Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-502 - Administration of medical programs-Providers › PROVIDER REQUIREMENTS › Section 182-502-0016 - Continuing requirements

Current through Register Vol. 24-14, July 15, 2024
(1) To continue
				  to provide services for eligible clients and be paid for those services, a
				  provider must:
(a) Provide all services
				  without discriminating on the grounds of race, creed, color, age, sex, sexual
				  orientation, religion, national origin, marital status, the presence of any
				  sensory, mental or physical handicap, or the use of a trained dog guide or
				  service animal by a person with a disability;
(b) Provide all services according to federal
				  and state laws and rules, medicaid agency billing instructions, provider alerts
				  issued by the agency, and other written directives from the agency;
(c) Inform the agency of any changes to the
				  provider's application or contract including, but not limited to, changes in:
(i) Ownership (see WAC
				  182-502-0018
				  );
(ii) Address or telephone
				  number;
(iii) The professional
				  practicing under the billing provider number; or
(iv) Business name.
(d) Retain a current professional state
				  license, registration, certification or applicable business license for the
				  service being provided, and update the agency of all changes;
(e) Inform the agency in writing within seven
				  calendar days of changes applicable to the provider's clinical
				  privileges;
(f) Inform the agency
				  in writing within seven business days of receiving any informal or formal
				  disciplinary order, disciplinary decision, disciplinary action or other
				  action(s) including, but not limited to, restrictions, limitations, conditions
				  and suspensions resulting from the practitioner's acts, omissions, or conduct
				  against the provider's license, registration, or certification in any
				  state;
(g) Screen employees and
				  contractors with whom they do business prior to hiring or contracting, and on a
				  monthly ongoing basis thereafter, 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;
(h) Report immediately to
				  the agency any information discovered regarding an employee's or contractor's
				  exclusion from receiving federal funds in accordance with
				  42
				  U.S.C. 1320a-7 and 42 U.S.C. 1320c-5. See WAC
				  182-502-0010(2)(j)
				  for information on the agency's screening process;
(i) Pass any portion of the agency's
				  screening process as specified in WAC
				  182-502-0010(2)(j)
				  when the agency requires such information to reassess a provider;
(j) Maintain professional and general
				  liability coverage to the extent the provider is not covered:
(i) Under agency, center, or facility
				  professional and general liability coverage; or
(ii) By the Federal Tort Claims Act,
				  including related rules and regulations.
(k) Not surrender, voluntarily or
				  involuntarily, the provider's professional state license, registration, or
				  certification in any state while under investigation by that state or due to
				  findings by that state resulting from the practitioner's acts, omissions, or
				  conduct;
(l) Furnish documentation
				  or other assurances as determined by the agency in cases where a provider has
				  an alcohol or chemical dependency problem, to adequately safeguard the health
				  and safety of medical assistance clients that the provider:
(i) Is complying with all conditions,
				  limitations, or restrictions to the provider's practice both public and
				  private; and
(ii) Is receiving
				  treatment adequate to ensure that the dependency problem will not affect the
				  quality of the provider's practice.
(m) Submit to a revalidation process at least
				  every five years. This process includes, but is not limited to:
(i) Updating provider information including,
				  but not limited to, disclosures;
(ii) Submitting forms as required by the
				  agency including, but not limited to, a new core provider agreement;
				  and
(iii) Passing the agency's
				  screening process as specified in WAC
				  182-502-0010(2)(j).
(n) Comply with the employee
				  education requirements regarding the federal and the state false claims
				  recovery laws, the rights and protections afforded to whistleblowers, and
				  related provisions in Section 1902 of the Social Security Act (
				  42 U.S.C.
				  1396a(68) ) and chapter
				  74.66 RCW when applicable. See WAC
				  182-502-0017
				  for information regarding the agency's requirements for employee education
				  about false claims recovery.