Section 140.14  Denial of Application to Participate in the Medical Assistance Program

a)         The Department may deny an application to participate in the Medical Assistance Program if the vendor has engaged in activities which constitute grounds for termination or suspension under Section 140.16.  If the activities were engaged in prior to December 1, 1977, they may be used as the basis for denial of an application only if the vendor had actual or constructive knowledge of the requirements which applied to his conduct or activities.

b)         In addition to the above basis, the Department may deny an application submitted by a vendor that has been previously terminated, barred or denied participation if:

1)         such vendor cannot reasonably be expected to meet the written requirements of the Department including those set forth in the Medical Assistance Program Handbooks and the Department's manuals, bulletins and releases; or

2)         the Department determines, after reviewing the activities which served as the basis for the earlier termination or barring, that the application should not be approved.  Factors to be considered by the Department in making this determination shall include:

A)        length of time the vendor has not participated in the Medical Assistance Program;

B)        magnitude and severity of the activities which led to the binding administrative decision which served as the basis for the vendor's termination, barring or denied participation;

C)        mitigating circumstances presented by the vendor;

D)        whether the deficiencies which served as the basis for the vendor to be terminated, barred or denied participation are corrected;

E)         whether the vendor demonstrates a fitness to participate in the Medical Assistance Program; and

F)         the extent to which any legally enforceable debts owed to the Department by the applicant or an entity in which the applicant or his nominee held a substantial ownership interest have been paid.

3)         These factors must be established by submission of documentary evidence in support of the application.

c)         The Department may deny an application of a previously terminated or barred applicant if the applicant, without special permission from the Department, has already become a vendor, an entity with management responsibility for a vendor, an incorporator, officer or member of the board of directors of a vendor, an entity owning (directly or indirectly) 5% or more of the shares of stock or other evidences of ownership in a corporate vendor, an owner of a sole proprietorship vendor, a partner in a partnership vendor, a technical or other advisor to a vendor, or an investor in a vendor.

d)         The Department shall deny an application to participate in the Medical Assistance Program if the vendor does not have a necessary license, certificate or authorization.

(Source:  Amended at 16 Ill. Reg. 19146, effective December 1, 1992)