In its May 2012 Bulletin, the Division of Medical Assistance (DMA) has again announced that it will require direct enrollment of all physician assistants (PAs) and nurse practitioners (NPs) who treat Medicaid patients. This time the enrollment deadline is June 30; these practitioners must bill under their own number as of July 1. Since additional details about this initiative have always been and remain suspiciously absent, the NCMS along with the North Carolina Academy of Physician Assistants (NCAPA), continue to urge medical practices to hold their enrollment applications.
Since last September, DMA has been looking to require direct enrollment of PAs and NPs, citing a new federal requirement aimed at improving program integrity in each state’s Medicaid program. It is true that DMA must eventually enroll these practitioners, but the NCMS position is that DMA can only do so after completing the agency rulemaking process that is required before an executive agency can adopt and enforce a new requirement upon you. Rulemaking is designed to compel DMA to describe how this requirement will affect PAs, NPs, and the medical practices that employ them. However, DMA has made it clear that it plans to shortcut this process and continue governing practices via monthly bulletin.
DMA’s handling of this issue has been opaque: cancelled meetings, unreturned phone calls and emails from stakeholders, and a lack of detail about how they will treat these practitioners once enrolled in Medicaid. For example, DMA only recently offered a PA enrollment form even though the original enrollment deadline was October. Moreover, the announcement goes beyond a simple enrollment requirement to say that “incident to” billing by PAs and NPs is no longer allowed.
We understand it is difficult for medical practices to stand idle in the face of DMA’s representations. Whether to proceed with the enrollment process is ultimately a decision for your practice to make.
Just know that at the NCMS we believe they lack the authority to require this, that the NCMS continues to press them on it, and that we believe standing by continues to be the safest option. We have notified the Attorney General’s Office and have requested a retraction of the bulletin articles and deadlines. We are also planning additional action against the agency to ensure that they comply with state law.
Related NCMS Bulletin articles:
Update on Medicaid’s Move to Require Direct Enrollment of PAs (03-02-12)
Physician Assistant Medicaid Enrollment Update (11-04-11)
Physician Assistants, Hold Your Medicaid Enrollment Applications! (10-07-11)
