C.M.R. 10, 144, ch. 101, ch. I, § 144-101-I-1, subsec. 144-101-I-1.19

Current through 2024-46, November 13, 2024

Subsection 144-101-I-1.19 - TERMINATION FROM PARTICIPATION IN MAINECARE

1.19-1Termination of Participation by Provider or Department

A.Non-Emergency Termination

The Department may terminate a provider's participation, or the provider may terminate participation in MaineCare, without cause. The terminating party must send written notification of the termination at least thirty (30) days prior to the effective date of termination. Providers must send this notification to the Director of Compliance, MaineCare Services, Department of Health and Human Services, 11 State House Station, Augusta, Maine 04333-0011.

Primary care providers must also abide by the termination regulations set forth in the Primary Care Case Management Policy.

B.Emergency Termination

The Department may terminate MaineCare participation of a provider immediately by giving written notice to the provider if the Department reasonably believes that conditions exist that place the health and safety of members in immediate jeopardy. The provider will be given the opportunity for an informal review after the effective date of the emergency termination. A request for an informal review must be made within seven (7) days of the date of the receipt of the termination notice, or an informal review shall be deemed waived. Any administrative hearing or informal review will be scheduled after the effective termination date and the transfer of members.

C.Procedures Following Notice of Termination

1. Except as otherwise directed by the Department, after notice of termination by either the provider or the Department or after notice of emergency termination, the provider shall furnish the Department with access to all information pertaining to each individual member presently being cared for by the provider in such detail as deemed necessary by the Department.

2. The Department shall reimburse providers for covered services rendered during the period following a notice of termination up to the effective date of termination. The Department may decide to extend the effective date of a termination for providers of residential services, if necessary, to achieve the safe relocation of members. A provider remains obligated to follow the provisions of its MaineCare Provider Agreement and all applicable sections of the MBM in order to continue to receive reimbursement for services.

C.M.R. 10, 144, ch. 101, ch. I, § 144-101-I-1, subsec. 144-101-I-1.19