Louisiana Medicaid Provider Enrollment Disaster Relief

Department of Health & Human Services
Centers for Medicare & Medicaid Services
1301 Young Street
Dallas, Texas 75202

July 12, 2019

Ms. Jen Steele, State Medicaid Director
Department of Health
628 North 4th St.
Post Office Box 91030
Baton Rouge, LA  70821-9030

Dear Ms. Steele:

We have reviewed your request for relief to CMS’ existing regulations and requirements to provider enrollment.  You indicated the need for temporary waivers to give you the needed flexibility to address the disaster caused by Tropical Storm Barry.  Under section 1135 waiver authority, we are able to grant your request.  The language below outlines what provisions CMS has waived:

Louisiana Medicaid Provider Enrollment Disaster Relief

Louisiana currently has the authority to rely upon screening that is performed by other SMAs and/or Medicare. Louisiana is not required to create a temporary provisional enrollment for providers who are enrolled with another SMA or Medicare.

With respect to providers not already enrolled with another SMA or Medicare, CMS will waive the following screening requirements so the state/territory may provisionally, temporarily, enroll the providers:

1. Payment of the application fee - 42 C.F.R 455.460
2. Criminal background checks associated with FCBC- 42 C.F.R Section 455.434
3. Site visits - 42 C.F.R Section 455.432
4. In-state/territory licensure requirements - 42 C.F.R Section 455.412

For those providers located out of state/territory and from which Louisiana Medicaid participants seek care, enrollment is not necessary if the following criteria are met:

1. The item or service is furnished by an institutional provider, individual practitioner, or pharmacy at an out-of-state/territory practice location– i.e., located outside the geographical boundaries of the reimbursing state/territory’s Medicaid plan,
2. The NPI of the furnishing provider is represented on the claim,
3. The furnishing provider is enrolled and in an “approved” status in Medicare or in another state/territory’s Medicaid plan,
4. The claim represents services furnished, and;
5. The claim represents either:
   • A single instance of care furnished over a 180 day period, or
   • Multiple instances of care furnished to a single participant, over a 180 day period 

If the Medicaid participant is enrolled with the Medicaid program from the disaster designated state, the final two criterion will be waived. Therefore, there is no limit to the instances of care furnished or to how many participants in a 180 day period.

In the instance that a certified provider is enrolled in Medicare or with a state/territory’s Medicaid program other than Louisiana, Louisiana may perform an expedited enrollment, as described above, of an out-of-state/territory facility in order to accommodate participants who were displaced by the disaster.

CMS is granting waiver authority to allow Louisiana to enroll providers who are not currently enrolled by meeting the following minimum requirements:

1. Must collect minimum data requirements in order to file claims and process, including, but not limited to NPI
2. Must collect SSN/EIN/TIN in order to perform the following screening requirements:
   • OIG exclusion list
   • State/territory licensure – provider must be licensed, and legally authorized, in any state/territory to practice or deliver the services for which they intend to file claims
3. Louisiana may grant a provisional temporary enrollment that meets the following requirements:
   • Must cease approving temporary provisional enrollments no later than the date that the disaster designation is lifted.
   • Must cease payment to providers who are temporarily enrolled within six months from the date that the disaster designation is lifted, unless a provider has submitted an application that meets all requirements for Medicaid participation and that application was subsequently reviewed and approved by Louisiana.
   • Louisiana must allow a retroactive effective date for provisional temporary enrollments that is no earlier than July 12, 2019.

Louisiana may temporarily cease revalidation of providers who are located in Louisiana or are otherwise directly impacted by the disaster.

These provider enrollment disaster relief efforts also apply to the Children’s Health Insurance Program (CHIP). 

We acknowledge the situation the State is currently experiencing, however we hope these waiver provisions will help assist you in providing the affected individuals in your State the services they need and will allow you to reimburse the providers who provided the needed care.

If you have any questions or concerns with what is outlined in this letter, please contact me at (214) 767-4461 or at bill.brooks@cms.hhs.gov.

Sincerely,

Bill Brooks
Centers for Medicaid & CHIP Services
Regional Operations Group