Kan. Admin. Regs. § 30-5-60 - Provider termination/suspension
(a) Any provider's
participation in the medicaid/medikan program may be terminated for one or more
of the following reasons:
(1) Voluntary
withdrawal of the provider from participation in the program;
(2) non-compliance with applicable state
laws, administrative regulations, or program issuances concerning medical
providers;
(3) non-compliance with
the terms of a provider agreement;
(4) non-compliance with the terms and
certification set forth on claims submitted to the agency for reimbursement;
(5) assignment, granting a power
of attorney over, or otherwise transferring right to payment of program claims
except as set forth in 42 U.S.C. 1396a (32), revised July 18, 1984, which is
adopted by reference;
(6) pattern
of submitting inaccurate billings or cost reports;
(7) pattern of submitting billings for
services not covered under the program;
(8) pattern of unnecessary utilization;
(9) unethical or unprofessional
conduct;
(10) suspension or
termination of license, registration, or certification;
(11) provision of goods, services, or
supplies harmful to individuals or of an inferior quality;
(12) civil or criminal fraud against
medicare, the Kansas medicaid/medikan or social service programs, or any other
state's medicaid or social service programs;
(13) suspension or exclusion by the secretary
of health and human services from the title XVIII or title XIX programs;
(14) direct or indirect ownership
or controlling interest of five percent or more in a provider institution,
organization or agency by a person who has been found guilty of civil or
criminal fraud against the medicare program or the Kansas medicaid/medikan or
social service programs or any other state's medicaid or social service
programs;
(15) employment or
appointment by a provider of a person in a managerial capacity or as an agent
if the person has been found guilty of civil or criminal fraud against the
medicare program or the Kansas medicaid/medikan or social service programs or
any other state's medicaid or social service programs;
(16) insolvency; or
(17) other good cause.
(b) Termination, unless based upon civil or
criminal fraud against the program, suspension or exclusion by the secretary of
health and human services, shall remain in effect until the agency determines
that the reason for the termination has been removed and that there is a
reasonable assurance that it shall not recur. Terminations based upon civil or
criminal fraud shall remain in effect for such time period as deemed
appropriate by the agency. Termination based upon suspension or exclusion by
the secretary of health and human services (HHS) shall remain in effect no less
than the time period specified in HHS' notice of suspension.
(c) Prior to the termination of a provider
from the program, the provider shall be sent a written notification by the
agency of the proposed termination and the reasons. The notice shall state
whether payment liability to the provider has been suspended pending further
proceedings. The notice shall further advise the provider that an appearance
before the section may be permitted at a specified time, not less than five
days nor more than 15 days from the date the notice is mailed to or served upon
the provider. At the appearance the provider may present any relevant evidence
and have an opportunity to be heard on the question of continuing eligibility
in the program. All evidence presented, including that of the provider, shall
be considered by the agency. If the decision is to terminate, a written order
of termination shall be issued, setting forth the effective date of the
termination and the basic underlying facts supporting the order.
(d) Any provider found not to be in
compliance with one or more requirements set forth in K.A.R. 30-5-59 may be
subject to suspension of payment or other remedies in lieu of termination. The
effective date of this regulation shall be May 3, 1993.
Notes
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