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(a) When the division intends to impose sanctions on a provider, written notice to the provider must be sent by certified mail. If suspension, termination, or withholding of payment is proposed, the provider must be permitted an appeal pursuant to sec. 980 of this chapter. Absent a request for appeal, the proposed sanction will become effective 30 days from the date of the notice.
(b) The notice shall set forth
(1) the nature of the discrepancies or violations;
(2) the dollar value of the discrepancies or violations;
(3) the method of computing the dollar value;
(4) notification of further actions to be taken or sanctions to be imposed by the division; and
(5) notification of any actions required of the provider and his right to a formal hearing.
(c) The notice shall state whether or not the division intends to withhold payments on pending and subsequently received claims in an amount reasonably calculated to approximate the amounts in question or that the division intends to suspend all payments to the provider.
(d) When sanctions have been imposed on a provider, the division will notify, as appropriate, the provider's professional societies, the division of occupational licensing of the Department of Commerce, Community, and Economic Development, and any other interested federal or state agency of the findings made and the sanctions imposed.
(e) If a provider's participation in the medicaid program has been suspended or terminated, the division will notify the recipients for whom the provider has submitted claims for services, that the provider has been suspended or terminated.
History: Eff. 8/18/79, Register 71; readopt 8/7/96, Register 139
Authority: AS 47.05.010
Editor's note: Effective 8/7/96, Register 139, the Department of Health and Social Services readopted 7 AAC 43.970 in its entirety, without change, under AS 47.05 and AS 47.07. Executive Order No. 72 transferred certain rate-setting authority to the department.
As of Register 171 (October 2004), the regulations attorney made technical revisions under AS\n 44.62.125(b)(6) to reflect the name change of the Department of Community and Economic Development to the Department of Commerce, Community, and Economic Development made by ch. 47, SLA 2004 and the corresponding title change of the commissioner of community and economic development.
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Last modified 7/05/2006