[Code of Federal Regulations]

[Title 42, Volume 4]

[Revised as of October 1, 2006]

From the U.S. Government Printing Office via GPO Access

[CITE: 42CFR1002.215]



[Page 1171]

 

                         TITLE 42--PUBLIC HEALTH

 

      GENERAL--HEALTH CARE, DEPARTMENT OF HEALTH AND HUMAN SERVICES

 

PART 1002_PROGRAM INTEGRITY_STATE-INITIATED EXCLUSIONS FROM MEDICAID--

 

                     Subpart C_Permissive Exclusions

 

Sec.  1002.215  Action on request for reinstatement.



    (a) The State agency may grant reinstatement only if it is 

reasonably certain that the types of actions that formed the basis for 

the original exclusion have not recurred and will not recur. In making 

this determination, the agency will consider, in addition to any factors 

set forth in State law--

    (1) The conduct of the individual or entity occurring prior to the 

date of the notice of exclusion, if not known to the agency at the time 

of the exclusion;

    (2) The conduct of the individual or entity after the date of the 

notice of exclusion; and

    (3) Whether all fines, and all debts due and owing (including 

overpayments) to any Federal, State or local government that relate to 

Medicare or any of the State health care programs, have been paid, or 

satisfactory arrangements have been made, that fulfill these 

obligations.

    (b) Notice of action on request for reinstatement. (1) If the State 

agency approves the request for reinstatement, it must give written 

notice to the excluded party, and to all others who were informed of the 

exclusion in accordance with Sec.  1002.212, specifying the date on 

which Medicaid program participation may resume.

    (2) If the State agency does not approve the request for 

reinstatement, it will notify the excluded party of its decision. Any 

appeal of a denial of reinstatement will be in accordance with State 

procedures and need not be subject to administrative or judicial review, 

unless required by State law.