North Dakota Administrative Code › Title 75 - Department of Human Services › Article 75-03 - Community Services › Chapter 75-03-23 - Provision of Home and Community-Based Services Under the Service Payments for Elderly and Disabled Program and the Medicaid Waiver for the Aged and Disabled Program › Section 75-03-23-08 - Denial of application to become a qualified service provider

Current through Supplement No. 393, July, 2024
The 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; or
16. For other good cause.
General Authority:
NDCC 50-06.2-03(6)
Law Implemented:
NDCC
					 50-06.2-03(5)