Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-502 - Administration of medical programs-Providers › ENROLLMENT › Section 182-502-0010 - When the medicaid agency enrolls

Current through Register Vol. 24-14, July 15, 2024
(1)
				  Nothing in this chapter obligates the medicaid agency to enroll any eligible
				  health care professional, health care entity, supplier or contractor of service
				  who requests enrollment.
(2) To
				  enroll as a provider with the agency, a health care professional, health care
				  entity, supplier or contractor of service must, on the date of application:
(a) Be currently licensed, certified,
				  accredited, or registered according to Washington state laws and rules, or, if
				  exempt under federal law, according to the laws and rules of any other state.
				  Persons or entities outside of Washington state, see WAC
				  182-502-0120;
(b) Be enrolled with medicare, when required
				  in specific program rules;
(c) Have
				  current professional liability coverage, individually or as a member of a
				  group, to the extent the health care professional, health care entity, supplier
				  or contractor is not covered by the Federal Tort Claims Act, including related
				  rules and regulations;
(d) Have a
				  current federal drug enforcement agency (DEA) certificate, if applicable to the
				  profession's scope of practice;
(e)
				  Meet the conditions in this chapter and other chapters regulating the specific
				  type of health care practitioner;
(f) Sign, without modification, a core
				  provider agreement (CPA) (HCA 09-015), disclosure of ownership form, and
				  debarment form (HCA 09-016) or a contract with the agency;
(g) Agree to accept the payment from the
				  agency as payment in full (in accordance with 42 C.F.R. § 447.15
				  acceptance of state payment as payment in full and WAC
				  182-502-0160 billing a
				  client);
(h) Fully disclose
				  ownership, employees who manage, and other control interests (e.g., member of a
				  board of directors or office), as requested by the agency. Indian health
				  services clinics are exempt from this requirement. If payment for services is
				  to be made to a group practice, partnership, or corporation, the group,
				  partnership, or corporation must enroll and provide its national provider
				  identifier (NPI) (if eligible for an NPI) to be used for submitting claims as
				  the billing provider;
(i) Have
				  screened employees and contractors with whom they do business prior to hiring
				  or contracting to assure that employees and contractors are not excluded from
				  receiving federal funds as required by
				  42 U.S.C.
				  1320a-7 and
				  42 U.S.C.
				  1320c-5;
(j) Pass the agency's screening process,
				  including license verifications, data base checks, site visits, and criminal
				  background checks, including fingerprint-based criminal background checks as
				  required by 42 C.F.R.
				  455.434 if considered high-risk under
				  42 C.F.R.
				  455.450. The agency uses the same screening
				  level risk categories that apply under medicare. For those provider types that
				  are not recognized under medicare, the agency assesses the risk of fraud,
				  waste, and abuse using similar criteria to those used in medicare;
				  and
(k) Agree to pay an application
				  fee, if required by CMS under
				  42 C.F.R.
				  455.460.