Mont. Admin. R. 37.85.502 - SANCTIONS
(1) The following sanctions may be invoked
against providers based on the grounds specified in ARM
37.85.501:
(a) Termination from participation in the
Medical Assistance program.
(b)
Suspension of participation in the Medical Assistance program.
(c) Suspension or withholding of payments to
a provider.
(d) Shortening of an
existing provider agreement as permitted by the terms of such
agreement.
(e) Required attendance
at provider education sessions, the cost of which shall not be reimbursed by
the department or any of its programs.
(f) Required prior authorization for
provision of services.
(g) 100%
review of the provider's claims prior to payment.
(h) Referral to the Department of Revenue for
any action deemed necessary.
(i) In
addition to the sanctions listed above, intermediate care facilities for the
mentally retarded, skilled nursing and nursing facilities shall be subject to
termination of participation when the deficiencies resulting from failure to
meet conditions or standards of participation pose immediate jeopardy or the
denial of payments for new admissions if the facility's deficiencies resulting
from failure to meet conditions or standards of participation do not pose
immediate jeopardy. Federal laws regarding termination from participation and
intermediate sanctions provided in
42 CFR
442.2,
42
CFR 442.117 through
442.119,
and 42 CFR Part 483 and 488, updated through February 2004 are incorporated by
reference. A copy of
42 CFR
442.2,
42
CFR 442.117 through
442.119,
and 42 CFR Part 483 and 488, updated through February 2004 may be obtained from
the Department of Public Health and Human Services, Quality Assurance Division,
2401 Colonial Drive, Helena, MT 59620-2953; or
(j) Notification to the public of sanctions
taken against a provider.
Notes
53-2-201, 53-2-803, 53-4-111, 53-6-108, 53-6-111, 53-6-113, MCA; IMP, 53-2-306, 53-2-801, 53-4-112, 53-6-106, 53-6-107, 53-6-111, MCA;
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