10 Colo. Code Regs. § 2505-10-8.125.15
Current through Register Vol. 47, No. 9, May 10, 2024
Section 10 CCR 2505-10-8.125.15 - DISCLOSURES BY MEDICAID PROVIDERS, MANAGED CARE ENTITIES, MEDICARE PROVIDERS AND FISCAL AGENTS8.125.15.A. All providers, disclosing entities, fiscal agents, and managed care entities must provide the following federally required disclosures to the Department: 1. The name and address of any entity (individual or corporation) with an ownership or control interest in the disclosing entity, fiscal agent, or managed care entity having direct or indirect ownership of 5 percent or more. The address for corporate entities must include, as applicable, primary business address, every business location, and P.O. Box address.2. For individuals: Date of birth and Social Security number3. For business entities: Other tax identification number for any entity with an ownership or control interest in the disclosing entity (or fiscal agent or managed care entity) or in any subcontractor in which the disclosing entity (or fiscal agent or managed care entity) has a 5 percent or more interest.4. Whether the entity (individual or corporation) with an ownership or control interest in the disclosing entity (or fiscal agent or managed care entity) is related to another person with ownership or control interest in the disclosing entity as a spouse, parent, child, or sibling; or whether the entity (individual or corporation) with an ownership or control interest in any subcontractor in which the disclosing entity (or fiscal agent or managed care entity) has a 5 percent or more interest is related to another person with ownership or control interest in the disclosing entity as a spouse, parent, child, or sibling.5. The name of any other disclosing entity (or fiscal agent or managed care entity) in which an owner of the disclosing entity (or fiscal agent or managed care entity) has an ownership or control interest.6. The name, address, date of birth, and Social Security Number of any managing employee of the disclosing entity (or fiscal agent or managed care entity).7. The identity of any person who has an ownership or control interest in the provider, or is an agent or managing employee of the provider who has been convicted of a criminal offense related to that person's involvement in any program under Medicare, Medicaid, Children's Health Insurance Program or the Title XX services since the inception of these programs.8. Full and complete information about the ownership of any subcontractor with whom the provider has had business transactions totaling more than $25,000 during the 12 month period ending on the date of the request; and any significant business transactions between the provider and any wholly owned supplier, or between the provider and any subcontractor, during the 5-year period ending on the date of the request.8.125.15.B. Disclosures from any provider or disclosing entity are due at any of the following times: 1. Upon the provider or disclosing entity submitting the provider application.2. Upon the provider or disclosing entity executing the provider agreement.3. Upon request of the Department during revalidation.4. Within 35 days after any change in ownership of the disclosing entity.8.125.15.C. Disclosures from fiscal agents are due at any of the following times:1. Upon the fiscal agent submitting its proposal in accordance with the State's procurement process.2. Upon the fiscal agent executing a contract with the State.3. Upon renewal or extension of the contract.4. Within 35 days after any change in ownership of the fiscal agent.8.125.15.D. Disclosures from managed care entities are due at any of the following times: 1. Upon the managed care entity submitting its proposal in accordance with the State's procurement process.2. Upon the managed care entity executing a contract with the State.3. Upon renewal or extension of the contract.4. Within 35 days after any change in ownership of the managed care entity.8.125.15.E. The Department will not reimburse any claim from any provider or entity or make any payment to an entity that fails to disclose ownership or control information as required by 42 CFR § 455.104. The Department will not reimburse any claim from any provider or entity or make any payment to an entity that fails to disclose information related to business transactions as required by 42 CFR § 455.105 beginning on the day following the date the information was due and ending on the day before the date on which the information was supplied. Any payment made to a provider or entity that is not reimbursable in accordance with this section shall be considered an overpayment.8.125.15.F. The Department may terminate the agreement of any provider or entity or deny enrollment of any provider that fails to disclose information when requested or required by 42 CFR § 455.100-106.38 CR 11, June 10, 2015, effective 7/1/201543 CR 11, June 10, 2020, effective 6/30/202046 CR 01, January 10, 2023, effective 1/1/202346 CR 07, April 10, 2023, effective 4/30/202347 CR 03, February 10, 2024, effective 1/12/2024, exp. 5/11/2024 (Emergency)