Michigan Department of Health And Human Services Reinstates Provider Enrollment and Revalidation Requirements

By: Rolf Lowe 11/28/22

Effective December 1, 2023, the Michigan Department of Health and Human Services (MDHHS) announced in Medical Services Administration (MSA) Bulletin 22-38 that it will be eliminating the remaining temporary suspensions of certain provider enrollment and revalidation requirements issued in the spring of 2020, shortly after the COVID 19 pandemic and federal emergency disrupted the normal course of business for providers and MDHHS. On April 30, 2020, MDHHS released MSA Bulletin 20-28, temporarily suspending certain Medicaid, Healthy Michigan, Maternity Outpatient Medical Services (MOMS), Children’s Special Health Care Services (CSHCS) and MI Health Link provider enrollment and revalidation requirements. The bulletin, which had an effective date of March 1, 2020, was intended to relax, and reduce potential administrative burdens on providers as they adapted to the challenges of the COVID 19 pandemic. MSA suspended the following federal provider enrollment requirements:

Community Health Automated Medicaid Processing System (CHAMPS) Enrollment Revalidations;

Site visits for prospective and current providers;

Fingerprint-based criminal background checks associated with providers in the high-risk level category; and

Payment of application fees – (Providers required to pay an application fee were able to request a postponement of the fee by declaring the payment a hardship during their CHAMPS enrollment or revalidation).

In the bulletin, MSA also described certain restrictions and requirements of the Public Health Code suspended by State Executive Order 2020-61, which included:

Allowing out of state licensed providers who are licensed and in good standing in any state or territory in the United States and practicing in to be reimbursed for Medicaid covered services. Out of state providers were still subject to program screening and enrollment requirements and had to be associated to in-state Medicaid enrolled provider;

Waiving Medicaid program requirements that diagnostic laboratory tests be ordered by enrolled providers, and, more specifically, allowing tests associated with COVID 19 to be ordered by non-enrolled registered nurses (RNs) and licensed practical nurses (LPNs) working in designated health care facilities, with the caveat that the NPI of attending physician or other qualified health professional overseeing the care be included in the ordering provider field as applicable; and

Suspending practitioner policy provisions of the Public Health Code relating to scope of practice, supervision, delegation, and written practice agreement requirements for services provided within a designated health care facility.

The suspension of the Public Health Code requirements were lifted early on during the COVID pandemic, being eliminated for dates of service on or after July 13, 2020, but the suspension of the enrollment revalidation, site visits, fingerprint background checks and the payment of fees requirements remained in place over the past two years. It is important to understand that while a suspension for the process was in place, when MDHHS resumes these activities providers will be subject to the same review standards previously used. Providers should also expect the upcoming reviews and revalidations to cover areas of compliance that still needed to be met during the period of suspension.

With the prospect of the suspended requirements being reinstated on the horizon, providers who have not been subject to a revalidation or a site visit in the past several years should take the time now to review the Medicaid enrollment and revalidation requirements and be able to identify, and potentially cure, any shortfalls in their documentation and records, including the requirements in the Public Health Code that were suspended for a few months in 2020. Failure to meet a few, or even one, of the Medicaid program requirements for reimbursement may subject providers to further scrutiny of their operations by MDHHS, and in some instances the identification of overpayments