CMS Delays Requirement that Part D Prescribers be Medicare-enrolled or in Valid Opt-out Status
Hospices should assess potential need for hospice physician Medicare enrollment
May 6, 2015 01:06 PM
On Friday, May 1, the Centers for Medicare & Medicaid Services (CMS) put on display at the Office of the Federal Register an interim final rule delaying a regulatory requirement that prescribers of Part D medications that are eligible to enroll in Medicare either be enrolled in Medicare in approved status or in a valid opt-out status. The enrollment requirement had been scheduled to go into effect on December 1, 2015 but will now be effective on January 1, 2016. Additionally, in cases where Part D enrollees submit prescriptions for processing through Part D that are not prescribed by an eligible professional that is either enrolled in Medicare in an approved status or is in a valid opt-out status, the Part D plan must provide a provisional prescription fill (3 month supply) for the Part D enrollee to allow the prescriber time to either enroll in Medicare or to allow the patient time to secure a prescription from another professional. The regulation is scheduled for publication in the Federal Register on Wednesday, May 6.
The National Association for Home Care & Hospice (NAHC) has been closely monitoring activity on this issue as some hospice physicians are not currently enrolled in Medicare in approved status (or in a valid opt-out status) and in cases where these physicians prescribe medications for non hospice-related conditions and the medications are processed through Part D, hospice patients could be negatively affected (please see previous NAHC Report coverage here and here). While these circumstances may not occur with frequency, hospice programs are advised to determine whether their physicians are Medicare-enrolled in approved status or in a valid opt-out status and, if they are not, determine whether there are cases in which these physicians prescribe medications for hospice patients for conditions that do not contribute to the six-month prognosis and if these medications would process through Part D. If such cases arise, these hospice physicians should consider either enrolling in Medicare or applying for opt-out status. CMS has indicated that it can take some months to get through the enrollment process, so it is not too soon to investigate these options. Information on the general provider enrollment process and the time frames for application processing can be found on CMS’ web site here, here and here.