7 Alaska Admin. Code § 165.050

Current through September 25, 2024

Section 7 AAC 165.050 - Program standards for continuing participation

(a) A provider who has received an incentive payment under this chapter must continue to meet the eligibility standards for that payment through the entire payment year.

(b) The department may investigate a provider and audit the provider's records to verify that the provider

(1) continues to be enrolled and in compliance with the Medicaid program under 7 AAC 105 - 7 AAC 160;

(2) continues to meet the requirements of this chapter, including

(A) the accurate calculation and reporting of Medicaid patient volume, needy individual patient volume, and total patient volume for the type of provider, in accordance with 42 C.F.R. 495.302 - 495.306, adopted by reference in 7 AAC 165.010(b) (1); and

(B) in each participation year after the provider's initial year of participation, meaningful use objectives and measures applicable to the type of provider that are established in 42 C.F.R. 495.6, adopted by reference in 7 AAC 165.020(c) (2);

(3) received accurate payments; and

(4) is not subject to any sanctions under 7 AAC 105.400 - 7 AAC 105.490.

(c) An investigation or audit conducted under (b) of this section may include any information the provider used to justify payment under this chapter, including the results of any Medicaid claim or payment information generated under 7 AAC 105 - 7 AAC 160.

(d) If the department finds that a provider is deficient for any reason listed in (b) of this section, the department may take any of the following actions:

(1) suspend an incentive payment until the provider has removed the deficiency to the satisfaction of the department;

(2) require full repayment of all or a portion of an incentive payment;

(3) terminate participation in the Alaska Medicaid electronic health record incentive program;

(4) terminate or suspend participation in the Medicaid program in this state.

(e) Any action taken by the department under (d) of this section may be appealed by the provider under 7 AAC 165.080.

7 AAC 165.050

Eff. 6/1/2011, Register 198; am 1/20/2013, Register 205

Authority:AS 47.05.010

AS 47.07.030

AS 47.07.040