Ill. Admin. Code tit. 89, § 140.19 - Application to Participate or for Reinstatement Subsequent to Termination, Suspension, Exclusion or Barring
a) A vendor that has been terminated,
suspended or excluded from the Medical Assistance Program may not apply to
participate for at least one year after the date of the final administrative
decision terminating, suspending or excluding eligibility, except that, if a
vendor has been terminated, suspended or excluded based on a conviction of a
violation of Article VIIIA of the Public Aid Code or a conviction of a felony
based on fraud or a willful misrepresentation related to subsection (a)(1), (2)
or (3), the vendor shall be barred from participation for five years or for the
length of the vendor's sentence for that conviction, whichever is longer.
1) The Medical Assistance Program under
Article V of the Public Aid Code;
2) A federal or another state's medical
assistance or health care program; or
3) The provision of health care
services.
b) After one
year, a vendor who has been terminated, suspended or excluded for any reason,
other than for the reasons in subsections (a)(1) through (3), may apply for
reinstatement to the Medical Assistance Program. If a vendor's application for
reinstatement is denied by the Department, he or she shall be barred from again
applying for reinstatement for one year after the date of the final
administrative decision denying his or her application for
reinstatement.
c) A vendor whose
termination, suspension or exclusion from participation in the Illinois Medical
Assistance Program under Article V was based solely on an action by a
governmental entity other than the Department may, upon reinstatement by that
governmental entity or upon reversal of the termination, suspension or
exclusion from participation in the Medical Assistance Program. Upon proper
application for rescission, the vendor may be deemed eligible by the Director
if the vendor meets the requirements for eligibility under the Public Aid
Code.
d) At the end of a period of
suspension, a vendor that has been suspended from the Medical Assistance
Program shall be reinstated upon completion of the necessary enrollment forms
and execution of a new vendor agreement unless it is determined that such
vendor has not corrected the deficiencies upon which the suspension was based.
If the deficiencies have not been corrected, the vendor shall, after notice and
hearing, be terminated. The notice in any termination action based on this
Section shall notify the vendor of the deficiencies not corrected.
e) An individual barred pursuant to Section
140.18
can apply to participate in the Medical Assistance Program. If an individual's
application is denied by the Department or if he or she is denied special
permission under Section
140.32,
he or she shall be barred from again applying for one year after the date of
the final administrative decision denying his or her application or special
permission.
f) If a vendor has been
terminated, suspended or excluded and reinstated to the Medical Assistance
Program and the vendor is terminated, suspended or excluded a second or
subsequent time from the Medical Assistance Program, the vendor shall be barred
from participation for at least two years, except that, if a vendor has been
terminated, suspended or excluded a second time based on a conviction of a
violation of Article VIIIA of the Public Aid Code or a conviction of a felony
based on fraud or a willful misrepresentation related to subsection (a)(1), (2)
or (3), the vendor shall be barred from participation for life.
g) At the end of two years, a vendor who has
been terminated, suspended or excluded for any reason, other than for the
reasons in subsections (a)(1) through (3), may apply for reinstatement to the
Medical Assistance Program. If a vendor's application for reinstatement is
denied by the Department, he or she shall be barred from again applying for
reinstatement for two years after the date of the final administrative decision
denying his or her application for reinstatement.
Notes
Amended at 37 Ill. Reg. 10282, effective June 27, 2013
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