N.Y. Comp. Codes R. & Regs. tit. 9 § 9800.7

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

Section 9800.7 - Continued enrollment/termination

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

(b) A provider's participation in the program may be terminated, suspended or restricted for a reasonable period of time if the provider has abused the program, and shall be terminated if the provider has engaged in fraud.

(c) A provider's participation shall be terminated or suspended as of the date of the provider's suspension or termination from Medicare or the medical assistance program.

(d) A provider's participation shall be terminated or suspended as of the date of any termination, revocation or suspension of its registration.

(e) A provider must maintain an up-to-date "Disclosure of Ownership and Control Interest Statement" on file with the contractor, amending it at least biennially or sooner when 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 contractor, will result in the termination of the provider's participation.

(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.

(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 section 9800.5(a) of this Part.

(h) Where a provider's participation is to be terminated, suspended or restricted, it is entitled to notice and an opportunity to be heard in accordance with the provisions of sections 9850.7 through 9850.13 of this Title. The provider must be given written notice of the action at least 15 days prior to its effective date, stating: the reasons for the action, the effective date, the effect of the action upon the provider's participation in the program, the earliest date on which participation may be reinstated, and the requirements for requesting a hearing.

N.Y. Comp. Codes R. & Regs. Tit. 9 § 9800.7