Section 51.152. Termination of provider agreement

(a) A provider’s MA provider agreement or MA waiver provider agreement, or both, may be terminated based upon one of the following:

(1) The provider has not complied with the terms of the MA waiver provider agreement or MA provider agreement.

(2) The provider has committed a violation as listed under § § 1101.75 and 1101.77 (relating to provider prohibited acts; and enforcement actions by the Department).

(3) The provider fails to render the HCBS and protect the health and welfare of a participant.

(4) The provider fails to meet a provision of this chapter.

(5) The provider fails to deliver an HCBS in the type, amount, frequency and duration authorized in the ISP when the participant is available for the delivery of the HCBS.

(6) The provider submits a fraudulent claim.

(7) The provider fails to develop or implement a CAP or DCAP timely.

(8) The provider fails to comply with the provider monitoring requirements in § 51.24 (relating to provider monitoring).

(9) The provider fails to comply with applicable Federal and other State laws and this chapter.

(10) The provider is identified on one of the following lists:

(i) EPLS.

(ii) LEIE.

(iii) Medicheck.

(b) This section does not apply to an SSW provider.