DMS begins CMS‑mandated off‑cycle provider revalidation; home‑health listed as high‑risk

Jennifer Dudinsky, division director for the Division of Program Integrity, told providers the department must carry out a CMS directive requiring a 24‑month off‑cycle revalidation for enrolled providers.

"So we are in the process of working through a provide provider revalidation, off cycle review. This was a directive made by CMS to us," Dudinsky said, and described a staged approach that begins with high‑risk provider types. She said high‑risk reviews will include fingerprint criminal background checks and site visits for owners or acting officers, and that providers who revalidated within the past 12 months are unlikely to be selected. Dudinsky added that DMS will notify providers through the partner portal (MPPA) and by mailed letters and that DMS will accept recent CMS accreditation records where appropriate.

Dudinsky also explained that DMS will use analytic data provided by CMS to help identify providers for follow‑up and said any audits will be targeted rather than random. Providers asked whether the analytic tools and potential audits could unduly burden otherwise compliant providers; Dudinsky said the CMS dashboard is not public and that state staff will validate flagged anomalies against state data before initiating audits. She suggested providers with concerns contact DMS finance or program integrity staff for further detail and said contact information and the presentation will be emailed to attendees.