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available. A level of care must be certified by the Department of Health and Human Services or its designee and the monthly recurring income computed. If an individual’s SSI is terminated while he is in the institution because of too much income, he may reapply for MAO. HISTORY: Amended by State Register Volume 16, Issue No. 6, eff June 26, 1992; State Register Volume 20, Issue No. 6, Part 1, eff June 28, 1996. Code Commissioner’s Note Pursuant to 2011 Act No. 47, §14(B), the Code Com- missioner substituted ‘‘intellectual disability’’ for ‘‘mental retardation’’ and ‘‘person with intellectual disability’’ or ‘‘persons with intellectual disability’’ for ‘‘mentally re- tarded’’. 126–380. Denial, Termination, or Reduction of Benefits. A. When an individual’s Medicaid benefits are denied, discontinued or changed, the individual shall receive notice pursuant to Title XIX of the Social Security Act. The notice shall include an explanation of the individual’s right to a fair hearing, the method to obtain a hearing, and the right to representation. B. Fair hearings shall be conducted pursuant to R126-150. C. An individual’s Medicaid benefits may be continued pending a fair hearing decision in accordance with Title XIX of the Social Security Act and the federal regulations promulgated in accordance therewith. 126–399. Conflict Between State and Federal Regulations. When the requirements of the State and the Federal regulations are not in agreement, the requirements of the Federal regulations shall prevail. ARTICLE 4 PROGRAM EVALUATION SUBARTICLE 1 ADMINISTRATIVE SANCTIONS AGAINST MEDICAID PROVIDERS 126–400. Definitions. A. Provider - means an individual, firm, corporation, association or institution which is providing, or has been approved to provide, medical assistance to a beneficiary pursuant to the State Medical Assistance Plan and in accord with Title XIX of the Social Security Act of 1932, as amended. B. Person - any natural person, company, firm, association, partnership, corporation or other legal entity. C. Practitioner - means a physician or other health care professional licensed under State law to practice his or her profession. D. Educational Intervention - means a visit to a provider by a staff member to explain Medicaid Program policies and procedures. This includes instructions on correct billing procedures. Educational intervention may also take the form of a telephone call or letter to a provider calling his or her attention to a particular problem in Program administration or billing practices. E. Abuse - provider practices that are inconsistent with sound fiscal, business, or medical practices, and result in an unnecessary cost to the Medicaid Program, or in reimbursement for services that are not medically necessary or that fail to meet professionally recognized standards for health care. F. Fraud - an intentional deception or misrepresentation made by a person with the knowledge that the deception could result in some unauthorized benefit to himself or some other person. It includes any act that constitutes fraud under applicable Federal or State law. [42 CFR § 455.2]. G. Conviction or convicted - means a judgment or conviction after trial, or the entry of a plea of guilty or a plea of no contest (nolo contendere) in a federal, state or local court, regardless of whether an appeal from that judgment is pending.