Section He-M 504.12 - Suspension and Revocation of Provider Enrollment(a) If the department finds at any time that an enrolled provider repeatedly fails to meet their participation, information sharing and billing obligations, or that their continued operations endanger the health, safety, or welfare of individuals, or the public, the department shall order the suspension or revocation of the enrolled provider.(b) Suspension shall include receiving notice from the department of its intent to suspend payment of any claims submitted or the provider enrollment ID for the specific service location associated with the violation or, if the violation is specific to all sites, the provider enrollment ID's for that provider agency.(c) Revocation shall include receiving notice from the department of its intent to revoke the provider enrollment ID for the specific service location associated with the violation or, if the violation is specific to all sites, the provider enrollment ID's for that provider agency. (d) When a claim or provider enrollment suspension is issued, pursuant to (b) above, a plan of correction shall be issued by the department which shall outline the conditions necessary for reinstatement including if the provider agency shall be permitted to continue to provide services during a claim suspension period.(e) If the provider agency is permitted to continue providing services during the suspension period, the processing and payment of claims shall be suspended until the provider has met the requirements of the corrective action plan.(f) If a provider agency is not permitted to continue providing services during the suspension period, the department shall deny claims for payment or other reimbursement requests for dates of service during the suspension period.(g) Provider agencies shall remain under suspension until specified conditions for reinstatement as outlined in a corrective action plan issued pursuant to (d) above, are met and approved by the department.(h) If the provider agency does not meet the conditions for reinstatement, as outlined in a corrective action plan, a recommendation shall be made for enrollment termination to the department's program integrity unit.(i) A provider agency may request an appeal, in accordance with He-C 200, regarding a proposed suspension or revocation of enrollment within 30 business days of the decision.(j) The provider's enrollment status shall be suspended until the appeal determination is adjudicated.(k) The revocation shall not become final until the period for requesting an appeal has expired, or, if the provider agency requests an appeal, until such time as the administrative appeals unit issues a decision upholding the department's decision.(l) If the department's decision is not upheld, the denial would be ineffective, and the provider shall continue to provide services.(m) Appeals shall be submitted in writing, to the bureau administrator in care of the department's office of client and legal services.N.H. Admin. Code § He-M 504.12
Derived from Number 28, Filed July 13, 2023, Proposed by #13679, EMERGENCY RULE, Effective 6/28/2023, Expires 12/25/2023.Amended by Number 50, Filed December 14, 2023, Proposed by #13807, Effective 11/17/2023, Expires 11/17/2033.