Provider Types Affected Provider Action Needed This special edition article is based on the Centers for Medicare & Medicaid Services (CMS) recent instructions to Medicare fiscal intermediaries (FIs) regarding the sunset of the provider nomination provision contained under Title XVIII of the Social Security Act, Section 1816, which expired on September 30, 2005. What You Need to Know CMS no longer allows freestanding or independent providers that enter the Medicare program to express a preference for a particular FI. The CMS Regional Offices (RO) must assign the newprovider to the designated local FI. What You Need to Do See the Background section of this article for further details. Background CMS has announced that the provider nomination provision contained under Title XVIII of the Social Security Act, Section 1816 ( http://www.ssa.gov/OP_Home/ssact/title18/1816.htm The Medicare Prescription Drug Improvement and Modernization Act of 2003 (MMA, Section 911(d) (2) (B) http://www.cms.hhs.gov/MMAUpdate Therefore, CMS no longer allows freestanding or independent providers that enter the Medicare program to express a preference for a particular FI. The CMS Regional Offices (RO) must assign the new provider to the designated local FI. Note: For Puerto Rico and the U.S. Virgin Islands, providers must be assigned to Cooperativa de Seguros de Vida de Puerto Rico. In situations where there is a Change of Ownership (CHOW), and the new owner does not accept assignment of the existing provider agreement, the new owner will be considered as a new applicant to the program. They will have to go through the application process, have the state survey agency (SA) perform a survey, and receive approval from the RO. Then the provider:
This is because the provider will be treated as a new enrollee if they do not accept assignment of the provider agreement. For state jurisdiction designations, please refer to the Intermediary-Carrier Directory, which is posted on the CMS Web site at http://www.cms.hhs.gov/contacts/incardir.asp Exceptions to this policy will be made for new and existing freestanding specialty providers, provider-based facilities, and providers that belong to CMS-certified chain organizations as follows:
These measures are effective immediately and are consistent with the effective and efficient administration of the Medicare program. Additional Information If you have any questions, please contact your FI on their toll-free number, which is available at http://www.cms.hhs.gov/MLNProducts/downloads/CallCenterTollNumDirectory.zip Disclaimer MLN Matters Number: SE0582 Revised Posted: 11/08/2006 CPT codes, descriptions, and other data only are copyright 2006 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS Apply.
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) expired on September 30, 2005. 
on the CMS Web site.
