Fingerprinting & Background Checks (FCBC) Michal Rudnick Project Manager AHCCCS Office of the Director

Background Section 6401 of the Affordable Care Act, Provider Screening and Other Enrollment Requirements under Medicare, Medicaid and CHIP Under 42 CFR , a state Medicaid agency must establish categorical risk levels for providers When determined high risk, providers must consent to FCBC Applies to high risk provider and any person with a 5% or more direct or indirect ownership interest in the provider 2 Reaching across Arizona to provide comprehensive quality health care for those in need

Background, continued Not required if determined high risk by Medicare and enrolled by Medicare Agency may rely on results from another state Medicaid or CHIP agency States may wish to leverage existing FCBC protocols used in the state (e.g. hiring, licensing, screening) 3 Reaching across Arizona to provide comprehensive quality health care for those in need

Terminating and Denying Enrollment Medicaid Agency must terminate or deny when provider: o Fails to submit within 30 days of the agency’s request o Fails to submit in the form and manner requested o Has been convicted of a criminal offense related to that person’s involvement with Medicare, Medicaid or CHIP in the last 10 years. 4 Reaching across Arizona to provide comprehensive quality health care for those in need

High Risk Providers Newly enrolled Home Health Agency (non- Medicare certified) Newly enrolled Durable Medical Equipment Providers Non-Emergency Medical Transportation Providers Attendant Care Providers 5 Reaching across Arizona to provide comprehensive quality health care for those in need

Effective Dates CMS State Medicaid Director Letter issued June 1, 2015 States required to begin implementation by August 1, 2015 States must complete implementation by June 1, Reaching across Arizona to provide comprehensive quality health care for those in need

Next Steps AHCCCS working with DPS to establish statutory authority to require FCBC for high risk providers AHCCCS determining number of impacted providers AHCCCS looking at access to care 7 Reaching across Arizona to provide comprehensive quality health care for those in need

Questions? 8

Thank You. 9 Reaching across Arizona to provide comprehensive quality health care for those in need