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

Current through Supplement No. 394, October, 2024

Section 75-02-05-04.1 - Denial of application to become a Medicaid or children's health insurance program provider

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.

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

Adopted by Administrative Rules Supplement 368, April 2018, effective 4/1/2018.

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

Law Implemented:42 CFR 431.107