Section 16.05.07.261 - REINSTATEMENT AFTER EXCLUSION FROM MEDICAID PROGRAMAn individual or entity who has been excluded from the Medicaid Program is not automatically reinstated at the end of the exclusion period. An individual or entity excluded by the Department must submit a written application for reinstatement to the Department. An applicant excluded by the Department must receive written notice of reinstatement from the Department before reinstatement is complete.
01.Conditions for Reinstatement. To be reinstated, the applicant must meet the following criteria:a. Not be currently excluded from the Medicaid program by the federal government or by any state Medicaid agency;b. Not have a currently terminated Medicaid provider number by any state Medicaid agency;c. Has all debts to the Department paid in full;d. Not be the subject of any civil, criminal, or state licensing authority investigation;e. Has not been convicted of any crime during the exclusion period;f. Has all the required, valid licensure and credentials necessary to provide services;g. Has met and continues to meet all terms and conditions of any court-ordered probation;h. Did not work in any capacity as an employee or contractor for any individual or entity receiving Medicaid funds during the applicant's exclusion period; andi. Did not submit claims or cause claims to be submitted for Medicaid reimbursement for services or supplies provided, ordered, or prescribed by an excluded individual or entity during the applicant's exclusion period.02.Applying for Reinstatement. An individual or entity may not begin the process of reinstatement earlier than one hundred twenty (120) days before the end of the exclusion period specified in the exclusion notice. The Department will not consider a premature application. An applicant that appears on the federal or any state exclusion list may apply for reinstatement, but consideration of the application will not start until after the excluding agency has reinstated the individual or entity.03.Request for Reinstatement. An excluded individual or entity must request an application form in writing from the Department and specifically request reinstatement. The request for reinstatement must include: a. The applicant's name, address, and phone number; andb. Copies of any required license, credentials, and provider number, if they exist.04.Complete Application for Reinstatement. The applicant must complete the reinstatement application form and return the fully executed and notarized form to the Department.05.Department Decision. The Department will issue a written decision to grant or deny a request for reinstatement.06.Reinstatement Denied. When an application for reinstatement is denied, the applicant is ineligible to reapply for one (1) year from the date the decision of denial becomes final.Idaho Admin. Code r. 16.05.07.261