Section 11-88.1-30 - Corrective action(a) When the department of human services or the division determines that a provider has failed or is unable to comply with the applicable requirements of the Medicaid provider agreement, the department of human services or the division shall notify the provider in writing of the specific areas of noncompliance and may do one or more of the following: (1) Establish a specific time frame for the correction of each area of noncompliance and require submission of an acceptable written corrective action plan from the provider that addresses each area of noncompliance; or(2) Where a provider fails to meet standards through a corrective action plan, the division and the department of human services may suspend the provider's certification to participate in the waiver program for all or new participants.(b) Any provider that is suspended from participation in the waiver program shall be offered provider appeal rights to the department of human services under subchapter 3 of chapter 17-1736.(c) When the identified areas of noncompliance are not corrected within the time specified in an accepted plan of correction, the department of human services or the division may require the transfer of participants to another provider and terminate the Medicaid provider agreement.(d) The Medicaid provider agreement shall be immediately terminated when there is noncompliance, as determined by the department of human services and the division, which poses an imminent and serious risk to the life, health, safety or welfare of participants.(e) Any provider whose Medicaid provider agreement is terminated from participation in the waiver program shall be offered provider appeal rights to the department of human services under subchapter 3 of 17-1736.(f) Upon termination of a Medicaid provider agreement:(1) The division shall immediately notify the provider's participants of the termination and assist participants in the selection of and transition to a new provider; and(2) The provider shall cease providing services immediately after existing participants have been transferred to another provider.(g) Should the department of human services and the division determine that the provider of a terminated Medicaid provider agreement is willing and able to comply with the requirements of the Medicaid provider agreement, a new application for a Medicaid provider agreement may be submitted. If the application is approved, the provider may enter into a new Medicaid provider agreement.(h) All suspensions or terminations of Medicaid provider agreements shall be authorized by the department of human services prior to being implemented by the division. Haw. Code R. § 11-88.1-30
[Eff 10/26/2014] (Auth: HRS §§ 321-9, 333F-18, 346-14) (Imp: 42 CFR part 455, subpart E)