(A)Defined Terms. For the purposes of 130 CMR 450.222 through 450.228, the following words and expressions have the indicated definitions. These definitions as they are applied in 130 CMR 450.222 through 450.228 are adopted pursuant to the provisions of 42 U.S.C. §§ 1320a-3, 1320a-5, 1396a(a)(38), 1396b(i)(2), and regulations at 42 CFR 455.100etseq.Agent - any person who has been delegated the authority to obligate or act on behalf of a provider.
Convicted - a judgment of conviction has been entered by a federal, state, or local court, regardless of whether an appeal from that judgment is pending.
Disclosing Entity - a provider or fiscal agent.
Other Disclosing Entity - any other disclosing entity and any entity that does not participate in MassHealth, but is required to disclose certain ownership and control information because of participation in any of the programs established under Title V, XVIII, or XX of the Social Security Act. This includes
(1) any hospital, nursing facility, home health agency, independent clinical laboratory, renal disease facility, rural health clinic, or managed care organization that participates in Medicare;(2) any Medicare intermediary or carrier; and(3) any entity (other than an individual practitioner or group practice that provides, or arranges for the provision of, health-related services for which it claims payment under any plan or program established under Title V or XX of the Social Security Act). Fiscal Agent - a contractor that processes or pays for provider claims on behalf of the MassHealth agency.
Indirect Ownership Interest - an ownership interest in an entity that has an ownership interest in the disclosing entity. This term includes an ownership interest in any entity that has an indirect ownership interest in the disclosing entity.
Managing Employee - a general manager, business manager, administrator, director, or other individual who exercises operational or managerial control over, or who directly or indirectly conducts the day-to-day operation of, an institution, organization, or agency.
Ownership Interest - the possession of equity in the capital, the stock, or the profits of the disclosing entity.
Person with an Ownership or Control Interest.
(1) a person or corporation that(a) has an ownership interest totaling 5% or more in a disclosing entity;(b) has an indirect ownership interest equal to 5% or more in a disclosing entity;(c) has a combination of direct and indirect ownership interests equal to 5% or more in a disclosing entity;(d) owns an interest of 5% or more in any mortgage, deed of trust, note, or other obligation secured by the disclosing entity if that interest equals at least 5% of the value of the property or assets of the disclosing entity;(e) is an officer or director of a disclosing entity that is organized as a corporation;(f) is a partner in a disclosing entity that is organized as a partnership; or(g) owns directly or indirectly an interest of 5% or more in any real property leased to a disclosing entity for use as a nursing facility, rest home, or hospital.(2) For the purpose of 130 CMR 450.221: Person with an Ownership or Control Interest, an individual is deemed to own any beneficial interest owned directly or indirectly by or for his or her minor children or spouse. Significant Business Transaction-any business transaction or series of transactions that, during any one fiscal year, exceed the lesser of $25,000 or 5% of a provider's total operating expenses.
Secretary - the Secretary of the U.S. Department of Health and Human Services.
Subcontractor.
(1) an individual, agency, or organization to which a disclosing entity has contracted or delegated some of its management functions or responsibilities of providing medical care to its patients; or(2) an individual, agency, or organization with which a fiscal agent has entered into a contract, agreement, purchase order, or lease (or leases of real property) to obtain space, supplies, equipment, or services provided under the MassHealth agreement. Supplier - an individual, agency, or organization from which a provider purchases goods and services used in carrying out its responsibilities under MassHealth (for example, a commercial laundry, a manufacturer of hospital beds, or a pharmaceutical firm).
Wholly Owned Supplier - a supplier whose total ownership interest is held by a provider or by a person, persons, or other entity with an ownership or control interest in a provider.