CMS: Hospitals can use service vendors to assist with PE determinations

AHA News Now

The Centers for Medicare & Medicaid Services today clarified that hospitals can continue to use service vendors to assist them in making Medicaid presumptive eligibility determinations under the Patient Protection and Affordable Care Act. CMS’ clarification, which was requested by AHA, says “hospitals can rely on third-party contractors to help staff their in-hospital PE operations, by staffing welcome desks, meeting with consumers, and helping them fill out PE applications as long as the hospital takes responsibility for the PE determinations that result.” In addition, CMS says that states “should not unduly limit a hospital’s ability to rely on third-party contractors as long as the hospital is not delegating its authority to determine presumptive eligibility to a third party and is meeting appropriate state-established performance standards.” CMS issued the clarifications in a series of FAQs on hospital PE.

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