The Centers for Medicare and Medicaid Services (CMS) requires a statewide process to ensure providers are qualified to render services to waiver-funded individuals. The Provider Qualification Process described below outlines the steps the Assigned AE and provider must follow to meet these requirements and the steps Supports Coordinators take to transition individuals if needed. This communication does not describe the qualification process for SC organizations.
New Provider Requalification
Following the provider’s initial qualification date, all providers classified as New are to be requalified by the end of the following fiscal year as designated on the DP 1059. For example, if a New provider’s first Qualification Begin Date in HCSIS is 01/20/2017, the provider must be requalified by 06/30/2018, which is the end of the following fiscal year. A New provider’s status is updated from New to Existing after the provider is requalified.
Existing Provider Requalification Cycle
Once a provider is classified as Existing, the provider is to be requalified on a three-year cycle based upon the last digit of the provider’s MPI number. By 5/1, sixty days prior to the provider’s qualification 6/30 end date, the Qualification Status will change to Expiring. If the provider is not requalified by the end of the fiscal year (6/30), the Qualification Status will change to expired.
The qualification statuses in HCSIS are as follows:
Service Qualification Status
- Qualified – The provider meets ODP’s qualification requirements
- Not Requalified – Assigned AE changes the status from ‘Qualified’ or ‘Expiring’ to ‘Not Requalified,’ if the provider no longer meets ODP’s qualification requirements by 6/30
- Not Qualified – HCSIS changes the status from ‘Not Requalified’ to ‘Not Qualified’ on 07/01 or ODP can change the status to ‘Not Qualified’ at any time, if the provider’s qualification is being terminated
- Expiring – HCSIS would automatically change the status from ‘Qualified’ to ‘Expiring’ on 05/01, if the provider has not been requalified
- Expired – HCSIS would change the status from ‘Expiring’ to ‘Expired’ on 07/01, if the provider has not been requalified
See ODP Announcement 20-007 for the full process and timeline.
The release of this communication obsoletes ODP Announcement 011-18 Provider Qualification Process.