Mont. Admin. R. 37.85.506 - SCOPE OF SANCTION
(1) A sanction may
be applied to all known affiliates of a provider, provided that each decision
to include an affiliate is made on a case by case basis after giving due
consideration to all relevant facts and circumstances. The violation, failure,
or inadequacy of performance may be imputed to an affiliate where such conduct
was accomplished within the course of the affiliate's official duty or was
effectuated by the provider with the knowledge or approval of the
affiliate.
(2) Suspension or
termination from participation of any provider shall preclude such provider
from submitting claims for payment, either personally or through claims
submitted by any clinic, group, corporation or other association to the
department or its fiscal agents for any services or supplies provided to
persons eligible for the Montana Medical Assistance program except for those
services or supplies provided prior to the suspension or termination. Providers
of long term care facility services may submit claims for supplies and services
provided for up to 30 days after the date of termination to allow for the
transfer of recipients.
(3) No
clinic, group, corporation, or other association which is a provider of
services shall submit claims for payment to the department or its fiscal agents
for any services or supplies provided by a person within such organization who
has been suspended or terminated from participation in the Montana Medical
Assistance program except for those services or supplies provided prior to the
suspension or termination. Providers of long term care facility services may
submit claims for supplies and services provided for up to 30 days after the
date of termination to allow for the transfer of recipients.
(4) When the provisions of (3) of this rule
are violated by a provider of services which is a clinic, group, corporation,
the department may suspend or terminate such organization and/or any individual
person within said organization who is responsible for such
violation.
Notes
53-2-201, 53-2-803, 53-4-111, 53-6-111, 53-6-113, MCA; IMP, 53-2-306, 53-2-801, 53-4-112, 53-6-111, MCA;
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