Special Bulletin 
 
Mandatory Fingerprinting of Providers and Owners of High 
Risk Entities 
The Affordable Care Act amended the Social Security Act (the Act) to require the Secretary, in consultation with the Office of the Inspector General to establish procedures for screening providers and suppliers under Medicare, Medicaid and CHIP. The Affordable Care Act also requires states to comply with the procedures established by the Secretary for screening providers and suppliers. The Centers for Medicare & Medicaid Services (CMS) implemented these requirements effective March 25, 2011. 
On December 23, 2011, CMS issued an Informational Bulletin to offer further information to states regarding the requirements of these regulations. The Informational Bulletin, which may be found here, referenced additional sub-regulatory guidance on fingerprint-based criminal background checks (FCBCs). This letter represents that guidance. 
A state Medicaid agency must require all enrolled providers to be screened according to the provisions set forth in these regulations. A state Medicaid agency is required to screen all applications, including initial applications, applications for a new practice location and applications for re-enrollment or revalidation, based on a categorical risk level of "limited," "moderate" or "high." A state Medicaid agency must establish categorical risk levels for providers and provider categories who pose an increased financial risk of fraud, waste or abuse to the Medicaid program. When the agency determines that a provider's categorical risk level is "high," or when the agency is otherwise required to do so under State law, the agency must require providers to consent to criminal background checks, including fingerprinting. When a state Medicaid agency designates a provider as a "high" categorical risk, the agency must do all of the following: 
Perform the limited and moderate screening requirements specified at 42 CFR 455.450(a) and (b); Require the submission of a set of fingerprints in accordance with 42 CFR 455.434; and, Conduct a criminal background check. 
For a list of Frequently Asked Questions, click HERE. 
 
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About DCH 
Through effective planning, purchasing and oversight, the 
Department of Community Health (DCH) provides access 
to affordable, quality health care to millions of Georgians, including some of the state's 
most vulnerable and underserved populations. 
DCH is responsible for Medicaid and PeachCare for Kids, the State Health Benefit 
Plan, Healthcare Facility Regulation and Health Information Technology in 
Georgia. Clyde L. Reese III, Esq. is Commissioner of the Georgia Department of Community 
Health. We are dedicated to A Healthy Georgia.    www.dch.georgia.gov 
 
Billing of Long Acting Reversible Contraceptive (LARC) on Inpatient UB-04 
Claims 
Effective February 25, 2016, institutional facilities enrolled in the Hospital Services program, Category of Service (COS) 010, began billing for the Long Acting Reversible Contraceptive (LARC) on their UB04 (inpatient) claim forms. Georgia Medicaid reimburses hospitals for their acquisition cost of LARC devices on the same UB-04 claim form as the delivery procedure. This allows both the delivery Diagnosis Related Grouper (DRG) and the associated cost of the LARC device to be reimbursed using only one UB-04 claim form. The specific criteria for billing the LARC device on the same delivery (inpatient) claim form was outlined in a banner message posted on February 26, 2016, on the Georgia Medicaid Management Information Services (GAMMIS) at www.mmis.georgia.gov under PROVIDER MESSAGES. 
For additional information, please refer to the first LARC banner message on April 15, 2014, regarding which LARC procedure codes, insertion codes and ICD-10 diagnosis codes to bill. 
 
DCH Mission We will provide Georgians with 
access to affordable quality health care through effective 
planning, purchasing and oversight. 
We are dedicated to A Healthy Georgia. 
About DCH-i DCH-i is the bi-monthly newsletter from the Georgia Department of Community Health for all matters DCH. It provides timely and important 
information to you as physicians, dentists, hospitals, third-party payers, vendors and 
health care advocates. Send us your questions at 
DCH-i@dch.ga.gov 
 
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