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HHS/CMS RIN: 0938-AP01 Publication ID: Fall 2014 
Title: Requirements for the Medicare Incentive Reward Program and Provider Enrollment (CMS-6045-F) 
Abstract: This final rule implements various provider enrollment requirements. These include: expanding the instances in which a felony conviction can serve as a basis for denial or revocation of a provider or supplier's enrollment; if certain criteria are met, enabling us to deny enrollment if the enrolling provider, supplier, or owner thereof had an ownership relationship with a previously enrolled provider or supplier that had a Medicare debt; enabling us to revoke Medicare billing privileges if we determine that the provider or supplier has a pattern or practice of submitting claims that fail to meet Medicare requirements; and limiting the ability of ambulance suppliers to "backbill" for services performed prior to enrollment. 
Agency: Department of Health and Human Services(HHS)  Priority: Economically Significant 
RIN Status: Previously published in the Unified Agenda Agenda Stage of Rulemaking: Long-Term Actions 
Major: Yes  Unfunded Mandates: No 
CFR Citation: 42 CFR 405    42 CFR 424    42 CFR 498   
Legal Authority: 42 USC 1395ww   
Legal Deadline:
Action Source Description Date
Final  Statutory  MMA Section 902  04/29/2016 
Timetable:
Action Date FR Cite
NPRM  04/29/2013  78 FR 25013   
NPRM Comment Period End  06/28/2013 
Final Action  04/00/2016 
Additional Information: Includes Retrospective Review under E.O. 13563
Regulatory Flexibility Analysis Required: No  Government Levels Affected: None 
Federalism: No 
Included in the Regulatory Plan: No 
RIN Data Printed in the FR: No 
Agency Contact:
John Spiegel
Director, Division of Policy and Regulatory Development, Medicare Program Integrity Group
Department of Health and Human Services
Centers for Medicare & Medicaid Services
Center for Program Integrity, MS: AR-18-50, 7500 Security Boulevard,
Baltimore, MD 21244
Phone:410 786-1909
Fax:410 786-0035
Email: john.spiegel@cms.hhs.gov