7 AAC 105.410 - Sanctions

(a) The department may impose the following sanctions against a provider based on the grounds specified in 7 AAC 105.400:

(1) termination from participation in the Medicaid program;

(2) suspension of participation in the Medicaid program;

(3) restriction or withholding of payments to a provider;

(4) referral to a utilization and quality control peer-review organization;

(5) transfer to a closed-end provider agreement not to exceed 12 months or the shortening of an already-existing, closed-end provider agreement;

(6) mandatory attendance at provider education sessions, including one-on-one sessions;

(7) requirement of prior authorization of services;

(8) department review of all claims submitted by a provider before payment to the provider;

(9) referral to the applicable jurisdiction licensing board for investigation;

(10) referral for fiscal audit under 7 AAC 160.110;

(11) public notice of suspension or termination of a provider;

(12) reporting the provider to the Healthcare Integrity and Protection Data Bank authorized under 45 C.F.R. Part 61;

(13) restrictions on payment under 7 AAC 105.470.

(b) In this section, "utilization and quality control peer-review organization" means an organization administered by a grant agency of the federal government and defined under 42 U.S.C. 1320c-1.

Notes

7 AAC 105.410

Eff. 2/1/2010, Register 193

Authority:AS 47.05.010

AS 47.07.040