1. (a) The department may impose the following sanctions against a provider based on the grounds specified in 7 AAC 105.400:

   1. (1) termination from participation in the Medicaid program;
   2. (2) suspension of participation in the Medicaid program;
   3. (3) restriction or withholding of payments to a provider;
   4. (4) referral to a utilization and quality control peer-review organization;
   5. (5) transfer to a closed-end provider agreement not to exceed 12 months or the shortening of an already-existing, closed-end provider agreement;
   6. (6) mandatory attendance at provider education sessions, including one-on-one sessions;
   7. (7) requirement of prior authorization of services;
   8. (8) department review of all claims submitted by a provider before payment to the provider;
   9. (9) referral to the applicable jurisdiction licensing board for investigation;
   10. (10) referral for fiscal audit under 7 AAC 160.110;
   11. (11) public notice of suspension or termination of a provider;
   12. (12) reporting the provider to the Healthcare Integrity and Protection Data Bank authorized under 45 C.F.R. Part 61;
   13. (13) restrictions on payment under 7 AAC 105.470.
2. (b) In this section, "utilization and quality control peer-review organization" means an organization administered by a grant agency of the federal government and defined under 42 U.S.C. 1320c-1.

(Eff. 2/1/2010, Register 193)

Authority: AS 47.05.010, AS 47.07.040