California Moves Forward with New Medi-Cal Provider Screening and Enrollment Requirements

California’s Department of Health Care Services (DHCS) recently announced a series of stakeholder meetings scheduled for March 2012. These meetings will gather participants’ reactions to the new Medi-Cal provider screening and enrollment requirements and give participants an opportunity to voice their concerns about potential effects that the requirements may have on various provider and beneficiary groups. Paradigm has submitted a request to attend these meetings on behalf of its California school district clients.

California’s Department of Health Care Services (DHCS) will use its upcoming stakeholder meetings as an opportunity to learn about involved parties’ reactions to the new Medi-Cal  provider screening and enrollment requirements and their concerns about the impact that the requirements may have on various provider and beneficiary groups. Topics planned for discussion include the possible requirement that all providers and referring staff use a national provider identification (NPI) system, which many in the school-based health community consider an excessive requirement for Local Education Agency (LEA) organizational providers.

Thus far, many LEAs have encountered at least minor changes in existing paperwork procedures. For example, reporting for California’s LEA Billing program now includes completing an annual Provider Participation Agreement. This measure may meet the Centers for Medicare and Medicaid Services (CMS) requirement that all states renew provider enrollment at least every five years.

Additional changes to state reporting requirements include assessing provider-type risk levels for false or erroneous claiming and expanded use of the national provider identification (NPI) system. It is important to note that at this point it is unclear whether organizational providers such as LEAs will be required to use NPIs.

Paradigm looks forward to the opportunity to attend the upcoming meetings on behalf of LEAs participating in school-based Medicaid reimbursement programs and to address issues that have been raised nationally. Specifically, we hope that DHCS will be receptive to the need to avoid implementing potentially burdensome administrative requirements on schools when alternative measures can be employed that could both satisfy the intent of the new federal regulations and complement the current billing process.


DHCS Stakeholder Communication Update: Transcript

The following notice was distributed via email by DHCS in February 2012:

“DHCS’ Provider Enrollment Division (PED) will facilitate stakeholder sessions on March 28 to 30 with provider representatives, interested parties, partners, and health care associations on several specific topics related to new federal requirements for all state Medicaid agencies.  The new requirements have been established by the federal Centers for Medicare & Medicaid Services (CMS) in Title 42, Code of Federal Regulations, to implement anti-fraud provisions of the Affordable Care Act (ACA), which became effective on March 25, 2011.

This is the second in a series of sessions that will aid DHCS in its awareness of the reactions, concerns, and impacts that these new requirements may have on the provider and beneficiary community.  Topics for discussion include Temporary Moratoria, Enrollment and Screening of Providers and National Provider Identifier, Application Fee, and Criminal Background Checks and Screening Levels.  If you would like to participate in these sessions, please send your name and contact information to

If you would like to sign up to receive stakeholder communications from DHCS, click here:


More on the New Provider Regulations

As part of the implementation of the provider integrity and anti-fraud provisions of health care reform, regulations establishing new state guidelines for screening and enrolling Medicaid providers were put into effect following the publication of CMS Rule 6028 in February 2011.

States were given until March 2012 to interpret  and implement changes for existing Medicaid providers such as LEAs that have already been participating in the LEA Billing program. The implementation deadline for new providers was March 25, 2011.

You can read more about CMS 6028 in Paradigm’s 2011 Legislative and Regulatory Policy Review.