HAR §17-1736-23. Suspension or termination

(a) The decision to suspend or terminate a provider from participation in the medical assistance program and the duration of any suspension shall be made by the DHS director. (b) The duration of the suspension imposed by the DHS director shall be conditioned upon the seriousness of the infraction but shall not exceed a period of five years. (c) The DHS director shall suspend or terminate any provider in the medical assistance program who has been suspended or terminated from the medicare program. Suspension or termination from the medical assistance program if based upon suspension from the medicare program shall be at least under the same conditions and for the same period of time as the suspension from the medicare program. The DHS director may determine that more stringent action under the medical assistance program than was taken under the medicare program is justified. In that event, the director shall take such steps as the director deems appropriate subject to the provisions of subchapter 3. (d) The DHS director shall suspend or terminate any provider in the medical assistance program whose license, certification, authorization or permit to practice is not current or has been suspended, revoked, or restricted by a state or federal government, court, or agency. (e) A provider who has terminated from the medical assistance program for a violation may not petition the director for reinstatement to the program for a period of five years at which time reinstatement may be permitted by the director, if justified, provided that at the time reinstatement is requested that no medicare sanctions remain applicable. (f) All legal actions, both civil and criminal, against providers certified under the medicaid program shall be handled by the State's medicaid fraud control unit. (g) Actions for suspension or termination of a provider may be initiated or continued even though a provider voluntarily withdraws from the program. The procedures for determining whether suspension or termination are appropriate and the length of time shall be governed by this subchapter and subchapter 3. [Eff 08/01/94 ] (Auth: HRS §346-14) (Imp: 42 C.F.R. §§455.16, 455.21) UNOFFICIAL 1736-16 §17-1736-24 Notification and effective date of suspension or termination of provider certification. (a) The provider shall be informed by certified mail of DHS's intent to suspend or terminate the provider's participation as a medical assistance provider. The notice shall include the following: (1) The reasons for the action; (2) If the action is a suspension, the duration of the suspension; (3) The provider's rights to request an administrative review, and to be represented at the provider's own expense by legal counsel or a designated representative at the administrative hearing provided for by subchapter 3; and (4) The effective date of the suspension or termination. (b) A suspension or termination of a provider's certification in the medical assistance program shall be effective thirty calendar days following the mailing of DHS's notice of intent to suspend or terminate, except a suspension or termination based on section 17-1736-23(d) which shall be effective from the date of license, certification, authorization, or permit suspension or revocation. (c) DHS shall notify DHHS whenever a state or federal court convicts a provider for a criminal office relating to the medical assistance program. This notice shall be sent within fifteen days of the time that DHS learns of the conviction. [Eff 08/01/94; am 01/29/96 ] (Auth: HRS §346-14) (Imp: 42 C.F.R. §455.212) §