The Centers for Medicare and Medicaid Services published a Final Rule on February 2, 2011, in the Federal Register (42 CFR Parts 405, 424, 447 et al.) with provisions to be implemented as they relate to Medicare, Medicaid and Children’s Health Insurance Programs (CHIP) for provider screening and prevention of provider fraud and abuse.  This Rule implemented provisions of the Patient Protection and Affordable Care Act (ACA). What follows on this webpage are various documents related to the implementation of the new Federal provider screening and enrollment requirements as they pertain to Medi-Cal providers.

Providers and stakeholders who would like to provide input to DHCS about the new provider screening requirements of the Affordable Care Act and the February 2, 2011, Federal Final Rule are encouraged to contact PED via email at PEDACA@dhcs.ca.gov.  When sending your email, please include one of the following in the subject line: Temporary Moratoria, Enrollment of Ordering and Referring Providers, Application Fees, Provider Screening Levels, and/or Background Checks/Fingerprinting.  PED appreciates your input as we work towards compliance with these new Federal regulations.

Federal Law

• Federal Register, February 2, 2011, Final Rule

State Law

• Senate Bill 1529 – Chaptered
• SPA 12-008
• Director’s Declaration Pursuant to Senate Bill 1529 Copy of Declaration of DHCS Director as required by Senate Bill 1529, Statutes of 2012.

DHCS Provider Bulletins for ACA Implementation

• Revised Medi-Cal Provider Disclosure Requirements for Compliance with 42 Code of Federal Regulations Sections 455.104 and 455.105
• Medi-Cal Application Fee Requirements for Compliance with 42 Code of Federal Regulations Section 455.460
• Medi-Cal Requirement for Ordering/Referring/Prescribing Providers Forms and Procedures
• Medi-Cal Screening Level Requirements for Compliance with 42 Code of Federal Regulations Section 455.450