New York Codes, Rules and Regulations › Title 18 - DEPARTMENT OF SOCIAL SERVICES › Chapter II - Regulations of the Department of Social Services › Subchapter E - Medical Care › Article 2 - Program Administration › Part 504 - Medical Care-enrollment Of Providers › Section 504.5 - Denial of an application

Current through Register Vol. 46, No. 28, July 10, 2024
(a) In
			 determining whether to enter into a contract with an applicant, the department
			 shall consider the following factors with respect to the applicant and any
			 affiliated person:
(1) any false
			 representation or omission of any material fact in making the
			 application;
(2) any previous or
			 current suspension, exclusion or involuntary withdrawal from participation in
			 the medical assistance program or the Medicaid program of any other state of
			 the United States or from participation in any other governmental or private
			 medical insurance program including, but not limited to, Medicare, Workers'
			 Compensation, Physically Handicapped Children's Program and Rehabilitation
			 Services;
(3) the receipt of, but
			 not having made restitution for, a Medicaid or Medicare overpayment, as
			 determined to have been made pursuant to a final decision or determination of
			 an agency having the powers to conduct the proceeding and after an adjudicatory
			 proceeding in which no appeal is pending or after resolution of the proceeding
			 by stipulation or agreement; however, if an applicant has entered into a plan
			 of restitution of such overpayments, an application may not be denied based
			 solely on this factor unless the applicant has defaulted in
			 repayment;
(4) any false
			 representation or omission of a material fact in making application in any
			 state of the United States for any license, permit, certificate or registration
			 related to a profession or business;
(5) any previous failure to correct
			 deficiencies in the operation of a business or enterprise after having received
			 written notice of the deficiencies from a State or Federal licensing or
			 auditing agency;
(6) any failure to
			 supply further information concerning the application after receiving a written
			 request for such further information;
(7) the submission of an application which
			 conceals an ownership or control interest of any person who would otherwise be
			 ineligible to participate;
(8) a
			 pending indictment for, or prior conviction of, any crime relating to the
			 furnishing of, or billing for, medical care, services or supplies or which is
			 considered an offense involving theft or fraud or an offense against public
			 administration or against public health and morals;
(9) a prior finding of having engaged in an
			 unacceptable practice in the medical assistance program, another state's
			 Medicaid program, the Medicare program or any other publicly funded
			 program;
(10) a pending indictment
			 for, or prior conviction of, any crime relating to the furnishing of or billing
			 for medical care, services or supplies, or a determination of having engaged in
			 an unacceptable practices in the medical assistance program
(11) a prior finding by a licensing,
			 certifying or professional standards board or agency of the violation of the
			 standards or conditions relating to licensure or certification or as to the
			 quality of services provided;
(12)
			 any prior pattern or practices in furnishing medical care, services or supplies
			 and any prior conduct under any private or publicly funded program or policy of
			 insurance;
(13) any other factor
			 having a direct bearing on the applicant's ability to provide high-quality
			 medical care, services or supplies to recipients of medical assistance
			 benefits, or to be fiscally responsible to the program for care, services or
			 supplies to be furnished under the program including actions by persons
			 affiliated with the applicant;
(14)
			 any other factor which may affect the effective and efficient administration of
			 the program, including, but not limited to, the current availability of medical
			 care, services or supplies to recipients (taking into account geographic
			 location and reasonable travel time).