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医疗保险、医疗补助和儿童健康保险计划;针对医疗服务提供者和供应商的额外筛查要求、申请费用、临时注册暂停、支付暂停及合规计划。有意见征求期的最终规则。

Medicare, Medicaid, and Children's Health Insurance Programs; additional screening requirements, application fees, temporary enrollment moratoria, payment suspensions and compliance plans for providers and suppliers. Final rule with comment period.

出版信息

Fed Regist. 2011 Feb 2;76(22):5861-971.

Abstract

This final rule with comment period will implement provisions of the ACA that establish: Procedures under which screening is conducted for providers of medical or other services and suppliers in the Medicare program, providers in the Medicaid program, and providers in the Children's Health Insurance Program (CHIP); an application fee imposed on institutional providers and suppliers; temporary moratoria that may be imposed if necessary to prevent or combat fraud, waste, and abuse under the Medicare and Medicaid programs, and CHIP; guidance for States regarding termination of providers from Medicaid and CHIP if terminated by Medicare or another Medicaid State plan or CHIP; guidance regarding the termination of providers and suppliers from Medicare if terminated by a Medicaid State agency; and requirements for suspension of payments pending credible allegations of fraud in the Medicare and Medicaid programs. This final rule with comment period also discusses our earlier solicitation of comments regarding provisions of the ACA that require providers of medical or other items or services or suppliers within a particular industry sector or category to establish compliance programs. We have identified specific provisions surrounding our implementation of fingerprinting for certain providers and suppliers for which we may make changes if warranted by the public comments received. We expect to publish our response to those comments, including any possible changes to the rule made as a result of them, as soon as possible following the end of the comment period. Furthermore, we clarify that we are finalizing the adoption of fingerprinting pursuant to the terms and conditions set forth herein.

摘要

本带有意见征求期的最终规则将实施《平价医疗法案》的相关规定,这些规定确立了:针对医疗保险计划中的医疗或其他服务提供者及供应商、医疗补助计划中的提供者以及儿童健康保险计划(CHIP)中的提供者进行筛查的程序;对机构提供者和供应商征收申请费;在必要时可实施的临时禁令,以防止和打击医疗保险、医疗补助计划及儿童健康保险计划中的欺诈、浪费和滥用行为;关于如果提供者被医疗保险或另一个医疗补助州计划或儿童健康保险计划终止,各州在将其从医疗补助计划和儿童健康保险计划中除名方面的指导意见;关于如果提供者被医疗补助州机构终止,医疗保险将其从提供者和供应商名单中除名的指导意见;以及在医疗保险和医疗补助计划中存在欺诈的可信指控期间暂停付款的要求。本带有意见征求期的最终规则还讨论了我们 earlier solicitation of comments regarding provisions of the ACA that require providers of medical or other items or services or suppliers within a particular industry sector or category to establish compliance programs.(此处原文“earlier solicitation of comments regarding...”表述有误,推测可能是“earlier solicitation of comments on...”,但按正确理解后的翻译是:我们之前就《平价医疗法案》中要求特定行业部门或类别内的医疗或其他物品或服务提供者或供应商建立合规计划的相关规定征求意见的情况。)我们已经确定了围绕某些提供者和供应商实施指纹识别的具体规定,如果收到的公众意见表明有必要,我们可能会对这些规定进行修改。我们预计在意见征求期结束后尽快公布我们对这些意见的回应,包括因这些意见而可能对规则做出的任何修改。此外,我们澄清,我们正在根据本文所述的条款和条件最终确定采用指纹识别的决定。

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