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HHS/CMS RIN: 0938-AQ01 Publication ID: Fall 2011 
Title: Changes in Provider and Supplier Enrollment, Ordering and Referring, and Documentation Requirements; and Changes in Provider Agreements (CMS-6010-F) 
Abstract: This final rule implements several provisions set forth in the Affordable Care Act. Specifically, the rule requires providers and suppliers under the Medicare and Medicaid programs that qualify for a national provider identifier (NPI) to include their NPI on all applications to enroll in such programs and all claims for payment submitted under such programs. The rule also requires, that physician and nonphysician practitioners (NPP) who are eligible to order and refer services for Medicare beneficiaries be enrolled in Medicare and adds requirements for physicians to provide documentation on referrals to programs at high risk of waste and abuse. 
Agency: Department of Health and Human Services(HHS)  Priority: Other Significant 
RIN Status: Previously published in the Unified Agenda Agenda Stage of Rulemaking: Long-Term Actions 
Major: No  Unfunded Mandates: No 
CFR Citation: 42 CFR 424   
Legal Authority: 42 USC 1302 and 1395hh   
Legal Deadline:
Action Source Description Date
Final  Statutory  MMA sec 902  05/05/2013 
Timetable:
Action Date FR Cite
Interim Final Rule  05/05/2010  75 FR 24437   
Interim Final Rule Comment Period End  07/06/2010    
Final Action  05/00/2013    
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