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SE20008: Medicare Clarifies Recognition of Interstate License Compact Pathways

Summary This revised SE Article comprises Subregulatory Guidance for recognition of interstate license compact pathways. An interstate license compact offers a new, voluntary, and faster pathway to licensure for qualified physicians and non-physician practitioners (NPPs) who wish to practice in multiple states. CMS policy or operation subject matter experts also reviewed/cleared this product. This SE Article educates physicians and non-physician practitioners (NPPs) (who get licenses through the interstate licensing compact pathways and wish to bill Medicare Administrative Contractors (MACs) for services they provide to Medicare patients) about CMS’ recognition of licenses through interstate license compact pathways as valid and full licenses for purposes of meeting federal license requirements. CMS will accept enrollment applications from providers reporting a license through the interstate license compact pathway. Providers must refer to Chapter 10, Section 10.2.3 of the Program Integrity Manual at https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/pim83c15.pdf regarding verification of license and certification requirements for enrollment. Revisions to this SE Article include following content updates:
• Added clarifying language for licenses that some providers get through interstate licensing compact pathways.
The previous version of this SE Article is available to the public and currently posted on the CMS website at https://www.cms.gov/files/document/se20008.pdf.

Download the Guidance Document

Final

Issued by: Centers for Medicare & Medicaid Services (CMS)

Issue Date: May 05, 2020

DISCLAIMER: The contents of this database lack the force and effect of law, except as authorized by law (including Medicare Advantage Rate Announcements and Advance Notices) or as specifically incorporated into a contract. The Department may not cite, use, or rely on any guidance that is not posted on the guidance repository, except to establish historical facts.