[Code of Federal Regulations]

[Title 42, Volume 4]

[Revised as of October 1, 2006]

From the U.S. Government Printing Office via GPO Access

[CITE: 42CFR1002.3]



[Page 1169-1170]

 

                         TITLE 42--PUBLIC HEALTH

 

      GENERAL--HEALTH CARE, DEPARTMENT OF HEALTH AND HUMAN SERVICES

 

PART 1002_PROGRAM INTEGRITY_STATE-INITIATED EXCLUSIONS FROM MEDICAID--

 

                      Subpart A_General Provisions

 

Sec.  1002.3  Disclosure by providers and State Medicaid agencies.



    (a) Information that must be disclosed. Before the Medicaid agency 

enters into or renews a provider agreement, or at any time upon written 

request by the Medicaid agency, the provider must disclose to the 

Medicaid agency the identity of any person described in Sec.  

1001.1001(a)(1) of this chapter.

    (b) Notification to Inspector General. (1) The Medicaid agency must 

notify the Inspector General of any disclosures made under paragraph (a) 

of this section within 20 working days from the date it receives the 

information.



[[Page 1170]]



    (2) The agency must promptly notify the Inspector General of any 

action it takes on the provider's application for participation in the 

program.

    (3) The agency must also promptly notify the Inspector General of 

any action it takes to limit the ability of an individual or entity to 

participate in its program, regardless of what such an action is called. 

This includes, but is not limited to, suspension actions, settlement 

agreements and situations where an individual or entity voluntarily 

withdraws from the program to avoid a formal sanction.

    (c) Denial or termination of provider participation. (1) The 

Medicaid agency may refuse to enter into or renew an agreement with a 

provider if any person who has ownership or control interest in the 

provider, or who is an agent or managing employee of the provider, has 

been convicted of a criminal offense related to that person's 

involvement in any program established under Medicare, Medicaid or the 

title XX Services program.

    (2) The Medicaid agency may refuse to enter into, or terminate, a 

provider agreement if it determines that the provider did not fully and 

accurately make any disclosure required under paragraph (a) of this 

section.



[57 FR 3343, Jan. 29, 1992, as amended at 63 FR 46691, Sept. 2, 1998]