Action Required Regarding 2019 CMS Mandatory Trainings

Date: 04/16/19

Sunrise, FL

The Centers for Medicare and Medicaid Services (CMS) require that Medicare Advantage Organizations inform network providers and practitioners about the requirements to complete annual training.  In 2019, the required trainings are:

Model of Care (MOC)
General Compliance (Compliance)
Fraud, Waste, and Abuse (FWA)*

For General Compliance and Fraud, Waste, and Abuse*: effective January 1, 2019, First-Tier, Downstream, and Related Entities (FDR), as well as delegated entities, will be required to complete training via the Medicare Learning Network (MLN) website.  The trainings must be completed by each individual provider/practitioner within the group rather than one person representing the group collectively.  The updated regulation requires all applicable entities (providers, practitioners, administrators) to complete the training within 90 days of contracting or becoming a delegated entity and annually thereafter.  Once the training is completed, each applicable entity will need to complete the certificate(s) of completion or attestation through the CMS MLN and provide a copy to Sunshine Health.

*Note:  FDR's deemed to have met the FWA training and education certification requirements through enrollment into Parts A or B of the Medicare program or through accreditation as a supplier of DMEPOS are exempt from the FWA training requirement only (General Compliance training remains a requirement)

To complete Compliance and FWA training (if applicable) and access your certificate of completion:

·         Visit the CMS MLN Provider Compliance page and refer to the following downloads:

Medicare Parts C and D General Compliance Training (PDF)
Combating Medicare Parts C and D Fraud, Waste, and Abuse (PDF)

·         Please provide Sunshine Health a copy of each certificate of completion:

Email to: compliancefl@centene.com
Fax to:  1-866-796-0540

For Medicare Advantage Model of Care (MOC), please visit Sunshine Health MOC Provider Training (PDF) and fill out the attestation form located at the end of the presentation and submit.  Attestation forms can be completed and submitted online per instructions.  Please note that when you complete the attestation form, remember to include all tax identification numbers (TIN) that you are representing.

Training	Training Location	Signed Attestation(s) From	Attestation Method
Medicare Advantage Model of Care	Sunshine Health MOC Provider Training (PDF)	Representative may attest for group or organization (TIN level)	Complete the electronic attestation form on Sunshine Health's website at the end of the training presentation.
General Compliance	Medicare Parts C and D General Compliance Training (PDF)	Each applicable provider, practitioner, administrator (entities classified as FDR)	Send a copy of the CMS certificate of completion to Sunshine Health at: compliancefl@centene.com
Fraud, Waste, and Abuse	Combating Medicare Parts C and D Fraud, Waste, and Abuse (PDF)	Each applicable provider, practitioner, administrator (entities classified as a FDR provided they are not exempt - see *note above)	Send a copy of the CMS certificate of completion to Sunshine Health at: compliancefl@centene.com

Sunshine Health is committed to working with you to fulfill these CMS requirements.  If you need additional information, please feel free to contact Provider Services at 1-844-477-8313.

Thank you for your participation.  We look forward to working with you to provide quality medical services and healthcare coverage to our Sunshine Health Medicare Advantage members.