N.D. Admin Code 75-02-05-04.1 - Denial of application to become a Medicaid or children's health insurance program provider

State Regulations
Compare

Current through Supplement No. 383, January, 2022

The department may deny an application to become a Medicaid or children's health insurance program provider if:

1. The applicant voluntarily withdraws the application;

2. The applicant is not in compliance with applicable federal law, federal regulation, state law, state rules, or program issuances governing providers;

3. The applicant, if previously enrolled as a Medicaid or children's health insurance program provider, was not in compliance with the terms set forth in the application or provider agreement;

4. The applicant, if previously enrolled as a Medicaid or children's health insurance program provider, was not in compliance with the provider certification terms on the claims submitted for payment;

5. The applicant, if previously enrolled as a Medicaid or children's health insurance program provider, had demonstrated a pattern of submitting inaccurate billings or cost reports;

6. The applicant, if previously enrolled as a Medicaid or children's health insurance program provider, had demonstrated a pattern of submitting billings for services not covered under department programs;

7. The applicant has been debarred or the applicant's license or certificate to practice in the applicant's profession or to conduct business has been suspended or terminated;

8. The applicant delivers goods, supplies, or services that are of an inferior quality or are harmful to individuals;

9. The applicant has been convicted of an offense in section 75-02-05-11, which is determined by the department to have a direct bearing upon the applicant's ability to be enrolled as a Medicaid or children's health insurance program provider, or the department determines, following conviction of any other offense, the applicant is not sufficiently rehabilitated;

10. The applicant, if previously enrolled as a Medicaid or children's health insurance program provider, owes the department money for payments incorrectly made to the provider;

11. The provider is currently excluded from participation in Medicare, Medicaid, children's health insurance program, or any other federal health care program; and

12. For good cause.

Notes

N.D. Admin Code 75-02-05-04.1

Adopted by Administrative Rules Supplement 368, April 2018, effective April 1, 2018.

General Authority: NDCC 50-06-01.9, 50-24.1-04, 50-29-02

Law Implemented: 42 CFR 431.107

The following state regulations pages link to this page.

State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.

The department may deny an application to become a Medicaid or children's health insurance program provider if:
1. The applicant voluntarily withdraws the application;
2. The applicant is not in compliance with applicable federal law, federal regulation, state law, state rules, or program issuances governing providers;
3. The applicant, if previously enrolled as a Medicaid or children's health insurance program provider, was not in compliance with the terms set forth in the application or provider agreement;
4. The applicant, if previously enrolled as a Medicaid or children's health insurance program provider, was not in compliance with the provider certification terms on the claims submitted for payment;
5. The applicant, if previously enrolled as a Medicaid or children's health insurance program provider, had demonstrated a pattern of submitting inaccurate billings or cost reports;
6. The applicant, if previously enrolled as a Medicaid or children's health insurance program provider, had demonstrated a pattern of submitting billings for services not covered under department programs;
7. The applicant has been debarred or the applicant's license or certificate to practice in the applicant's profession or to conduct business has been suspended or terminated;
8. The applicant delivers goods, supplies, or services that are of an inferior quality or are harmful to individuals;
9. The applicant has been convicted of an offense in section 75-02-05-11, which is determined by the department to have a direct bearing upon the applicant's ability to be enrolled as a Medicaid or children's health insurance program provider, or the department determines, following conviction of any other offense, the applicant is not sufficiently rehabilitated;
10. The applicant, if previously enrolled as a Medicaid or children's health insurance program provider, owes the department money for payments incorrectly made to the provider;
11. The provider is currently excluded from participation in Medicare, Medicaid, children's health insurance program, or any other federal health care program; and
12. For good cause.

History: Effective April 1, 2018.

General Authority: NDCC 50-06-01.9, 50-24.1-04, 50-29-02

Law Implemented: 42 CFR 431.107