Section 75-03-23-08 - Denial of application to become a qualified service providerThe department may deny an application to become a qualified service provider if:
1. The applicant voluntarily withdraws the application;2. The applicant is not in compliance with applicable state laws, state regulations, or program issuances governing providers;3. The applicant, if previously enrolled as a qualified service provider, was not in compliance with the terms set forth in the application or provider agreement;4. The applicant, if previously enrolled as a qualified service provider, was not in compliance with the provider certification terms on the claims submitted for payment;5. The applicant, if previously enrolled as a qualified service provider, had assigned or otherwise transferred the right to payment of a program claim, except as provided in 42 U.S.C. 1396a(a) (32);6. The applicant, if previously enrolled as a qualified service provider, had demonstrated a pattern of submitting inaccurate billings or cost reports;7. The applicant, if previously enrolled as a qualified service provider, had demonstrated a pattern of submitting billings for services not covered under department programs;8. 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;9. The applicant has delivered goods, supplies, or services that are of an inferior quality or are harmful to individuals;10. The applicant has been convicted of an offense determined by the department to have a direct bearing upon the applicant's ability to be enrolled as a qualified service provider, or the department determines, following conviction of any other offense, the applicant is not sufficiently rehabilitated;11. The applicant, if previously enrolled as a qualified service provider, owes the department money for payments incorrectly made to the provider;12. The qualified service provider is currently excluded from participation in Medicare, Medicaid, or any other federal health care program;13. The applicant has not provided sufficient evidence to the department, after obtaining a formal evaluation under subsection 3 of section 75-03-23-07, that the applicant is physically, cognitively, socially, or emotionally capable of providing the care;14. The applicant previously has been terminated for inactivity and does not have a prospective public pay-eligible individual;15. The applicant previously has been terminated for inactivity and has not provided valid reason for the inactivity; or16. For other good cause.N.D. Admin Code 75-03-23-08
Effective June 1, 1995; amended effective January 1, 2009.Amended by Administrative Rules Supplement 2014-354, October 2014, effective 10/1/2014. .Amended by Administrative Rules Supplement 2016-360, April 2016, effective 4/1/2016.Amended byAdministrative Rules Supplement 375, January 2020, effective1/1/2020Amended by Administrative Rules Supplement 2021-383, January 2022, effective 1/1/2022.Amended by Administrative Rules Supplement 2022-386, October 2022, effective 10/1/2022.Amended by Administrative Rules Supplement 2023-391, January 2024, effective 1/1/2024.General Authority: NDCC 50-06.2-03(6)
Law Implemented: NDCC 50-06.2-03(5)