Health Center Regulatory Issues, Uncategorized

Federal Antifraud Rule’s New Fees Will Apply to FQHCs

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.

1 Comment

  1. Why is CMS making us pay for covering the cost of busting companies that commit fraud. We paid for bond and to get accredited. What’s next going to court.

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