Termination of Provider Participation FAQs
Section 6501 of the Affordable Care Act requires each State Medicaid program to terminate any provider who has been terminated under Medicare or by another State Medicaid program. The Centers for Medicare & Medicaid Services (CMS) has defined “termination” as occurring when a State Medicaid program, CHIP, or the Medicare program has taken action to revoke a Medicaid or CHIP provider’s or Medicare provider or supplier’s billing privileges and the provider, supplier, or eligible professional has exhausted all applicable appeal rights or the timeline for appeal has expired. The requirement to terminate only applies in cases where providers, suppliers, or