182-502-0012  <<  182-502-0014 >>   182-502-0016

WAC 182-502-0014

Review and consideration of an applicant's history.

(1) The medicaid agency may consider enrolling a health care professional, health care entity, supplier or contractor of service for reasons which include, but are not limited to, the following:
(a) The agency determines that:
(i) There is not a quality of care issue with significant risk factors that endanger client health or safety, or both;
(ii) There are not risk factors that affect the credibility, honesty, or veracity of the applicant; and
(iii) The applicant is not likely to repeat the violation that led to a restriction or sanction.
(b) The health care professional, health care entity, supplier or contractor of service has:
(i) Been excluded from participation in medicare, medicaid, or any other federally funded health care program but is not currently excluded; or
(ii) A history of probation, suspension, termination, revocation, or a surrendered professional license, certification, accreditation, or registration as defined under chapter 18.130 RCW but currently has an active license, certification, accreditation, or registration; or
(iii) A restricted or limited professional license, certification, accreditation, or registration as defined under RCW 18.130.160; or
(iv) A history of denial, limitation, suspension or termination of participation or privileges by any health care institution, plan, facility, clinic, or state agency for quality of care issues or inappropriate billing practices and the quality of care issue or inappropriate billing practices have been corrected to the agency's satisfaction.
(2) The agency conducts a screening process as specified in WAC 182-502-0010 (2)(j) on any applicant applying for a core provider agreement (CPA) or enrolling to provide services to eligible clients.
(3) The agency's response to a review of a request for enrollment is based on the information available to the agency at the time of application.
[Statutory Authority: RCW 41.05.021 and 42 C.F.R. 455. WSR 13-03-068, § 182-502-0014, filed 1/14/13, effective 2/14/13. WSR 11-14-075, recodified as § 182-502-0014, filed 6/30/11, effective 7/1/11. Statutory Authority: RCW 74.08.090, 74.09.080, and 74.09.290. WSR 11-11-017, § 388-502-0014, filed 5/9/11, effective 6/9/11.]
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