[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: 42CFR455.104]



[Page 337]

 

                         TITLE 42--PUBLIC HEALTH

 

  CHAPTER IV--CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF 

                  HEALTH AND HUMAN SERVICES (CONTINUED)

 

PART 455_PROGRAM INTEGRITY: MEDICAID--Table of Contents

 

   Subpart B_Disclosure of Information by Providers and Fiscal Agents

 

Sec.  455.104  Disclosure by providers and fiscal agents: Information 



on ownership and control.



    (a) Information that must be disclosed. The Medicaid agency must 

require each disclosing entity to disclose the following information in 

accordance with paragraph (b) of this section:

    (1) The name and address of each person with an ownership or control 

interest in the disclosing entity or in any subcontractor in which the 

disclosing entity has direct or indirect ownership of 5 percent or more;

    (2) Whether any of the persons named, in compliance with paragraph 

(a)(1) of this section, is related to another as spouse, parent, child, 

or sibling.

    (3) The name of any other disclosing entity in which a person with 

an ownership or control interest in the disclosing entity also has an 

ownership or control interest. This requirement applies to the extent 

that the disclosing entity can obtain this information by requesting it 

in writing from the person. The disclosing entity must--

    (i) Keep copies of all these requests and the responses to them;

    (ii) Make them available to the Secretary or the Medicaid agency 

upon request; and

    (iii) Advise the Medicaid agency when there is no response to a 

request.

    (b) Time and manner of disclosure. (1) Any disclosing entity that is 

subject to periodic survey and certification of its compliance with 

Medicaid standards must supply the information specified in paragraph 

(a) of this section to the State survey agency at the time it is 

surveyed. The survey agency must promptly furnish the information to the 

Secretary and the Medicaid agency.

    (2) Any disclosing entity that is not subject to periodic survey and 

certification and has not supplied the information specified in 

paragraph (a) of this section to the Secretary within the prior 12-month 

period, must submit the information to the Medicaid agency before 

entering into a contract or agreement to participate in the program. The 

Medicaid agency must promptly furnish the information to the Secretary.

    (3) Updated information must be furnished to the Secretary or the 

State survey or Medicaid agency at intervals between recertification or 

contract renewals, within 35 days of a written request.

    (c) Provider agreements and fiscal agent contracts. A Medicaid 

agency shall not approve a provider agreement or a contract with a 

fiscal agent, and must terminate an existing agreement or contract, if 

the provider or fiscal agent fails to disclose ownership or control 

information as required by this section.

    (d) Denial of Federal financial participation (FFP). FFP is not 

available in payments made to a provider or fiscal agent that fails to 

disclose ownership or control information as required by this section.