10 Colo. Code Regs. § 2505-10-8.7403

Current through Register Vol. 47, No. 24, December 25, 2024

Section 10 CCR 2505-10-8.7403 - Provider Agency Certification, Decertification and Termination

A. Certification

1. For services that require HCBS Certification, Provider Agencies shall obtain Certification prior to rendering or billing for services.

2. A Provider Agency seeking HCBS Certification must submit a request to the Department or its agent.

3. Upon receipt of the request, the Department or its agent shall forward Certification information and relevant state application forms to the requesting Agency.

4. Upon receipt of the completed application from the requesting Agency, the Department or its agent shall review the information and complete an on-site review of the Agency, based on the state regulations for the service for which Certification has been requested.

5. Following completion of the on-site review, the Department or its agent shall notify the Provider Agency Applicant of its recommendation by forwarding the following information:

a. Results of the on-site survey;

b. Recommendation of approval, denial, or provisional approval of Certification; and

c. If appropriate, a Corrective Action Plan to satisfy the requirements of a provisional approval.

6. Determination of Certification approval, provisional approval, or denial shall be made by the Department after the completed application is submitted by the Agency.

B. Change in Information

1. Provider Agencies shall notify the Department of any material or substantial change in information contained in the enrollment application given to the Department by the Provider Agency. This notification shall be made in the Provider Portal within 35 calendar days of the event triggering the reporting obligation. A material or substantial change includes a change in ownership; disclosures; licensure; federal tax identification number, bankruptcy; address, telephone number, or email address; criminal convictions related to involvement in any Medicare, Medicaid or Social Security Act, Title XX Health Services Block Grant program; or change in Geographic Service Area.

2. Pursuant to Section 8.130.45, Provider Agencies shall notify the Department within 35 calendar days of the loss or termination of Certification and/or licensure that is required for Home and Community-Based Services provider enrollment. The notification shall be submitted through the Provider Portal as a maintenance application to terminate the Provider Agency's enrollment of a specialty or as a Medicaid provider.

C. Decertification

1. The Department may decertify a Provider Agency if any of the following occur:

a. The Provider Agency fails to comply with any federal or state statute, rules, or guidance.

b. The Provider Agency fails to comply with any lawful requests by the Department or its agents, including providing timely access to records.

c. The Provider Agency is no longer eligible to provide the services for which the provider has received Certification.

d. The Provider Agency poses a threat to the health, safety, or welfare of Medicaid Members.

2. Decertification may occur without prior notice if the decertification is imperatively necessary for the preservation of the public health, safety or welfare and observance of this notice requirement would be contrary to the public interest. For any decertification action taken without prior notice, the Department shall issue a written notice of decertification within five business days of the action.

3. If the Provider Agency elects to dispute the decertification, the Department must receive the Provider Agency's written request to dispute the decertification within thirty (30) calendar days of the date of the decertification notice or the dispute will not be considered.

4. The Department's determination on the decertification dispute shall include a statement of the Provider Agency's appeal rights set forth in Section 8.050.

5. The effective date of the inactivation may be backdated to the date of the occurrence described above.

10 CCR 2505-10-8.7403

47 CR 03, February 10, 2024, effective 3/16/2024

47 CR 21, November 10, 2024, effective 11/30/2024