(1) The following sanctions may be invoked against providers based on the grounds specified in ARM 37.85.501:
(a) Termination from participation in the Medical Assistance program.
(b) Suspension of participation in the Medical Assistance program.
(c) Suspension or withholding of payments to a provider.
(d) Shortening of an existing provider agreement as permitted by the terms of such agreement.
(e) Required attendance at provider education sessions, the cost of which shall not be reimbursed by the department or any of its programs.
(f) Required prior authorization for provision of services.
(g) 100% review of the provider's claims prior to payment.
(h) Referral to the Department of Revenue for any action deemed necessary.
(i) In addition to the sanctions listed above, intermediate care facilities for the mentally retarded, skilled nursing and nursing facilities shall be subject to termination of participation when the deficiencies resulting from failure to meet conditions or standards of participation pose immediate jeopardy or the denial of payments for new admissions if the facility's deficiencies resulting from failure to meet conditions or standards of participation do not pose immediate jeopardy. Federal laws regarding termination from participation and intermediate sanctions provided in 42 CFR 442.2, 42 CFR 442.117 through 442.119, and 42 CFR Part 483 and 488, updated through February 2004 are incorporated by reference. A copy of 42 CFR 442.2, 42 CFR 442.117 through 442.119, and 42 CFR Part 483 and 488, updated through February 2004 may be obtained from the Department of Public Health and Human Services, Quality Assurance Division, 2401 Colonial Drive, Helena, MT 59620-2953; or
(j) Notification to the public of sanctions taken against a provider.
History: 53-2-201, 53-2-803, 53-4-111, 53-6-108, 53-6-111, 53-6-113, MCA; IMP, 53-2-306, 53-2-801, 53-4-112, 53-6-106, 53-6-107, 53-6-111, MCA; NEW, 1980 MAR p. 1619, Eff. 6/13/80; AMD, 1984 MAR p. 1639, Eff. 11/16/84; AMD, 1987 MAR p. 2164, Eff. 11/28/87; TRANS, from SRS, 2000 MAR p. 479; AMD, 2004 MAR p. 736, Eff. 4/9/04.