§ 1101.82. Re-enrollment.
(a) Request for re-enrollment. To request re-enrollment, the provider shall send a written request to the Department’s Office of Medical Assistance, Bureau of Provider Relations. For the request to be considered, it should include statements from peer review bodies, probation officers where appropriate, or professional associates, giving factual evidence of why they believe the violations 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 any licensure action against the provider, whether the provider has been convicted in a State, Federal or local court of Medicaid offenses and whether there are any 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. Departmental 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 within 60 days of the date of receipt of the application. Under no circumstances will re-enrollment be granted retroactive to the date of application.
Source The provisions of this § 1101.82 amended November 18, 1983, effective November 19, 1983, 13 Pa.B. 3653. Immediately preceding text appears at serial pages (47807) and (62900).
Cross References This section cited in 55 Pa. Code § 1101.74 (relating to provider fraud); 55 Pa. Code § 1127.81 (relating to provider misutilization); and 55 Pa. Code Chapter 1181 Appendix O (relating to OBRA sanctions).
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