Hardship Waiver Requests
State and federal regulations (13 CSR 65-2 and 42 CFR 455.460) require MMAC to collect an application fee, currently set at $688.00 (Jan. 1, 2023), from all new and revalidating “institutional” Medicaid providers. “Individual” providers such as physicians, dentists and other individual non-physician practitioners are not required to pay the application fee.
Effective July 1, 2015, MMAC began collecting the required application fee from all new, reenrolling and revalidating MO HealthNet institutional providers.
Providers can request a hardship waiver of the application fee from the Centers for Medicare and Medicaid (CMS), but the fee must be submitted before the application will be processed by MMAC. If CMS approves the hardship waiver, MMAC will refund the application fee to the provider.
A provider that is requesting a hardship exception from the application fee must include with its enrollment application a letter (and supporting documentation) that describes the hardship and why the hardship justifies an exception. The hardship letter must accompany the application. A hardship letter will not be considered if it is submitted separately from an application. It will be returned to the applicant with notification via letter, e-mail, or telephone, that it will not be considered.
Upon receipt of a hardship waiver request with an application, MMAC will send the request and all accompanying documentation to CMS. CMS will determine if the request should be approved. CMS will communicate its decision to the institutional provider and MMAC via letter.
In requesting a hardship waiver, it is not enough for the provider to simply assert that the imposition of the application fee represents a financial hardship. The provider must instead make a strong argument to support its request, including providing comprehensive documentation (which may include, without limitation, historical cost reports, recent financial statements such as balance sheets and income statements, cash flow statements, tax returns, etc.).
Other factors that may suggest a hardship exception is appropriate include the following:
Considerable bad debt expenses,
Significant amount of charity care/financial assistance furnished to patients,
Presence of substantive partnerships with those who furnish care to a disproportionately low-income population,
Whether an institutional provider receives considerable amounts of funding through disproportionate share hospital payments, or
Whether the provider is enrolling in a geographic area that is a Presidentially-declared disaster area under the Robert T. Stafford Disaster Relief and Emergency Assistance Act.
Note that if a provider fails to submit appropriate documentation to support its hardship exemption request, MMAC is not required to contact the provider to request it. Ultimately, it is the provider’s responsibility to furnish the necessary supporting evidence at the time it submits its hardship request.
Appeal of the Denial of a Hardship Waiver Request
If the provider is dissatisfied with CMS’s decision, it may file a written reconsideration request with CMS within 60 calendar days from receipt of the notice of initial determination. The request must be signed by the individual provider, a legal representative, or any authorized official within the entity. The procedures for submitting an appeal will be provided on the denial letter from CMS
Click here for more information regarding requesting a hardship waiver of the required application fee from CMS.