CMS Issues Reassignment of Medicaid Provider Claims Final Rule and Clarifies Scope

On Thursday, the Center for Medicare and Medicaid Services (CMS) released its final rule for the Reassignment of Medicaid Provider Claims. This final rule reinterprets the scope of the requirement that state payments for Medicaid services must generally be made directly to an individual practitioner or institution providing services and authorizes states to make payments to third parties where the payments are made “for individual practitioners’ health insurance and welfare benefits, skills training, and other benefits customary for employees, if the individual practitioner consents to such payments on their behalf.” The rule is effective 30 days from the date of its publication in the federal register on May 16.

Last year, ANCOR submitted comments in response to CMS’s proposed rule during the notice and comment period to request clarification of the term “individual practitioner.” Although CMS did not make any changes to the rule in its final form, it did respond directly to ANCOR’s comments limiting the term “individual practitioner” to individuals, and explicitly excluding Medicaid Home and Community Based Services (HCBS) provider entities. CMS also reiterated its intent in promulgating the rule, stating that the “flexibility permitted under the rule would help protect the economic security for home care providers as well as protect and strengthen the HCBS workforce.”