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Update on DOPL Rules, DEA Use of Home Address Concerns, and Medicaid Changes for Billing

Posted over 2 years ago by Amy Baird

Here are some important updates from the Board Meeting on Saturday:

DOPL Update: We expect the rules to go into effect around December 13, 2021

 Timeline

  • After we passed SB27 & SB28, it went to DOPL for the rules-making process. The bills became effective May 7th.
  • First week in November - the public comments for the Rules were finalized and are posted.
  • Rules will go into effect either 30 days after the closure of that public comment period or at the next DOPL meeting (not sure which).
  • DOPL indicated it may be 12/13/2021 at that DOPL meeting.
  • We like the Rules as they currently stand. Everyone is encouraged to look at those rules to understand them and how they will impact practice.
  • You can find the complete document here: https://dopl.utah.gov/laws/Prop_R156-70a_OAR_53945.pdf

DEA Updates: New Graduate Changes & Home Address Use and Possibility of Home Search

DEA / Supervising Physician for New Graduates:

  • For new PA graduates being hired, DEA is putting up a roadblock - requiring a Supervising Physician be listed on their license.
  • This is delaying hiring new graduate PAs.
  • We are working with AAPA who is working with the DEA to bring their operating rules into compliance without new Utah rules.
  • They have a state-by-state matrix regarding what NPs and PAs can do with their license, so they need to update that based on each state’s laws.
  • That is governed by state law more so than federal law. That is what is holding up hiring new graduates by Intermountain. Hopefully, that will be resolved before the next PA classes graduate. But if new graduates list a Supervising Physician with the DEA, that will speed up the hiring process.
  • FYI: The legislation changed from Supervising Physician to Collaborating Physician - and should be reflected in the DEA change. Medicare will allow direct billing by PAs as of December 1st.

DEA Home Address: Open for Search and Seizure

Medicaid Update: PAs Able to Bill Directly for Medicaid 

 Medicaid has changed their rules and PAs will now be able to bill directly for Medicaid patients. It should be effective December 1st.

  • Classifications: If you are billing for your clinic, it doesn’t require significant changes. If you are practicing independently and collecting those fees yourself, there will be a change in the way you enroll.
  • There are three levels for registration for Medicaid. So if you are practicing independently, you will need to change the way you  are registered with Medicaid.
  • More to come.
  • Here is the text:
  • This is the relevant section for PA's:  
    21-65 Upcoming Physician Assistant Billing Changes In accordance with Senate Bill 27, Physician Assistant Act Amendments and Senate Bill 28, Physician Assistant Mental Health Practice passed during the 2021 Legislative General Session, Utah Medicaid is in the process of creating a pathway for eligible Physician Assistants to bill Medicaid for appropriate services. Due to minor programming delays, our new target effective date is November 1, 2021, with retroactive effective enrollment dates and billing capabilities effective on May 5, 2021. MEDICAID INFORMATION BULLETIN: Interim September 2021 Page 2 of 5 We request that providers do not bill for these services until November 1, 2021, so that we can complete the necessary programming in order for Physician Assistants to bill. Utah Medicaid requires that providers, including Physician Assistants, submit claims only for services permitted within their scope of practice, training, and licensure in accordance with Utah State statutes and federal regulations. Scope of practice is outlined by the Division of Occupational and Professional Licensing in Administrative Rule. Physicians Assistants currently enrolled in Utah Medicaid may retain or update their provider type to one of the following: ● Ordering, Referring, and Prescribing Only - if you will continue to only order, refer, and/or prescribe for Medicaid members; ● Rendering/Servicing - if you will be providing services on behalf of a group; or ● Individual/Sole Proprietor - if you will be providing services independently and billing on behalf of yourself. ○ For this applicant type, you must upload a completed W-9. To review your current provider type and make any desired changes, please visit: https://medicaid.utah.gov/become-medicaid-provider. For any questions regarding this process, please contact the Provider Enrollment Team at 1-800-662- 9651, press option 3, then option 4. Physician Assistants who plan to operate independently, or become a rendering/servicing provider, will be assigned provider type 25. Physician Assistants are required to verify services are covered through their provider type prior to rendering services to enrolled Medicaid members. More information about coverage will be added here: https://health.utah.gov/stplan/lookup/CoverageLookup.php.