Section 22.85. Re-enrollment of providers whose agreements have been terminated

(a) Request for re-enrollment. To request re-enrollment the provider shall send a written request to the Department. For the request to be considered, it should include statements from peer review bodies, probation officers where appropriate or professional associates, giving factual evidence to support their belief that the violation leading to the termination will not be repeated. A statement from the provider setting forth the reasons why he should be re-enrolled should also be included.

(b) Criteria for provider re-enrollment. In considering the provider’s request for re-enrollment, the Department will take into account such factors as the severity of the offense, whether there has been licensure action against the provider, whether the provider has been convicted in a State, Federal or local court of Medicaid offenses or similar offenses and whether there are claims or penalties outstanding against the provider. If the Department’s notice of termination or exclusion specifies a date after which the Department will consider re-enrolling the provider, the Department will under no circumstances consider re-enrolling the provider before the specified date. Under § 22.101(b)(3) (relating to provider appeals), the Department rejection of a request for re-enrollment prior to the specified date is not subject to appeal.

(c) Notification of action on re-enrollment request. The provider will be notified in writing of the Department’s decision on a request for re-enrollment within 60 days of the date of receipt of the application. The Department’s notification of approval of a re-enrollment request shall contain an effective date of re-enrollment.

The provisions of this § 22.85 adopted December 15, 1984, effective December 16, 1984, 14 Pa.B. 2109; amended March 29, 1985, effective March 30, 1985, 15 Pa.B. 1163. Immediately preceding text appears at serial pages (89814) to (89815).

Notation

Cross References

This section cited in 6 Pa. Code § 22.61 (relating to conditions of provider eligibility).