Cal. Code Regs. Tit. 22, § 51000.53 - Deactivation of a Provider Number(s) or Location(s)

Current through Register 2021 Notice, Register No. 40, October 1, 2021

(a) The Department shall deactivate, immediately and without prior notice, a provider's provider number(s) or location(s) used to obtain reimbursement from the Medi-Cal program, under the following circumstances:
(1) When warrants or documents mailed to a provider's mailing address, pay to address, or business address, are returned by the United States Postal Service as not deliverable.
(2) When a provider has not submitted a claim for reimbursement from the Medi-Cal program for one year.
(3) When the person or entity that was enrolled no longer exists by operation of law or otherwise.
(4) When an application for change in location, pursuant to Welfare and Institutions Code Section 14043.26(k), is approved the prior location shall be deactivated.
(5) When the provider has a license, certificate, or other approval to provide healthcare revoked or suspended by a federal, California, or another state's licensing, certification, or approval authority, or has otherwise lost that license, certificate, or approval, or has surrendered that license, certificate, or approval while a disciplinary hearing on that license, certificate, or approval was pending.
(6) When a provider receives written notice that it is subject to the requirement for continued enrollment pursuant to Section51000.55 and fails to respond to the Department within the time frames required by Sections 51000.50 and 51000.55.
(7) When a provider submits a written request for termination or deactivation of its provider number(s) or location(s).
(8) When an application submitted pursuant to Section51000.30(b) is approved, and the provider transferor and transferee applicant meet the requirements set forth in Section 51000.32, the provider status of the transferor at that location shall be deactivated.
(9) When an application submitted pursuant to Section51000.30(b) is denied on the transferee applicant's failure to meet the criteria specified in Section 51000.50(a), the provider transferor's provider number or location shall be deactivated.
(b) Prior to taking action to deactivate a provider's number or specific location used by a provider to obtain reimbursement from the Medi-Cal program pursuant to subsections (a)(1) and (a)(2), the Department shall use due diligence in attempting to contact the provider by telephone or in writing to ascertain whether the provider wishes to continue to participate in the Medi-Cal program.
(c) During the provisional provider status period or preferred provisional provider status period, the Department shall deactivate a provider's number or the specific location used by a provider to obtain reimbursement from the Medi-Cal program pursuant to Welfare and Institutions Code Section 14043.27.
(d) An applicant or provider who has used one or more provider numbers to obtain reimbursement from the Medi-Cal program for a specific location and who's provider number(s) or location(s) has been deactivated pursuant to this section may appeal this action pursuant to Welfare and Institutions Code Section 14043.65.

Notes

Cal. Code Regs. Tit. 22, § 51000.53

Note: Authority cited: Section 20, Health and Safety Code; and Sections 10725, 14043.75 and 14124.5, Welfare and Institutions Code. Reference: Sections 14043.2, 14043.26, 14043.27, 14043.28, 14043.36, 14043.37, 14043.45, 14043.62 and 14043.7, Welfare and Institutions Code; 42 U.S.C. Sections 1320a-3, 1320a-7, 1396a(a)(39) and 1396b(i)(2); and 42 Code of Federal Regulations Part 455.

1. New section filed 9-29-2004 as an emergency; operative 10-7-2004 (Register 2004, No. 41). A Certificate of Compliance must be transmitted to OAL by 2-4-2005 or emergency language will be repealed by operation of law on the following day. Deemed emergency exempt from OAL pursuant to Welfare and Institutions Code section 14043.75.
2. New section refiled 1-27-2005 as an emergency; operative 2-5-2005 (Register 2005, No. 4). A Certificate of Compliance must be transmitted to OAL by 6-6-2005 or emergency language will be repealed by operation of law on the following day. Deemed emergency exempt from OAL review pursuant to Welfare and Institutions Code section 14043.75.
3. New section refiled 6-2-2005 as an emergency; operative 6-7-2005 (Register 2005, No. 22). A Certificate of Compliance must be transmitted to OAL by 10-5-2005 or emergency language will be repealed by operation of law on the following day. Deemed emergency exempt from OAL review pursuant to Welfare and Institutions Code section 14043.75.
4. Certificate of Compliance as to 6-2-2005 order, including amendment of section, transmitted to OAL 9-29-2005 and filed 11-10-2005 (Register 2005, No. 45).
5. Editorial correction of subsection (a)(8) (Register 2006, No. 36).
6. Change without regulatory effect amending section heading, section and Note filed 1-23-2009 pursuant to section 100, title 1, California Code of Regulations (Register 2009, No. 4).
7. Change without regulatory effect amending subsection (b) and Notefiled 6-21-2012 pursuant to section 100, title 1, California Code of Regulations (Register 2012, No. 25).

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