10A NCAC 22F .0603       PROVIDER LOCK-OUT

(a)  The Division may suspend the provider, based on the factors set out in Rule .0602(b) of this Subchapter, from participating in the Medicaid program, provided that the Division meets the requirements of 42 C.F.R. 431.54(f), which is adopted and incorporated by reference with subsequent changes or amendments and available free of charge at https://www.ecfr.gov/.

(b)  Suspension or termination from participation of any provider shall preclude the provider from submitting claims for payment to the Division. No claims may be submitted by or through any clinic, group, corporation, or other association for any services or supplies provided by a person within such organization who has been suspended or terminated from participation in the Medicaid program, except for those services or supplies provided prior to the suspension or termination effective date.

History Note:        Authority G.S. 108A‑25(b); 108A-54; 108A-54.1B; 42 C.F.R. 440.230; 42 C.F.R. 440.260; 42 C.F.R. Part 431; 42 C.F.R. 431.54; 42 C.F.R. Part 455;

Eff. May 1, 1984;

Amended Eff. December 1, 1995;

Readopted Eff. September 1, 2018.