(a) Payments only to provider's. No person or entity that provides services to a recipient shall receive Medicaid funds unless the person or entity is a party to a fully executed provider agreement and is enrolled.
(b) Enrollment as provider. An individual or entity which wishes to participate in the Medicaid program shall apply to be a provider on the forms specified by the Division. The Division shall review the application within ten working days after the date it receives the application and all necessary information, including supplemental information requested by the Division. If the application is not approved, the Division shall, in writing, specify the reasons for the decision and advise the applicant of its right to reapply.
(c) Duration of provider agreement. A provider agreement shall become effective when fully executed and shall remain in effect until terminated pursuant to subsection 4(d).
(d) Termination of provider agreement. - (i) A provider which loses its state licensure or Medicare certification, or which voluntarily withdraws from Medicare when Medicare certification is a prerequisite to Medicaid enrollment, shall be terminated as a provider effective the same date the provider loses Medicare certification or state licensure. The suspension or termination shall be the same as and shall run contemporaneously with the period of the provider's suspension or termination from Medicare or the period of voluntary non-participation, or the period for which it is not licensed; or
- (ii) A provider agreement may be terminated pursuant to the provider agreement, Chapter 16 or as otherwise provided by law.
(e) Administrative remedies. - (i) A provider who is terminated as a Medicaid provider or otherwise sanctioned pursuant to Chapter 16 is entitled to reconsideration and an administrative hearing as set forth in that Chapter.
- (ii) A provider whose provider agreement is terminated for cause pursuant to the provider agreement shall be entitled to reconsideration and an administrative hearing as set forth in this Chapter.
(f) Sale of provider. - (i) A provider agreement cannot be transferred at the time a provider is sold except in accordance with applicable law.
- (ii) A provider which sells or otherwise transfers ownership or control of his or its practice, or which sells or otherwise transfers ownership or control of an entity which has a provider agreement, shall notify the Division, in writing, of the proposed sale or transfer no later than sixty days before the effective date of the sale or transfer. The failure to give such notice shall result in the termination of the provider agreement.
- (iii) A change in the ownership or control of a provider as specified in paragraph 4(f)(ii) shall not relieve the provider of its obligations pursuant to the provider agreement and/or this Chapter.
(g) No assignment. No party to a provider agreement shall assign or otherwise transfer any of its rights pursuant to that agreement without the prior written consent of the other party.
(h) Not collateral. A provider shall not use a provider agreement as collateral for any of the provider's financial obligations.