Current through Register Vol. 24-18, September 15, 2024
(1) Nothing in this chapter obligates the
medicaid agency to enroll any eligible health care professional, health care
entity, supplier or contractor of service who requests enrollment.
(2) To enroll as a provider with the agency,
a health care professional, health care entity, supplier or contractor of
service must, on the date of application:
(a)
Be currently licensed, certified, accredited, or registered according to
Washington state laws and rules, or, if exempt under federal law, according to
the laws and rules of any other state. Persons or entities outside of
Washington state, see WAC
182-502-0120;
(b) Be enrolled with medicare, when required
in specific program rules;
(c) Have
current professional liability coverage, individually or as a member of a
group, to the extent the health care professional, health care entity, supplier
or contractor is not covered by the Federal Tort Claims Act, including related
rules and regulations;
(d) Have a
current federal drug enforcement agency (DEA) certificate, if applicable to the
profession's scope of practice;
(e)
Meet the conditions in this chapter and other chapters regulating the specific
type of health care practitioner;
(f) Sign, without modification, a core
provider agreement (CPA) (HCA 09-015), disclosure of ownership form, and
debarment form (HCA 09-016) or a contract with the agency;
(g) Agree to accept the payment from the
agency as payment in full (in accordance with 42 C.F.R. § 447.15
acceptance of state payment as payment in full and WAC
182-502-0160 billing a
client);
(h) Fully disclose
ownership, employees who manage, and other control interests (e.g., member of a
board of directors or office), as requested by the agency. Indian health
services clinics are exempt from this requirement. If payment for services is
to be made to a group practice, partnership, or corporation, the group,
partnership, or corporation must enroll and provide its national provider
identifier (NPI) (if eligible for an NPI) to be used for submitting claims as
the billing provider;
(i) Have
screened employees and contractors with whom they do business prior to hiring
or contracting to assure that employees and contractors are not excluded from
receiving federal funds as required by
42 U.S.C.
1320a-7 and
42 U.S.C.
1320c-5;
(j) Pass the agency's screening process,
including license verifications, data base checks, site visits, and criminal
background checks, including fingerprint-based criminal background checks as
required by 42 C.F.R.
455.434 if considered high-risk under
42 C.F.R.
455.450. The agency uses the same screening
level risk categories that apply under medicare. For those provider types that
are not recognized under medicare, the agency assesses the risk of fraud,
waste, and abuse using similar criteria to those used in medicare;
and
(k) Agree to pay an application
fee, if required by CMS under
42 C.F.R.
455.460.
Statutory Authority:
RCW
41.05.021 and 42 C.F.R. 455. 13-03-068,
§182-502-0010, filed 1/14/13, effective 2/14/13. Statutory Authority:
RCW
41.05.021 and Affordable Care Act (ACA) - 76
Fed. Reg. 5862, 42 C.F.R. Parts 405, 424, 447, 455, 457, and 498. 12-15-015,
§182-502-0010, filed 7/10/12, effective 9/1/12. 11-14-075, recodified as
§182-502-0010, filed 6/30/11, effective 7/1/11. Statutory Authority:
RCW
74.08.090,
74.09.080, and
74.09.290. 11-11-017, §
388-502-0010, filed 5/9/11, effective 6/9/11. Statutory Authority:
RCW
74.09.521. 08-12-030, § 388-502-0010,
filed 5/29/08, effective 7/1/08. Statutory Authority:
RCW
74.08.090,
74.09.080,
74.09.120. 03-14-106, §
388-502-0010, filed 6/30/03, effective 7/31/03. Statutory Authority:
RCW
74.08.090,
74.09.500, and
74.09.530. 01-07-076, §
388-502-0010, filed 3/20/01, effective 4/20/01; 00-15-050, § 388-502-0010,
filed 7/17/00, effective 8/17/00.
