471 Neb. Admin. Code, ch. 2, § 008

Current through September 17, 2024

Section 471-2-008 - DISCLOSURE OF INFORMATION BY PROVIDERS

Under 42 CFR 455, Subpart B, the Department requires providers to disclose the following information:

(1) Ownership and control;

(2) Business transactions; and

(3) The providers' owners and other persons convicted of crimes against Medicare, Medicaid, or Title XX (Social Services Block Grant) programs.

008.01OWNERSHIP AND CONTROL. For each managing employee, person or entity with an ownership or control interest in the provider, and subcontractor of which the provider owns at least five percent, a provider must disclose the following:

(1) The name, address including, as applicable, the primary business address, every business location, and P.O. Box address, date of birth or incorporation, and Tax Identification Number or social security number as applicable;

(2) Whether anyone is related to another as spouse, parent, child, or sibling; and

(3) The name of any other disclosing entity in which a person named in this chapter has an ownership or controlling interest.

008.01(A)PERIODIC SURVEY AND CERTIFICATION. Any provider that is subject to periodic survey and certification of its compliance with Medicaid standards must supply this information to the Department at the time it is surveyed. Any provider that is not subject to periodic survey and certification must supply the information before entering into a service provider agreement with the Department as a part of the initial enrollment, re-enrollment, reactivation, or revalidation.

008.01(B)DISCLOSURE OF OWNERSHIP. The Department must not approve a service provider agreement, and must terminate an existing service provider agreement, if the provider fails to disclose ownership or control information. The Department shall not pay a provider who fails to disclose ownership or control information.

008.01(C)CHANGE OF INFORMATION. A provider must notify the Department of any changes or updates to the information supplied under 471 NAC 2 not later than 35 days after such changes or updates take effect.

008.02BUSINESS TRANSACTIONS. Under 42 CFR 455.105(b) when requested, a provider must disclose, within 35 days of the date on the request, the following information:

(1) The ownership of any subcontractor with whom the provider has had business transactions totaling more than $25,000 during the 12-month period ending with the date of the request; and

(2) Any significant business transaction between the provider and any wholly-owned supplier, or between the provider and any sub-contractor, during the five-year period ending on the date of the request.

008.02(A)PAYMENT FOR SERVICES. The Department shall not pay providers who fail to comply with a request for this information, or pay for services provided during the period beginning on the day following the date the information was due to the Department and ending on the day before the date the Department received the information.

008.03PERSONS CONVICTED OF CRIMES. Before the Department enters into or renews a service provider agreement, or upon request by the Department, the provider must disclose to the Department the identity of any person who:

(1) Has ownership or control interest in the provider, or is an agent or managing employee of the provider; and

(2) Has been convicted of a criminal offense related to that person's involvement in any program under Medicare, Medicaid, Title XXI Children's Health Insurance Program (CHIP), or the Social Services Block Grant (Title XX) programs.

008.03(A)ENROLLMENT TERMINATION. The Department may refuse to enter into or renew a service provider agreement if any person who has an 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 under Medicare, Medicaid, Title XXI Children's Health Insurance Program (CHIP), or the Social Services Block Grant (Title XX). The Department may deny or terminate enrollment if it determines that the provider did not fully and accurately disclose this information.

471 Neb. Admin. Code, ch. 2, § 008

Adopted effective 2/10/2020

Amended effective 9/21/2020