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

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

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