Commonwealth of the Northern Mariana Islands Medicaid Provider Enrollment Disaster Relief

Department of Health & Human Services
Centers for Medicare & Medicaid Services
Division of Medicaid & Children's Health Operations
San Francisco Regional Office
90 Seventh Street, Suite 5-300 (5W)
San Francisco, CA 94103-6706

October 25, 2018

Helen Sablan, Administrator
CNMI Medicaid Agency
Caller Box 10007
Saipan, MP 96950

Re:  Commonwealth of the Northern Mariana Islands Medicaid Provider Enrollment Disaster Relief

Dear Ms. Sablan:

Commonwealth of the Northern Mariana Islands (CNMI) Medicaid currently has the authority to rely upon screening that is performed by other SMAs and/or Medicare. CNMI is not required to create a temporary provisional enrollment for providers who are enrolled with another SMA or Medicare.

With respect to providers not already enrolled with another SMA or Medicare, CMS will waive the following screening requirements so the territory may provisionally, temporarily, enroll the providers:

1. Payment of the application fee - 42 C.F.R 455.460
2. Criminal background checks associated with FCBC- 42 C.F.R Section 455.434
3. Site visits - 42 C.F.R Section 455.432
4. In-state/territory licensure requirements - 42 C.F.R Section 455.412

For those providers located out of the territory and from which CNMI Medicaid participants seek care, enrollment is not necessary if the following criteria are met.

1. The item or service is furnished by an institutional provider, individual practitioner, or pharmacy at an out-of-state/territory practice location– i.e., located outside the geographical boundaries of the reimbursing state/territory’s Medicaid plan,
2. The NPI of the furnishing provider is represented on the claim,
3. The furnishing provider is enrolled and in an “approved” status in Medicare or in another state/territory’s Medicaid plan,
4. The claim represents services furnished, and;
5. The claim represents either:
   • A single instance of care furnished over a 180 day period, or
   • Multiple instances of care furnished to a single participant, over a 180 day period

If the Medicaid participant is enrolled with the Medicaid program from the disaster designated territory, the final two criterion will be waived. Therefore, there is no limit to the instances of care furnished or to how many participants in a 180 day period.

In the instance that a certified provider is enrolled in Medicare or with a state/territory’s Medicaid program other than CNMI, CNMI may perform an expedited enrollment, as described above, of an out-of-state/territory facility in order to accommodate participants who were displaced by the disaster.

CMS is granting waiver authority to allow CNMI to enroll providers who are not currently enrolled by meeting the following minimum requirements:

1. Must collect minimum data requirements in order to file claims and process, including, but not limited to NPI
2. Must collect SSN/EIN/TIN in order to perform the following screening requirements:
   • OIG exclusion list
   • State/territory licensure – provider must be licensed, and legally authorized, in any state/territory to practice or deliver the services for which they intend to file claims
3. CNMI may grant a provisional temporary enrollment that meets the following requirements:
   • Must cease approving temporary provisional enrollments no later than the date that the disaster designation is lifted
   • Must cease payment to providers who are temporarily enrolled within six months from the date that the disaster designation is lifted, unless a provider has submitted an application that meets all requirements for Medicaid participation and that application was subsequently reviewed and approved by CNMI.
   • CNMI must allow a retroactive effective date for provisional temporary enrollments that is no earlier than October 24, 2018.

CNMI may temporarily cease revalidation of providers who are located in CNMI or are otherwise directly impacted by the disaster.

If you have any questions or concerns with what is outlined in this letter, please contact Dzung Hoang at (415) 744-3589 or Dzung.Hoang@cms.hhs.gov.

Sincerely,

Dzung Hoang
Acting Associate Regional Administrator
Division of Medicaid & Children’s Health Operations