North Carolina Administrative Code (Last Updated: November 13, 2014) |
TITLE 10A. HEALTH AND HUMAN SERVICES |
CHAPTER 22. MEDICAL ASSISTANCE ELIGIBILITY |
SUBCHAPTER N. PROVIDER ENROLLMENT |
10A NCAC 22N .0203. ENROLLMENT RESTRICTIONS
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(a) The Department shall deny enrollment, including enrollment for new or additional services in accordance with G.S. 122C-23(e1) and G.S. 131D-10.3(h). They may be accessed online at
http://www.ncleg.net/statutes/generalstatutes/html/bysection/chapter_122c/gs_122c-23.html and
http://www.ncleg.net/statutes/generalstatutes/html/bysection/chapter_131d/gs_131d-10.3.html.
(b) The Department may deny enrollment when an applicant meets any of the following conditions:
(1) if the Department has initiated revocation or summary suspension proceedings against any facility licensed pursuant to G.S. 122C, Article 2, G.S. 131D, Articles 1 or 1A, or G.S. 110, Article 7 which was previously held by the applicant and the applicant voluntarily relinquished the license;
(2) there is a pending appeal of a denial, revocation or summary suspension of any facility licensed pursuant to G.S. 122C, Article 2, G.S. 131D, Articles 1 or 1A, or G.S. 110, Article 7 which is owned by the applicant;
(3) the applicant had an individual as part of their governing body or management who previously held a license which was revoked or summarily suspended under G.S. 122C, Article 2, G.S. 131D, Articles 1 or 1A, and G.S. 110, Article 7 and the rules adopted under these laws; or
(4) the applicant is an individual who has a finding or pending investigation by the Health Care Personnel Registry in accordance with G.S. 131E -256.
(c) When an application for enrollment of a new service is denied:
(1) Pursuant to G.S. 150B-22, the applicant shall be given an opportunity to provide reasons why the enrollment should be granted or the matter otherwise settled;
(2) DMA shall give the applicant written notice of the denial, the reasons for the denial and advise the applicant of the right to request a contested case hearing pursuant to G.S. 150B; and
(3) The provider shall not provide the new service until a decision is made to enroll the provider, despite an appeal action.
(d) If the action is reversed on appeal, the owner may re-apply for enrollment and may be approved back to the date of the denied application if all qualifications are met.
History Note: Authority G.S. 108A-54; 143B-139.1;
Eff. July 1, 2004.