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The purpose of this bulletin is to address changes to the risk-based screening and enrollment requirements for Skilled Nursing Facility (SNF) and Hospice providers enrolled with the Department of Medical Assistance Services (DMAS). 

In accordance with Section 6401(a) of the Affordable Care Act (ACA), the Centers for Medicare and Medicaid Services (CMS) requires all state Medicaid agencies to screen and enroll and periodically revalidate providers in accordance with standards explained in the Code of Federal Regulations (CFR), at 42 CFR § 455 Subpart E. 

Updated Screening Activities by Risk Level 

All providers are screened in accordance with federally mandated requirements prior to the approval or renewal of their participation in Virginia Medicaid by DMAS. In addition to initial risk-based screening, DMAS performs monthly screening of all participating providers, as well as a comprehensive screening at the time of revalidation.

The screening measures required vary by categorical risk level, as defined by federal guidelines—limited, moderate, or high.

As part of recent federal updates, CMS has revised risk-based screening and enrollment requirements, stipulating that Skilled Nursing Facility (SNF) and Hospice providers must undergo:

• High-risk screening for initial enrollment, re-enrollment, and changes in ownership

• Moderate-risk screening for revalidations

A summary of these changes is included in the table below. All providers are required to revalidate at least every five years.

Effective December 1, 2025, DMAS will implement these mandatory updates to align with CMS directives.

Note: Although Skilled Nursing Facilities (SNFs) will be classified as “High Risk” effective December 1, 2025, and subject to associated screening requirements, the Medicare revalidation application deadline for all SNFs has been extended from August 1, 2025, to January 1, 2026.

DMAS strongly encourages Skilled Nursing Facility (SNF)and Hospice providers to ensure their Medicare enrollment records are current. When a provider’s Medicare enrollment information is accurate and aligned with the details in their PRSS Medicaid enrollment application, DMAS may rely on the site visits and screening activities previously conducted by Medicare.

Additional information regarding screening and enrollment can be found on the DMAS Medicaid Enterprise System (MES) provider webpage. 

For direct assistance, please contact DMAS’s provider enrollment vendor, Gainwell via email at virginiaproviderenrollment@gainwelltechnologies.com 1-888-829-5373.