1. (1) Providers wishing to enroll must submit a written request to Medicaid and

   1. (a) Proof of current hospital licensure if not already on file at Medicaid,
   2. (b) Proof of current Medicare swing bed certification if not already on file at Medicaid,
   3. (c) Proof of a CON if not on file at Medicaid. Each request will be reviewed for completeness and accuracy prior to approval of the application.
2. (2) Providers approved for enrollment will be issued a provider agreement which must be signed and returned to Medicaid within 30 days of the date mailed to the provider.
3. (3) Provider agreements are valid for no more than 12 calendar months.
4. (4) The effective date of enrollment cannot be earlier than the date of the enrollment application.

Author: Vicki Huff

Statutory Authority: Title XIX, Social Security Act; State Plan, Attachment 3.1-A, 4.19-D; 42 CFR §482.66.

History: Emergency rule effective March 30, 1989. Permanent rule effective July 13, 1989.