1066
42 CFR Ch. V (10–1–00 Edition)
§ 1002.215
(b) An individual or entity who has
been excluded from Medicaid may be
reinstated only by the Medicaid agency
that imposed the exclusion.
(c) An individual or entity may sub-
mit to the State agency a request for
reinstatement at any time after the
date specified in the notice of exclu-
sion.
§ 1002.215 Action on request for rein-
statement.
(a) The State agency may grant rein-
statement only if it is reasonably cer-
tain that the types of actions that
formed the basis for the original exclu-
sion have not recurred and will not
recur. In making this determination,
the agency will consider, in addition to
any factors set forth in State law—
(1) The conduct of the individual or
entity occurring prior to the date of
the notice of exclusion, if not known to
the agency at the time of the exclu-
sion;
(2) The conduct of the individual or
entity after the date of the notice of
exclusion; and
(3) Whether all fines, and all debts
due and owing (including overpay-
ments) to any Federal, State or local
government that relate to Medicare or
any of the State health care programs,
have been paid, or satisfactory ar-
rangements have been made, that ful-
fill these obligations.
(b) Notice of action on request for re-
instatement. (1) If the State agency ap-
proves the request for reinstatement, it
must give written notice to the ex-
cluded party, and to all others who
were informed of the exclusion in ac-
cordance with § 1002.212, specifying the
date on which Medicaid program par-
ticipation may resume.
(2) If the State agency does not ap-
prove the request for reinstatement, it
will notify the excluded party of its de-
cision. Any appeal of a denial of rein-
statement will be in accordance with
State procedures and need not be sub-
ject to administrative or judicial re-
view, unless required by State law.
Subpart D—Notification to OIG of
State or Local Convictions of
Crimes Against Medicaid
§ 1002.230 Notification of State or local
convictions of crimes against Med-
icaid.
(a) The