Subsection 144-101-III-97-1900 - TERMINATION UNDER TITLE XIX Termination of participation in Title XIX will result in the provider being terminated simultaneously from financial participation under PNMI cost reimbursement.
Alternatively, termination of participation in cost reimbursement will result in the provider being terminated simultaneously from participation in Title XIX. Conditions that may result in termination of participation in MaineCare are listed in Chapter I of the MaineCare Benefits Manual. These conditions may result in termination of the provider contract to provide PNMI services:
1900.1 The Federal Government fails to provide agreed upon funds; or1900.2 The State share of funds is unavailable; or1900.3 The life, health, or safety of persons served is endangered, in the opinion of the Department; or1900.4 The provider fails to submit fiscal or program reports on the prescribed dates; or 1900.5 Either the Department or the provider receives a written notice from the other for any reason stating that termination will occur in no later than 30 days; or1900.6 The provider fails to meet the applicable licensing regulations after a reasonable time for correction, or if the provider fails to deliver services in accordance with the plan of care; or1900.7 The license to operate is revoked by Department or court action, or if the facility's owner or its administrator is convicted of any crime related to operation of the facility; or1900.8 The same services can be provided at a lower rate on a fee-for-service basis or if the per diem rate is greater than the rates that third party payers are paying for comparable services under comparable circumstances. C.M.R. 10, 144, ch. 101, ch. III, 144-101-III-97, subsec. 144-101-III-97-1900