Termination Of Fiscal Employer Agent (Fea) Provider Agreements

In the event of termination of a provider agreement, the provider must: (7-1-26) IDAHO ADMINISTRATIVE CODE IDAPA 16.03.26 Department of Health & Welfare Medicaid Plan Benefits Section 846 Page 181 01. Continuation of Services. Ensure continuation of services to participants for the period in which a PMPM payment has been made, and submit the information, reports and records, including the Medicaid Billing Report as specified in these rules. (7-1-26) 02. Advanced Notice. Provide to the Department a written notice ninety (90) days in advance and the change notification must occur at the end of the next calendar quarter. (7-1-26) 03. Termination of Service. Provide to the participant a written notice ninety (90) days in advance. The change notification must occur at the end of the next calendar quarter. (7-1-26) 846. REMEDIES TO NONPERFORMANCE OF A FISCAL EMPLOYER AGENT (FEA) SERVICE PROVIDER. 01. Remedial Action. If any of the services do not comply with the performance metrics under these rules, the Department will consult with the provider and may, at its sole discretion, require any of the following remedial actions, taking into account the scope and severity of the noncompliance, compliance history, the integrity of the program, and the potential risk to participants. (7-1-26) a. Require the provider to take corrective action to ensure that performance meets the performance metrics under Section 842 of these rules; (7-1-26) b. Reduce payment to reflect the reduced value of services received; (7-1-26) c. Require the provider to subcontract all or part of the service at no additional cost to the Department; (7-1-26) d. Terminate the provider agreement with notice. (7-1-26) 02. Direct Monetary Action. If any of the performance metrics under Section 842 of these rules are not met, the Department will enforce a fifty dollar ($50) a week penalty for each performance metric not met. The penalty will be captured prior to any payment from the Department to the provider. (7-1-26) 847. – 959. (RESERVED) DUAL ELIGIBLES (Sections 960 - 979) SUB AREA: MEDICARE SAVINGS PROGRAM (Sections 960-969)