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Recently, the CMS made updates to the Medicare Enrollment chapter of the Program Integrity Manual. These changes are effective December 5, 2022.  Notable changes include updated provider enrollment instructions for: 

• Ownership disclosures
• Electronic funds transfers (EFTs)
• Special payment addresses

Please make sure that the individuals responsible for licensing, revalidation and other updates to your provider enrollment record are aware of these changes and updates. More details below. 

Ownership Disclosures

CMS re-emphasizes the following:

• The provider or supplier must disclose ALL persons and entities that meet the definition of “owner” in Section 10.1.1 of this Chapter
• You must show the applicable ownership percentage for each owner if the provider enrollment application you’re completing requires it 
• There can’t be indirect owners without direct owners 
• The combined disclosed ownership percentages for the provider  or  supplier’s  organizational and individual owners can’t be greater than 100% 

Special Instructions for EFT Accounts and Special Payment Addresses

A. Enrolled Providers or Suppliers

You may only have 1 EFT account and 1 special payment address (SPA) per enrollment. As a general rule, multiple EFT accounts or SPAs within an existing enrollment will remain in effect only until you send any update to your EFT information or SPA data, respectively, for any of these accounts or addresses. At that time, the EFT account or SPA for which you submitted the update will become the lone EFT account or SPA (as applicable) for that enrollment.

Example – Provider X is enrolled as a group practice and a Home Infusion Therapy (HIT) supplier (2 separate enrollments) in State Y. Currently:

• The group practice enrollment has 2 EFT accounts (1 with Smith Bank and 1 with Jones Bank) and 2 SPAs (100 James Street and 200 Johnson Street)
• The HIT supplier enrollment has the same 2 EFT accounts and SPAs as the group practice

Provider X submits a change to its Smith Bank account information for the group practice enrollment. In this scenario:

1. The Smith Bank account becomes the lone EFT account for the group practice
2. The group practice’s Jones Bank account becomes inactive in PECOS effective on the date of the notice to the provider or supplier that the originally submitted EFT change was approved, denied, rejected, or returned.
3. The Smith Bank and Jones Bank accounts for the HIT supplier enrollment are unaffected
4. The SPAs for Provider X’s 2 enrollments aren’t affected

B. Providers or Suppliers Initially Enrolling or Undergoing a Change of Ownership (CHOW) Consistent with the Principles of 42 CFR 489.18 The above policy that a provider or supplier may only have 1 EFT account and 1 SPA per enrollment also applies to:

1. 1. Providers or suppliers submitting an initial enrollment application; and
2. New owners in a certified provider or supplier CHOW  

Resources: 

Change Request (CR 12880): Seventh Generation Update to Provider Enrollment Instructions in Chapter 10 of CME Publication 100-08

MLN Matters Article (MM12880): Provider Enrollment Instructions: Seventh Generation Update