441—79.14 (249A) Provider enrollment.
	 79.14(1) Application request. A provider of medical or remedial services that wishes to enroll as an Iowa Medicaid provider shall begin the enrollment process by contacting the provider services unit at the Iowa Medicaid enterprise to request an application form.
	  a.   	 A nursing facility shall also complete the process set forth in 441—subrule 81.13(1).
	  b.   	 An intermediate care facility for persons with mental retardation shall also complete the process set forth in 441—subrule 82.3(1).
	 79.14(2) Submittal of application. The provider shall submit the appropriate application forms to the Iowa Medicaid enterprise provider services unit at P.O. Box 36450, Des Moines, Iowa 50315.
	  a.   	 Providers of home- and community-based waiver services shall submit Form 470-2917, Medicaid HCBS Provider Application, at least 90 days before the planned service implementation date.
	  b.   	 All other providers shall submit Form 470-0254, Iowa Medicaid Provider Enrollment Application.
	  c.   	 The application shall include the provider’s national provider identifier number or shall indicate that the provider is an atypical provider that is not issued a national provider identifier number.
	 79.14(3) Notification. Providers shall be notified of the decision on their application by the Iowa Medicaid enterprise provider services unit within 30 calendar days.
	 79.14(4) Providers not approved as the type of Medicaid provider requested shall have the right to appeal under 441—Chapter 7.
	 79.14(5) Effective date of approval. Applications shall be approved retroactive to the date requested by the provider or the date the provider meets the applicable participation criteria, whichever is later, not to exceed 12 months retroactive from the receipt of the application forms by the Iowa Medicaid enterprise provider services unit.
	 79.14(6) Providers approved for certification as a Medicaid provider shall complete a provider participation agreement as required by rule 441—79.6(249A).
	 79.14(7) No payment shall be made to a provider for care or services provided prior to the effective date of the department’s approval of an application, unless the provider was enrolled and participating in the Iowa Medicaid program as of April 1, 1993.
	 79.14(8) Payment rates dependent on the nature of the provider or the nature of the care or services provided shall be based on information on the application form, together with information on claim forms, or on rates paid the provider prior to April 1, 1993.
	 79.14(9) Amendments to application forms shall be submitted to the Iowa Medicaid enterprise provider services unit and shall be approved or denied within 30 calendar days. Approval of an amendment shall be retroactive to the date requested by the provider or the date the provider meets all applicable criteria, whichever is later, not to exceed 30 days prior to the receipt of the amendment by the Iowa Medicaid enterprise provider services unit. Denial of an amendment may be appealed under 441—Chapter 7.
	 79.14(10) Providers who have not submitted claims in the last 24 months will be sent a notice asking if they wish to continue participation. Providers failing to reply to the notice within 30 calendar days of the date on the notice will be terminated as providers. Providers who do not submit any claims in 48 months will be terminated as providers without further notification.
	 79.14(11) Report of changes. The provider shall inform the Iowa Medicaid enterprise of all pertinent changes to enrollment information within 60 days of the change. Pertinent changes include, but are not limited to, changes to the business entity name, individual provider name, tax identification number, mailing address, and telephone number.
	  a.   	 When a provider fails to provide current information within the 60-day period, the department may terminate the provider’s Medicaid enrollment upon 30 days’ notice. The termination may be appealed under 441—Chapter 7.
	  b.   	 When the department incurs an informational tax-reporting fine because a provider submitted inaccurate information or failed to submit changes to the Iowa Medicaid enterprise in a timely manner, the fine shall be the responsibility of the individual provider to the extent that the fine relates to or arises out of the provider’s failure to keep all provider information current.
	 (1) 	 The provider shall remit the amount of the fine to the department within 30 days of notification by the department that the fine has been imposed.
	 (2) 	 Payment of the fine may be appealed under 441—Chapter 7.
This rule is intended to implement Iowa Code section 249A.4.