on new providers where the Secretary of HHS has determined there is a high risk of fraud.
NACHC will keep you updated on any new developments on these new requirements.