Mont. Admin. R. 37.85.402 - PROVIDER ENROLLMENT AND AGREEMENTS
(1) Providers must enroll in the Montana
Medicaid program for each category of services to be provided. As a condition
of granting enrollment approval or of allowing continuing enrollment, the
department may require the provider to:
(a)
complete and submit an enrollment application or form;
(b) complete and submit agreements or other
forms applicable to the provider's category of service;
(c) provide information and documentation
regarding ownership and control of the provider entity and regarding the
provider's ownership interest or control rights in other providers that bill
Medicaid;
(d) provide information
and documentation regarding:
(i) any
sanctions, suspensions, exclusions or civil monetary penalties imposed by the
Medicare program, any state Medicaid program or other federal program against
the provider, a person or entity with an ownership or control interest in the
provider or an agent or managing employee of the provider; and
(ii) any criminal charges brought against and
any criminal convictions of the provider, a person or entity with an ownership
or control interest in the provider or an agent or managing employee of the
provider related to that person's or entity's involvement in Medicare,
Medicaid, or the Title XX Services program; and
(e) submit documentation and information
demonstrating compliance with participation requirements applicable to the
provider's category of service.
(2) Providers shall provide the department's
fiscal agent with 30 days advance written notice of any change in the
provider's name, address, tax identification number, group practice
arrangement, business organization or ownership.
(a) An enrolled provider is not entitled to
change retroactively the category of service for which the provider is
enrolled, but must enroll prospectively in the new program category. The change
in service category will be effective only upon approval of a completed
enrollment application for the new service category and on or after the
effective date of all required licenses and certifications. The change will
apply only to services provided on or after the effective date of the
enrollment change.
(3)
Except as provided in (2)(a), an approved enrollment is effective on the later
of:
(a) one year prior to the date the
completed enrollment application is received by the department's fiscal agent;
or
(b) the date as of which all
required licenses and certifications are effective.
(4) Providers, whose services are covered by
the Title XVIII program (Medicare), shall meet the certification standards of
Medicare except as provided otherwise in these rules.
(5) Providers shall render services to an
eligible Medicaid recipient in the same scope, quality, duration and method of
delivery as to the general public, unless specifically limited by these
regulations.
(6) Providers shall not discriminate
illegally in the provision of service to eligible Medicaid recipients or in
employment of persons on the grounds of race, creed, religion, color, sex,
national origin, political ideas, marital status, age, or disability. Providers
shall comply with the Civil Rights Act of 1964 ( 42 USC 2000 d, et seq.), The
Age Discrimination Act of 1975 (
42 USC 6101,
et seq.), The Americans With Disabilities Act of 1990 (
42 USC
12101, et seq.), section 504 of the
Rehabilitation Act of 1973 (
29 USC
794 ), and the applicable provisions of Title
49, MCA, as amended and all regulations and rules implementing the
statutes.
Notes
53-2-201, 53-6-113, MCA; IMP, 53-2-201, 53-6-101, 53-6-111, 53-6-113, 53-6-131, 53-6-141, MCA;
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