N.Y. Comp. Codes R. & Regs. tit. 18 § 504.7

Current through Register Vol. 46, No. 45, November 2, 2024

Section 504.7 - Continued enrollment termination

(a) A provider's participation in the program may be terminated by either the provider or the department upon 30 days' written notice to the other without cause.

(b) A provider's participation in the program may be terminated, suspended or restricted for a reasonable period of time if the department finds that the provider has engaged in an unacceptable practice as set forth in Part 515 of this Title. A provider whose participation is so terminated, suspended or restricted is entitled to notice and an opportunity to be heard in accordance with Part 515 of this Title.

(c) A provider's participation is automatically terminated or suspended as of the date of the provider's suspension or termination from Medicare. A notice confirming the termination or suspension will be sent to the provider.

(d)

(1) A provider's participation in the medical assistance program is automatically terminated as of the date of any termination, revocation or suspension of a license to practice a medical profession, or the termination, revocation or suspension of any registration, certification, license or other approval required to provide medical care, services or supplies under the medical assistance program. However, a provider of intermediate care facility services for the developmentally disabled, licensed or operated by the Office of Mental Retardation and Developmental Disabilities, whose participation in the medical assistance program is terminated by the department because the provider no longer meets the requirements for participation or whose participation in such program is not renewed upon expiration of its provider agreement with the department, remains eligible to participate in the program if the Department of Health certifies that the provider's continuation in the medical assistance program will not jeopardize a medical assistance recipient's health and safety and the provider has requested an administrative evidentiary hearing which is held after the effective date of termination or nonrenewal or is held before such date but not completed until after such date.

(2) A provider who is permitted to remain in the medical assistance program as a result of meeting the conditions of continuation, as set forth in paragraph (1) of this subdivision, may remain in the program until the earlier of:

(i) the date that an administrative hearing decision is issued in the evidentiary hearing which upholds the department's termination or nonrenewal action; or

(ii) the 120th day after the effective date of termination of the facility's provider agreement or, if the agreement is not terminated, the 120th day after the effective date of expiration.

(e) A provider must maintain an up-to-date "Disclosure of Ownership and Control Interest Statement" on file with the department, as required by Part 502 of this Title, amending it annually and from time to time, as necessary, to assure that the information contained in the statement is true, accurate and complete. Failure to maintain an up-to-date disclosure form on file or to submit one within 35 days of a request by the department or to disclose any information as required by section 502.6 of this Title will result in the automatic termination of the provider's participation in the medical assistance program. A notice confirming the termination will be sent to the provider.

(f) A provider's participation may be terminated and a new application for enrollment required where the ownership or control of the provider has substantially changed since acceptance of its enrollment application, whether by the sale or exchange of the capital stock in a provider organized as a corporation, the addition or elimination of one or more partners in a provider organized as a partnership, or the sale of the business or assets of any provider entity. A notice advising of the termination and of the requirement to submit a new application for enrollment will be sent to the provider prior to its termination from the program.

(g) A provider's participation will be terminated where the provider furnished incorrect, inaccurate or incomplete information in connection with an application and where provision of correct, accurate and complete information would have resulted in the denial of the application based upon one or more of the factors set forth in subdivision (a) of section 504.5 of this Part. A notice, as provided for in subdivision (b) of section 504.5, shall be sent to the provider confirming the termination and stating the reason or reasons for which a denial would have been made.

(h) A provider's participation will be terminated where the provider fails or refuses to pay the full amount of any penalty imposed, including any interest thereon, pursuant to Part 516 of this Title on or before the 90th day after the date of the department's notice or, where a hearing has been requested pursuant to Part 519 of this Title, on or before the 90th day after the date of a decision after hearing which affirms the penalty.

N.Y. Comp. Codes R. & Regs. Tit. 18 § 504.7