Corporate Counsel News - Trends and Developments,CMS updates Medicare, Medicaid, and CHIP application fee for 2015

By Bryant Storm, J.D.

CMS has issued a notice announcing a $533.00 application fee for institutional providers that are enrolling in the Medicare, Medicaid, or Children’s Health Insurance Program (CHIP), revalidating their Medicare, Medicaid, or CHIP enrollment, or adding a new Medicare practice location in calendar year (CY) 2015. The fee will be required for any enrollment application submitted by an institutional provider between January 1, 2015, and December 31, 2015 ( Notice, 79 FR 72183, December 5, 2014)

Application fee. In a 2011 Final rule ( 76 FR 5862), CMS set out provisions related to application fees that are required for provider enrollment in Medicare, Medicaid, and CHIP. The application fee requirements, set out in 42 C.F.R. Section 424.514 and Section 1866(j)(2)(C)(i) of the Social Security Act, apply to any provider designated as an institutional provider by 42 C.F.R. Section 424.502. The notice specifies that an institutional provider is a provider that is defined as such under the Medicare regulations, defined as such under a state plan, or in the case of Medicaid and CHIP-only providers, an institutional provider may be a nursing facility, an intermediate care facility for persons with mental retardation, or a psychiatric residential treatment facility.

2014. On December 2, 2013, CMS published a notice ( 78 FR 72089) setting the application fee for 2014. The fee for January 1, 2014, through December 31, 2014, was set at $542.00.The fee was initially set at $500 by Soc. Sec. Act Section 1866(j)(2)(C)(i)(I) in 2010. Since then, the fee has been increased to reflect changes in the consumer price index (CPI).

2015. For the 2015 application fee update, CMS reached the $533 figure by analyzing the CPI and Bureau of Labor Statistics (BLS) data. The relevant CPI increase from 2013 to 2014 was 2.1 percent, which accounts for the increase in the application fee from 2014 to 2015. The notice indicates that the 2015 application fee will be $6 higher than the $547 application fee that CMS had projected for 2015 in the 2011 Final rule.

Published Date: 

Tuesday, December 16, 2014