If excluded, a party must submit an application for reinstatement if the party wishes to be enrolled/reinstated into the Medicaid program. OMIG has 90 days to complete its review and render a decision. (This timeframe may be extended if OMIG or the New York State Department of Health (DOH) requires more time to review the application and sends a letter for extension to the applicant, or if OMIG or DOH sends a letter requesting information to the applicant.) Decisions are based on information submitted with the application or letter. If the applicant is denied enrollment or reinstatement based upon prior conduct, the applicant cannot re-apply for enrollment or reinstatement for two years from the date of the denial (see 18 NYCRR §504.5(d)).
When submitting a reinstatement application, it is the applicant's responsibility to provide information and/or documentation detailing corrective steps taken to assure OMIG that the violations that led to the exclusion will not be repeated (see 18 NYCRR §515.10(e)). Reinstatement into the Medicaid program may be granted only if it is reasonably certain that the violations that led to the exclusion will not be repeated.
Any provider who has been terminated on or after January 1, 2011 from Medicare or from the Medicaid program or CHIP of any other state may not be enrolled or reinstated in the New York State Medicaid program (42 CFR 455.416 (c)).
Applications for enrollment or reinstatement may be obtained by accessing www.eMedny.org, and clicking on Provider Enrollment Forms (using the same form and process as initial enrollment). Applicants for reinstatement use the same application that new applicants use, but the box for "reinstatement" must be checked if an excluded provider wishes to be reinstated into the program.
Parties who do not want to enroll in the Medicaid program or are in a category that does not require enrollment in the Medicaid program (such as staff pharmacists or nurses who do not directly bill for home care), but seek removal from the NYS Medicaid Exclusion List may do so by sending a letter to OMIG's Enrollment and Reinstatement Unit at the address listed below.
Enrollment and Reinstatement Unit
Office of the Medicaid Inspector General
800 North Pearl Street – 1st Floor
Albany, NY 12204
The letter must include the party's name, phone number, and license or provider number (if applicable), specifically state that that party is requesting only removal from the exclusion list and not reinstatement. The letter should also address the issue that led to exclusion, and may include documentation of any steps or actions that the party has taken as a result. Removal from a list without being enrolled or reinstated will not allow a party to bill Medicaid.