MedicaidAdministrativeMedium impact
Assignment of ACA Categorical Risk Levels and the Implementation of Site Visits MAB 99-16-13
Pennsylvania Medicaid (DHS)·PA · Physical Therapy, Occupational Therapy, Psychiatry +1 more·Provider Bulletin
Effective date
Aug 4, 2016
We identified it
Jun 20, 2026
Summary
Pennsylvania Department of Human Services is implementing ACA-required risk-based provider screening with categorical risk levels (limited, moderate, high) and mandatory site visits for moderate/high-risk providers. This affects provider enrollment, revalidation, and ongoing compliance requirements for Medical Assistance (Medicaid) programs.
Action Required
By September 25, 2016: All providers enrolled on or before September 25, 2011 must complete revalidation through PROMISe system at least 60 days prior to deadline. All providers must permit unannounced site visits at any location. Providers categorized as moderate or high risk (including home health, DME, mental health, rehab facilities, hospice) must prepare for pre-enrollment and post-enrollment site visits unless already screened by Medicare or another state.