Idaho Admin. Code r. 16.03.09.205

Current through September 2, 2024
Section 16.03.09.205 - AGREEMENTS WITH PROVIDERS
01.In General. All individuals or organizations must enter into a written provider agreement accepted by the Department prior to receipt of any reimbursement for services. Agreements may contain any terms or conditions deemed appropriate by the Department. All provider agreements must be signed by the provider or by an owner or officer who has the legal authority to bind the provider in the agreement.
02.Federal Disclosure Requirements. To comply with the disclosure requirements in 42 CFR 455, Subpart B, each provider, other than an individual practitioner or a group of practitioners, must disclose to the Department:
a. The full name and address of each individual who has either direct or indirect ownership interest in the disclosing entity or in any subcontractor of five percent (5%) or more prior to entering into an agreement or at the time of survey and certification; and
b. Whether any person named in the disclosure is related to another person named in the disclosure as a spouse, parent, or sibling.
03.Provider Agreement Enforcement Actions and Terminations. Provider agreements may be terminated with or without cause. Terminations for cause may be appealed as a contested case in accordance with the IDAPA 16.05.03, "Contested Case Proceedings and Declaratory Rulings." The Department may, at its discretion, take any of the following actions for cause based on the provider's conduct or the conduct of its employees or agents, or when the provider fails to comply with any term or provision of the provider agreement, or any applicable state or federal regulation:
a. Require corrective actions as described in IDAPA 16.05.07, "The Investigation and Enforcement of Fraud, Abuse, and Misconduct," Section 270.
b. Require a corrective action plan to be submitted by the provider to address noncompliance with the provider agreement;
c. Reduce, limit, or suspend payment of claims pending the submission, acceptance, or completion of a corrective action plan;
d. Limit or suspend provision of services to participants who have not previously established services with the provider pending the submission, acceptance, or completion of a corrective action plan; or
e. Terminate the provider's agreement.
04.Termination of Provider Agreements. Due to the need to respond quickly to state and federal mandates, as well as the changing needs of the State Plan, the Department may terminate provider agreements without cause by giving written notice to the provider as set forth in the agreement. If an agreement does not provide a notice period, the period is twenty-eight (28) days. Terminations without cause may result from elimination or change of programs or requirements, or the provider's inability to continue providing services due to the actions of another agency or board. Terminations without cause are not subject to contested case proceedings since the action will either affect a class of providers, or will result from the discretionary act of another regulatory body.

Idaho Admin. Code r. 16.03.09.205

Effective March 17, 2022