Missouri Code of State Regulations › Title 13 - DEPARTMENT OF SOCIAL SERVICES › Division 65 - Missouri Medicaid Audit and Compliance › Chapter 2 - Medicaid › Section 13 CSR 65-2.030 - Denial or Limitations of Applying Provider

Current through Register Vol. 49, No. 14, July 15, 2024
PURPOSE: This amendment combines and clarifies the
				  procedures found in this regulation and the procedure formerly found at
				  13 CSR
				  70-3.020, which is being rescinded. MO HealthNet
				  providers will no longer have to look in two (2) locations to find the basis on
				  which providers may be approved or denied as a new provider and/or revalidating
				  provider, for the basis on which a new practice location may be approved or
				  denied, or for the revalidation requirements. Additionally, this regulation now
				  mirrors federal Medicaid program integrity regulatory requirements that
				  Missouri must follow as a condition of its federal Medicaid
				  funding.
(1) Missouri
				Medicaid Audit Compliance (MMAC) may terminate the provider's enrollment or
				deny enrollment-
(A) Where the provider did
				not submit timely and accurate information or did not cooperate with screening
				methods required under applicable statutes and regulations unless the provider
				cures the failure to comply with this subsection within thirty (30) days of
				MMAC's notice that it intends to terminate the provider or deny
				enrollment;
(B) Where the provider
				or any person with an ownership or control interest has been convicted of or
				pled guilty to a criminal offense, including any suspended imposition of
				sentence, any suspended execution of sentence, or any period of probation or
				parole, related to their involvement with the Medicare, Medicaid, or Title XXI
				program in the last ten (10) years, unless MMAC determines that denial or
				termination of enrollment is not in the best interests of the MO HealthNet
				Program and MMAC documents that determination in writing;
(C) Where the provider or any person with an
				ownership or control interest has been convicted of or pled guilty to a
				misdemeanor or felony charge, including any suspended imposition of sentence,
				any suspended execution of sentence, or any period of probation or parole
				relating to:
1. Endangering the welfare of a
				child;
2. Abusing or neglecting a
				resident, patient, or client;
3.
				Misappropriating funds or property belonging to a resident, patient, or client;
				or
4. Falsifying documentation
				verifying delivery of services to a personal care assistance services
				consumer;
(D) Where the
				provider or any person with an ownership or control interest has been placed on
				the Family Care Safety Registry as mandated by sections 210.900-210.936, RSMo;
				or been placed on the Missouri Sex Offender Registry as mandated by sections
				589.400-589.425 and
				43.650,
				RSMo;
(E) Where the provider is
				terminated under Title XVIII of the Social Security Act or under the Medicaid
				Program or Children's Health Insurance Program (CHIP) of any other state unless
				MMAC determines that the termination was not for cause, which may include, but
				is not limited to, fraud, integrity, or quality. Termination or denial of
				enrollment will not be required if MMAC determines it would not be in the best
				interests of the MO HealthNet Program and MMAC receives a waiver from the
				United States Department of Health and Human Services, Centers for Medicare and
				Medicaid Services pursuant to
				42
				U.S.C. 1320a-7;
(F) Where the provider or a person with an ownership
				or control interest or who is an agent or managing employee of the provider
				fails to submit timely or accurate information, unless MMAC determines that
				termination or denial of enrollment is not in the best interests of the MO
				HealthNet Program, and MMAC documents that determination in writing;
(G) Where the provider, or any person with
				ownership or control interest, fails to submit fingerprints in a form and
				manner to be determined by MMAC within thirty (30) days of a request by Centers
				for Medicare and Medicaid Services (CMS) or MMAC, unless MMAC determines that
				termination or denial of enrollment is not in the best interests of the MO
				HealthNet Program, and MMAC documents that determination in writing;
(H) Where the provider fails to permit
				access to provider locations for any site visits under
				13 CSR
				65-2.020, unless MMAC determines that termination or
				denial of enrollment is not in the best interests of the MO HealthNet Program,
				and MMAC documents that determination in writing;
(I) Where the provider fails to complete an
				application for provider direct deposit as required by
				13 CSR
				70-3.140;
(J) Where the provider or a person with an
				ownership or control interest submitted false information to MMAC; or
(K) Where the identity of any provider or
				person with an ownership or control interest cannot be
				verified.