California Code of Regulations › Title 22 - Social Security › Division 3 - Health Care Services › Subdivision 1 - California Medical Assistance Program › Chapter 3 - Health Care Services › Article 1 - Application and Enrollment › Section 51000.50 - Application Review Criteria and Notice of Department Action

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) The Department
					 shall review the applicant's or provider's completed application package for
					 enrollment, continued enrollment, enrollment at a new, additional, or change in
					 location, or enrollment pursuant to Section
					 51000.30(b) in
					 the Medi-Cal program. The applicant or provider shall meet the following
					 requirements for enrollment in the Medi-Cal program:
(1) The application package shall be signed
					 and notarized if required by Section
					 51000.30(a)(2).
(2) The information specified in Sections
					 51000.30,
					 51000.35, and
					 51000.45, and all required
					 submittals and attachments to the application package have been received by the
					 Department.
(3) The applicant or
					 provider has a valid license, certificate, or other approval necessary to
					 perform the healthcare services or to provide the goods, supplies, or
					 merchandise within the applicable provider of service category or subgroup of
					 that category.
(4) The applicant or
					 provider meets all applicable standards for participation in the Medi-Cal
					 program specified in Chapter 7 (commencing with section
					 14000) and Chapter 8 (commencing
					 with 14200) of Part 3 of Division 9 of the Welfare and Institutions Code, and
					 Division 3, Title 22, California Code of Regulations.
(5) The applicant or provider has obtained
					 all state and local licenses, permits, or authorizations necessary to operate a
					 business at the business address for which the application package is submitted
					 and to perform the health care services or to provide the goods, supplies, or
					 merchandise with the applicable provider of service category or subgroup of
					 that category.
(6) All fines, and
					 debts due and owing, including overpayments and penalty assessments, to any
					 federal, state, or local government entity that relates to Medicare, Medicaid,
					 Medi-Cal, or any other federal and state health care program, have been paid,
					 or satisfactory arrangements have been made to fulfill the obligation or the
					 fine or debt has been excused by legal proceedings.
(7) No applicant, provider, person with an
					 ownership or control interest in the applicant or provider, or person who is a
					 director, officer, or managing employee of an applicant or provider, has been
					 convicted of any felony, or convicted of any misdemeanor involving fraud or
					 abuse in any government program, related to neglect or abuse of a patient in
					 connection with the delivery of a healthcare item or service, or in connection
					 with the interference with, or obstruction of, any investigation into health
					 care related fraud or abuse, or has been found liable for fraud or abuse in any
					 civil proceeding, or has entered into a settlement in lieu of conviction for
					 fraud or abuse in any government program within ten years of the date of the
					 application package.
(8) No
					 applicant, provider, person with an ownership or control interest in the
					 applicant or provider, or person who is a director, officer, or managing
					 employee of an applicant or provider shall be under investigation for any
					 healthcare related fraud or abuse at the time of the application for
					 enrollment, continued enrollment, enrollment at a new, additional, or change in
					 location, enrollment pursuant to Section
					 51000.30(b), or
					 during the preenrollment period.
(9) The applicant or provider has
					 satisfactorily corrected any discrepancies in the application package or
					 identified in a background check, preenrollment inspection or unannounced visit
					 within the time limit specified by the Department. If the applicant or provider
					 cannot satisfactorily correct one or more discrepancies because they occurred
					 in the past, then the application shall be denied.
(10) The applicant or provider has
					 satisfactorily demonstrated to the Department that the business address for
					 which the application package was submitted is an established place of business
					 as specified in Section
					 51000.60, at the time of
					 application and at the time of any background check, preenrollment inspection
					 or unannounced visit.
(11) If
					 applicable, the period of time during which an applicant or provider has been
					 barred from reapplying has passed.
(12) The information submitted by the
					 applicant or provider is accurate and complete.