Denied Medicaid Renewal Appeal

I am in Georgia

I am a Georgia Service Provider Denied Renewal with DCH due to a failed site inspection and making appeal as no 2nd site visit was done prior to denial and reimbursements turned off POLICIES AND PROCEDURES For MEDICAID/PEACHCARE FOR KIDS PARTI GEORGIA DEPARTMENT OF COMMUNITY HEALTH DIVISION OF MEDICAID April *, * *.* Termination Georgia Service Provider Denied Renewal with DCH due to a failed site inspection and making appeal as no 2nd site visit was done prior to denial and reimbursements turned off POLICIES AND PROCEDURES For MEDICAID/PEACHCARE FOR KIDS PARTI GEORGIA DEPARTMENT OF COMMUNITY HEALTH DIVISION OF MEDICAID April *, * *.* Termination Georgia Service Provider Denied Renewal with DCH due to a failed site inspection and making appeal as no 2nd site visit was done prior to denial and reimbursements turned off POLICIES AND PROCEDURES For MEDICAID/PEACHCARE FOR KIDS PARTI GEORGIA DEPARTMENT OF COMMUNITY HEALTH DIVISION OF MEDICAID April *, * *.* Termination

*.* Termination and Georgia § *-*-* and *-*-* I should have been granted a second site visit prior to services and reimbursements being terminated

*.* Termination J) The Department shall terminate a provider’s enrollment in the categorical risk providers; however, the Division reserves the right to conduct site visits for any category of service. The purpose of the site visit is to verify that the information submitted to the Division is accurate and to determine compliance with Federal and State enrollment requirements. Based on the results of the site visit, providers may be denied enrollment, suspended or terminated from the Medicaid/PeachCare for Kids program for any of the following, but not limited to: • Current provider or applicant’s service location is not operational; • Current provider or applicant’s service location is not physically located at the address identified in the enrollment application; If the service location is closed, inoperable, or at a different location other than the address provided in the application at the time of the initial site visit, the Division will conduct a second unannounced site visit. First visit on May *, * Reenrollment denied on May *, *- Reimbursement denied Reapplied on May *, * -denied and locked out of system Second visit on June *, * *.* Suspensions A) Suspensions shall apply to all Medicaid/PeachCare for Kids services at all provider locations. B) Suspension, other than for inactivity, shall be in effect for the period set forth in the Division’s Notice of Suspension or in the Administrative Law Judge’s decision, if any. C) The Division will re-enroll any suspended provider at the expiration of the period of suspension following receipt of a provider’s written request for re-enrollment. Rev. */* Rev. */* D) The Department’s suspension of a Medicaid/PeachCare for Kids provider is neither subject to administrative review nor an administrative law hearing if said action is based on the provider failing to submit a revalidation application within 60 days of the date of the re-credentialing notice First visit on May *, * Reenrollment denied on May *, *- Reimbursement denied Reapplied on May *, * -denied and locked out of system Second visit on June *, * *.* Suspensions A) Suspensions shall apply to all Medicaid/PeachCare for Kids services at all provider locations. B) Suspension, other than for inactivity, shall be in effect for the period set forth in the Division’s Notice of Suspension or in the Administrative Law Judge’s decision, if any. C) The Division will re-enroll any suspended provider at the expiration of the period of suspension following receipt of a provider’s written request for re-enrollment. Rev. */* Rev. */* D) The Department’s suspension of a Medicaid/PeachCare for Kids provider is neither subject to administrative review nor an administrative law hearing if said action is based on the provider failing to submit a revalidation application within 60 days of the date of the re-credentialing notice First visit on May *, * Reenrollment denied on May *, *- Reimbursement denied Reapplied on May *, * -denied and locked out of system Second visit on June *, * *.* Suspensions A) Suspensions shall apply to all Medicaid/PeachCare for Kids services at all provider locations. B) Suspension, other than for inactivity, shall be in effect for the period set forth in the Division’s Notice of Suspension or in the Administrative Law Judge’s decision, if any. C) The Division will re-enroll any suspended provider at the expiration of the period of suspension following receipt of a provider’s written request for re-enrollment. Rev. */* Rev. */* D) The Department’s suspension of a Medicaid/PeachCare for Kids provider is neither subject to administrative review nor an administrative law hearing if said action is based on the provider failing to submit a revalidation application within 60 days of the date of the re-credentialing notice