Medicaid New Enrollment and Change of Ownership

Medicaid New Enrollment and Change of Ownership Instructions 1 Medicaid New Enrollment and Change of Ownership When Medicaid providers undergo a change of ownership or enroll as a new provider, the following documents are required and will need to be completed and returned to KDADS. [...] The required Medicaid forms will also be included with the initial email from KDADS. [...] The state forms may also be found at services-supports/nursing-facility-and-adult-care-home-programs under the Change of Ownership or Revalidation section. [...] The following forms are required to change ownership and enroll in the Medicaid Program and once completed, must be submitted to KDADS via email at kdads.providerassessment@ks.gov: • State of Kansas Disclosure of Ownership and Control Interest Statement • National Provider Identifier Update and Enrollment Type Form and Confirmation email from NPPES • Medicaid Provider Agreement • CMS 671 [...] • Effective January 1, 2023, The Centers for Medicare and Medicaid Services (CMS) designated skilled nursing facilities (SNFs) that are initially enrolling (which includes most undergoing a change in ownership (CHOW)) as “High” Risk. • All individuals with 5 percent or more direct or indirect ownership interest in a SNF are required to obtain and submit fingerprints either to CMS or to the [...] • Any SNF with a 5% owner barred from enrollment, or failure to submit fingerprints, may result in termination or denial per 42 CFR 455.416. [...] § 455.101 for the definition of person with an ownership or control interest and § 455.102 for determination of ownership or control percentages. • The Centers for Medicare and Medicaid (CMS) sets a fee each calendar year to cover the cost of the screenings and background checks.Medicaid New Enrollment and Change of Ownership Instructions 2 • Based on the enrollment type selected on the Na [...] The new forms are as follows: • Kansas Organizational Provider Credentialing/Recredentialing Application • Section 12 Attestation/Consent and Release Form These forms will be included in KDADS’ initial email communication; any questions or requests for assistance will need to be directed to the MCO(s). Submit the completed forms via email to one or more of the MCOs which your facility plans [...] R.) 129-10-17 for full details. If you require assistance in filing a cost report, please contact the Cost Report team at kdads.costreports@ks.gov. [...] If you have questions regarding a new enrollment or a change of ownership, contact Trescia Power at 785-368-6685 or via email at Trescia.