Authority: IC 12-21-2-3; IC 12-21-2-8; IC 12-21-5-1.5

Affected: IC 12-21-2-8; IC 12-21-5-1.5

Sec. 7. (a) The division shall, at any time during the fiscal year, change the certification status of a managed care provider to that of conditional certification if the division determines that the managed care provider has not met the requirements in this article or has not met the requirements of the managed care provider contract with the division.

(b) Within a conditional certification period, the division may:

1. (1) grant an extension of the conditional certification;
2. (2) reinstate the regular or temporary certification of the managed care provider if the division requirements are met timely; or
3. (3) terminate the managed care provider certification if the division requirements are not met within the imposed deadline.

(c) The division may issue a conditional certification for one (1) or more specific populations served by the managed care provider.

(d) The division shall notify the chief executive officer of the managed care provider of the change in certification status in writing. The notice shall include the following:

1. (1) The standards not met and the actions the provider must take to meet those standards.
2. (2) Any intermediate steps required by the division toward meeting the standards.
3. (3) The amount of time granted the managed care provider to meet the required standard.

(e) The division has the discretion to determine the time period and frequency of a conditional certification; however, a conditional certification plus any extensions may not exceed twelve (12) months from the date that conditional certification was effective.

(f) Extension requirements are as follows:

1. (1) If the division grants an extension of a conditional certification, the division shall notify the managed care provider in writing.

2. (2) The notice shall include the following:

   1. (A) The time period of the extension.
   2. (B) The intermediate steps required by the division.

(g) If the provider does not attain the standard required by the division within the period of time required, the provider's certification shall be terminated.

(Division of Mental Health and Addiction; 440 IAC 4.3-2-7; filed Oct 11, 1996, 2:00 p.m.: 20 IR 757; filed Mar 13, 2000, 7:44 a.m.: 23 IR 1990; readopted filed May 10, 2001, 2:30 p.m.: 24 IR 3235; readopted filed Apr 7, 2008, 3:40 p.m.: 20080507-IR-440070745RFA; readopted filed Aug 11, 2014, 11:21 a.m.: 20140910-IR-440140240RFA; readopted filed Nov 9, 2020, 3:09 p.m.: 20201209-IR-440200502RFA)