HCPF requests feedback on proposed rules for becoming a medicaid provider
The Colorado Department of Healthcare Policy & Finance are requesting feedback and comment on new federal provider screening rules.
The Department has posted an initial draft of the rule that will implement these regulations on our website and is seeking feedback from providers and other stakeholders. The Department has limited flexibility in implementing the new federal regulations, but is seeking feedback in a few key areas where the federal government has granted some flexibility.
More information, including a copy of the draft rule and instructions for submitting comments, can be found on the Department's website under the "Federal Provider Screening Regulations" section ofColorado.gov/hcpf/provider-implementations. Stakeholders may submit comments through December 1st.
The federal regulations allow the Department to require additional screening of certain
providers that is above and beyond the federal requirements (42 CFR § 455.452). Should
some providers be subject to screening procedures beyond federal requirements? Which
providers and what additional screening should be required?
2.) Federal rules require the Department to assign risk categories to Medicaid-only provider
types. The draft rule below proposes risk categories for these providers based on CMS
guidance and the risk of waste, fraud and abuse unique to each provider type. Following
CMS' guidance (see the Federal Register at 76 FR 5867, 5895-5896), to what screening
levels should each Medicaid-only provider type be assigned?
3.) The draft rule does not yet include specific details regarding site visits for moderate and
high risk providers. Following CMS' guidance (see the Federal Register at 76 FR 5869,
5899) and experience from other states, what should pre- and post-enrollment site visits
in Colorado consist of? Should requirements differ based on provider type? If so, what
should provider-type specific requirements include and for which providers?
4.) Within the confines of the federal regulations and guidance, are there ways HCPF can
reduce any potential issues providers may encounter with these new rules?
Please submit formal comments and questions about this rule to
Providers Identified as Moderate Risk in new Draft Rules include:
Community Mental Health center Providers
Providers of the following services for HCBS waiver clients:
i. Alternative Care Facility
ii. Adult Day Services
iii. Alternative/Integrative Therapies
iv. Assistive Technology, if the provider is re-validating
v. Behavioral Programming
vi. Behavioral Therapies
vii. Behavioral Health Services
viii. Behavioral Services
ix. Community Connector
x. Home Accessible Adaptations
xi. Initial/Ongoing Treatment Evaluation (for Children with Autism)
xii. Post-Service Evaluation (for Children with Autism)
xiii. Community Transition Services
AND MANY MORE.......