On May 8, the North Carolina Medical Society (NCMS) and the North Carolina Academy of Physician Assistants (NCAPA) submitted a rulemaking petition to the Department of Health and Human Services (DHHS) regarding mandatory Medicaid enrollment for physician assistants (PAs) and nurse practitioners (NPs) who provide care to Medicaid and North Carolina Health Insurance Program for Children (CHIP) patients. View the petition here. It is the position of both the NCMS and NCAPA that DHHS may not require enrollment of PAs and NPs until a rule is adopted pursuant to the state Administrative Procedure Act, NC General Statute 150B-1. DHHS has 30 days to respond to the petition.

In the petition, the NCMS and NCAPA offer the following reasons why the proposed rule should be adopted:

• To comply with federal regulations published by the Center for Medicare and Medicaid Services (CMS) that mandate, “the State Medicaid agency must require all ordering physicians or other professionals providing services under the state plan or under a waiver of the plan to be enrolled as participating providers.” In October 2011, DHHS requested that CMS approve the addition of PAs to the State Plan. That request is still pending, but is expected to be approved.
• DHHS cannot unilaterally require PAs, NPs or other healthcare professionals to enroll as participating providers because the rulemaking exemption available to DHHS for developing medical coverage policies does not apply “in adopting new or amending existing medical coverage policies pursuant to GS 108A-54.2”
• DHHS Division of Medical Assistance (DMA) has made multiple, conflicting announcements over the last nine months. These monthly changes have created confusion about what the DHHS/DMA expect from the provider community.
• DHHS officials have already agreed with the NCMS and NCAPA that rules are required to mandate direct enrollment. Even though DMA has made promises to have stakeholder meetings and has given verbal assurances since September that draft rules were being developed and would be available shortly, no rules have materialized and planned meetings called by DMA were cancelled. DMA continues to signal that it will proceed with requiring direct enrollment before completing the rulemaking process, despite repeated objections from both the NCMS and NCAPA.

The NCMS and NCAPA will continue to press the DHHS and DMA about abiding by existing protocol in amending the State Plan. Updates will continue to be provided in future Bulletin issues.