Sec. 10.09.03.03. Conditions for Participation

To participate in the Program, the provider shall:

A. Meet the licensure requirements in Regulation .02 of this chapter;

B. Apply for participation in the Program using the application form designated by the Department;

C. Be approved for participation by the Department;

D. Accept, as payment in full, the amounts paid by the Program plus any copayment required by Regulation .05C(5) of this chapter;

E. Maintain adequate records and prescriptions for a minimum of 6 years, and make them available for inspection, upon request, to the Department or its designee;

F. Ensure that all prescriptions contain sufficient information to justify the invoice charges;

G. Provide services without regard to race, creed, color, age, sex, national origin, marital status, physical or mental handicap;

H. Agree that the provider may not employ knowingly a person who has been disqualified from the Program to compound or dispense Medical Assistance prescriptions, unless prior written approval has been received from the Department;

I. Verify the participant’s eligibility before dispensing covered drugs;

J. Place no restriction on the participant’s right to select providers of the participant’s choice;

K. Agree that if the Program denies payment or requests repayment on the basis that an otherwise covered service was not medically necessary, the provider may not seek payment for that service from the participant;

L. Maintain a record of the individual who picks up a prescription that includes:

(1) The prescription number;

(2) The name of the individual picking up the prescription;

(3) The signature of the individual picking up the prescription; and

(4) The date the prescription was picked up;

M. Reverse invoice charges for any prescription not picked up by the participant or their designee within 14 days;

N. Maintain a record of a participant or designee’s written authorization for automatic refill, if automatic refills are provided;

O. Agree that the provider may not deny services to any participant because of the individual’s inability to pay the copayment;

P. Agree that if the Program denies payment due to late billing, the provider may not seek payment from the participant;

Q. On the Department’s request, provide within 15 days all invoices, as defined in Regulation .01B(24)(b) of this chapter, to assess the AAC; and

R. Participate in the cost of dispensing survey and, on the Department’s request and within the Department’s timeline, provide to the Department all documentation that the Department or its designee determines is necessary.