Wis. ForwardHealth Online Handbook, Hospice, Topic #14137

Act

In 2010, the federal government signed into law the ACA (Affordable Care Act), also known as federal health care reform, which

affects several aspects of Wisconsin health care. ForwardHealth worked toward ACA compliance by implementing requirements

for providers and provider screening processes. To meet federally mandated requirements, ForwardHealth implemented changes

in phases, the first of which began in 2012. A high-level list of the changes included under ACA is as follows:

• Providers are assigned a risk level of limited, moderate, or high. Most of the risk levels have been established by the federal

CMS (Centers for Medicare & Medicaid Services) based on an assessment of potential fraud, waste, and abuse for each

provider type.

• Providers are screened according to their assigned risk level. Screenings are conducted during enrollment, re-enrollment,

and revalidation.

• Certain provider types are subject to an application fee. This fee has been federally mandated and may be adjusted

annually. The fee is used to offset the cost of conducting screening activities.

• Providers are required to undergo revalidation every three years.

• All physicians and other professionals who prescribe, refer, or order services and other providers who receive Medicaid

funds are required to be enrolled as a participating Medicaid provider.

• Payment suspensions are imposed on providers based on a credible allegation of fraud.

• Providers are required to submit personal information about all persons with an ownership or controlling interest, agents,

and managing employees at the time of enrollment, re-enrollment, and revalidation.