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H. Exclusion - means that a health care provider, either an individual practitioner or facility, organization, institution, business, or other type of entity, cannot receive Medicaid payment for any health care services rendered. [42 CFR § 455.2]. I. Suspension of Payment - means that upon determination by the Department that there is a credible allegation of fraud against a specified provider for which an investigation is pending under the Medicaid program, all payments pending at the time of determination and all payments for items or services furnished by the specified provider will be retained by the Department until resolution of the investigation, unless the Department determines that good cause to not suspend or to only suspend in part exists, as set forth in 42 CFR § 455.23(e) and § 455.23(f) respectively. [§ 455.23]. J. Termination - occurs when the Medicare program, a State Medicaid program, or Children’s Health Insurance Program (CHIP) has taken an action to revoke a provider’s billing privileges, a provider has exhausted all applicable appeal rights or the timeline for appeal has expired, and there is no expectation on the part of a provider or supplier or the Medicare program, State Medicaid program, or CHIP that the revocation is temporary. The requirement for termination based upon a termination in another program applies in cases where providers, suppliers, or eligible professionals were terminated or had their billing privileges revoked for cause which may include reasons based on fraud, integrity, or quality. [Section 6501 of the Affordable Care Act amended section 1902(a)(39) of the Social Security Act (the Act) and requires State Medicaid agencies to terminate the participation of any individual or entity if such individual or entity is terminated under Medicare or under the Medicaid program or CHIP of any other state]. K. Suspension - means that items or services furnished by a specified provider who has been convicted of a program-related offense in a Federal, State, or local court will not be reimbursed under Medicaid.[42 CFR § 455.2]. HISTORY: Amended by SCSR42–5 Doc. No. 4746, eff May 25, 2018. 126–401. Sanctions. A. The Administrator of the Title XIX Single State Agency may invoke one (1) or more of the following administrative sanctions against a Medicaid provider who has been determined to have abused the Medicaid Program: (1) Educational Intervention; (2) Postpayment Review of Claims; (3) Prepayment Review of Claims; (4) Referral to Licensing/Certifying Boards or Agencies; (5) Peer Review; (6) Suspension; (7) Termination. B. The Administrator of the Title XIX Single State Agency may invoke one (1) or more of the following administrative sanctions against a Medicaid provider who has been determined to be guilty of fraud or convicted of a crime related to his or her participation in Medicare or Medicaid, or for any reason for which the Secretary of the United States Department of Health and Human Services could exclude an individual or entity under 42 CFR §§ 1001 and 1003. [42 CFR § 1002.210]: (1) Suspension; (2) Termination; (3) Exclusion. HISTORY: Amended by SCSR42–5 Doc. No. 4746, eff May 25, 2018. 126–402. Factors for Sanction. The factors to be considered in determining sanctions shall include, but not be limited to, the following: A. Seriousness of the offense(s); B. Extent of violation(s);