440 IAC 4.3-2-9 Termination of certification

Sec. 9. (a) The division may terminate the certification of a managed care provider immediately upon the occurrence of any of the following: (1) Revocation of the accreditation of the managed care provider by the provider's accrediting agency. (2) Failure of the managed care provider to maintain accreditation. (3) Failure of the managed care provider to meet the conditions of any conditional certification. (4) Conduct or practice of the managed care provider or its subcontractors that is found by the division to be detrimental to the welfare of individuals served by the managed care provider. (5) Fraudulent conduct or practice of the managed care provider or its subcontractors. (6) The termination of the managed care provider's contract with the division. (7) A change resulting in the entity's ineligibility to be a managed care provider. (b) If payments to the managed care provider under the contract are suspended, the managed care provider's regular certification must be converted to a conditional certification or terminated. (c) If the division terminates a portion of the contract addressing a specific population, the provider's certification for that population shall be terminated. (d) If a managed care provider's certification for a specific population is terminated, the portion of the contract addressing that population shall be terminated. (e) The division shall notify the Indiana family and social services administration, the Indiana state department of health, and the Indiana department of administration that the managed care provider's certification has been terminated. (f) An entity whose contract is terminated may not reapply to become a managed care provider until the next scheduled application period after the lapse of one (1) year from the date of termination. (g) If the division terminates a portion of an entity's contract addressing a specific population, the entity may not reapply to become a managed care provider for that population or for any population that the provider is not currently serving until the next scheduled application period after the lapse of one (1) year from the date of termination.