[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: 42CFR1007.15]



[Page 1208-1209]

 

                         TITLE 42--PUBLIC HEALTH

 

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

 

PART 1007_STATE MEDICAID FRAUD CONTROL UNITS--Table of Contents

 

Sec.  1007.15  Applications, certification and recertification.



    (a) Initial application. In order to receive FFP under this part, 

the unit must submit to the Secretary, an application approved by the 

Governor,



[[Page 1209]]



containing the following information and documentation--

    (1) A description of the applicant's organization, structure, and 

location within State government, and an indication of whether it seeks 

certification under Sec.  1007.7 (a), (b), or (c);

    (2) A statement from the State Attorney General that the applicant 

has authority to carry out the functions and responsibilities set forth 

in this part. If the applicant seeks certification under Sec.  

1007.7(b), the statement must also specify either that--

    (i) There is no State agency with the authority to exercise 

Statewide prosecuting authority for the violations with which the unit 

is concerned, or

    (ii) Although the State Attorney General may have common law 

authority for Statewide criminal prosecutions, he or she has not 

exercised that authority;

    (3) A copy of whatever memorandum of agreement, regulation, or other 

document sets forth the formal procedures required under Sec.  

1007.7(b), or the formal working relationship and procedures required 

under Sec.  1007.7(c);

    (4) A copy of the agreement with the Medicaid agency required under 

Sec.  1007.9;

    (5) A statement of the procedures to be followed in carrying out the 

functions and responsibilities of this part;

    (6) A projection of the caseload and a proposed budget for the 12-

month period for which certification is sought; and

    (7) Current and projected staffing, including the names, education, 

and experience of all senior professional staff already employed and job 

descriptions, with minimum qualifications, for all professional 

positions.

    (b) Conditions for, and notification of certification. (1) The 

Secretary will approve an application only if he or she has specifically 

approved the applicant's formal procedures under Sec.  1007.7 (b) or 

(c), if either of those provisions is applicable, and has specifically 

certified that the applicant meets the requirements of Sec.  1007.7;

    (2) The Secretary will promptly notify the applicant whether the 

application meets the requirements of this part and is approved. If the 

application is not approved, the applicant may submit an amended 

application at any time. Approval and certification will be for a period 

of 1 year.

    (c) Conditions for recertification. In order to continue receiving 

payments under this part, a unit must submit a reapplication to the 

Secretary at least 60 days prior to the expiration of the 12-month 

certification period. A reapplication must--

    (1) Advise the Secretary of any changes in the information or 

documentation required under paragraphs (a) (1) through (5) of this 

section;

    (2) Provide projected caseload and proposed budget for the 

recertification period; and

    (3) Include or reference the annual report required under Sec.  

1007.17.

    (d) Basis for recertification. (1) The Secretary will consider the 

unit's reapplication, the reports required under Sec.  1007.17, and any 

other reviews or information he or she deems necessary or warranted, and 

will promptly notify the unit whether he or she has approved the 

reapplication and recertified the unit.

    (2) In reviewing the reapplication, the Secretary will give special 

attention to whether the unit has used its resources effectively in 

investigating cases of possible fraud, in preparing cases for 

prosecution, and in prosecuting cases or cooperating with the 

prosecuting authorities.



(Approved by the Office of Management and Budget under control number 

0990-0162)