GIS 12 MA/014: Medicaid Requirements Regarding Ordering and Referring Physicians

To: Local District Commissioners, Medicaid Directors

From: Jason A. Helgerson, Medicaid Director and Deputy Commissioner Office of Health Insurance Programs

Subject: Medicaid Requirements Regarding Ordering and Referring Physicians

Effective Date: Immediately

Contact Person: Personal Care Services Program Staff at 518-474-5888

The purpose of this GIS is to inform local departments of social services that requirements set forth in GIS 11 MA/024 have been temporarily suspended pending direction from the Center for Medicare & Medicaid Services.

This GIS, as well as the aforementioned GIS, pertain to recent federal regulations governing physicians who order services for Medicaid recipients. Federal regulation [42 CFR §455.410] had precipitated a requirement specified in GIS 11 MA/024 which affected the Personal Care Services Program, Personal Emergency Response Services, Consumer Directed Personal Assistance Program, Limited Licensed Home Care Services Agencies and Assisted Living Program. Specifically, it was required that all consumers in receipt of, or applying for, participation in these programs must use participating physicians to sign the physician's order.

The Department will provide further guidance as developments warrant. Any questions concerning the content of this directive can be directed to the district's home care liaison at 518-474-5888.