Medi-Cal Enrollment of Non-Physician Medical Practitioners
Non-physician Medical Practitioners (NMPs) are sometimes referred to as mid-level providers.
Title 22, CCR Section 51240 addresses enrollment and supervision requirements for NMPs. This regulation stipulates the requirements of the Physician-Practitioner Interface Agreement for the various NMP types and also stipulates that they must be enrolled pursuant to Section 51000.30. Physician-Practitioner Interface documents include the specific standardized procedures and supervisory guidelines required by Title 16, CCR Sections 1399.540, 1399.545(e) and 1470.
Physician Assistants, Nurse Practitioners and Certified Nurse Midwives
Physician Assistants, Nurse Practitioners and Certified Nurse Midwives are all considered to be NMPs for purposes of Medi-Cal provider enrollment:
Physician Assistants (PAs) must be supervised by a physician. PA's enroll in Medi-Cal using PAVE. PA's may not enroll as groups and may not enroll as stand-alone providers.
Nurse Practitioners (NPs) who work for physicians or physician groups use PAVE to enroll. NPs enrolling as stand-alone providers use PAVE to enroll.
In order to enroll in Medi-Cal as a "stand-alone NP", a Nurse Practitioner must have completed a clinical and didactic educational program of at least six months in the field of Pediatrics or Family Care. The program must have been completed in a college or university that offers a baccalaureate or higher degree, or in a health care agency that has an academic affiliation with such a college or university.
(Assembly Bill 1591 enacted on September 29, 2006, amended the Welfare and Institutions Code Section 14132.41 to allow Nurse Practitioners to bill Medi-Cal independently for their services. This state legislation allowed for NPs of any specialty to enroll in Medi-Cal as stand-alone providers. Subsequently, DHCS developed a State Plan Amendment to give DHCS the legal authority to make payments directly to all specialty areas of certified nurse practitioners. The Medi-Cal payment system is currently undergoing the system changes needed in order to process claims for payment to NPs specializing in areas other than Pediatrics or Family Care.)
In addition to enrolling with a physician or physician group or enrolling as stand-alone providers, NPs may also enroll as groups, and as rendering provider members of NP Groups. Currently, to enroll as a Nurse Practitioner Group, all of the rendering NPs in the group must specialize in either Family Care or Pediatrics. NP Groups use PAVE to enroll. The NPs who are rendering members of an NP group also enroll in the NP group using PAVE. Stand-alone NPs and NP groups may also qualify to enroll as Facility-Based Providers.
CERTIFIED NURSE MIDWIFE (CNM) CNMs Certified Nurse Midwifes (CNMs) working for obstetric physicians or physician groups use PAVE to enroll.
CNMs enrolling as stand-alone providers, including enrollment as stand-alone "Clinic Based Certified Nurse Midwife" providers, use PAVE to enroll. "Stand-alone CNMs" are enrolled using their own NPI and the RN number from their license.
CNMs may enroll as groups and as rendering members of CNM groups. CNM groups enroll using PAVE. CNMs who are group members rendering to a CNM group, use PAVE to enroll as such.
Stand-alone CNMs and CNM groups may also qualify to enroll as Facility-Based Providers.
Proceed to the PAVE portal.
Last modified on:
3/7/2019 9:20 AM