Ohio Admin. Code 5160-1-17.3 - Provider disclosure requirements
(A)
Definitions:
(1)
"Disclosing provider" means a medicaid provider,
managed care entity, or fiscal agent under contract with the department of
medicaid (ODM).
(2)
"Managing employee" means 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.
(3)
"Agent" means
any person who has been delegated the authority to obligate or act on behalf of
a provider.
(4)
"Person with an ownership or control interest" means a
person or corporation that meets any of the following:
(a)
Has an ownership
interest totaling five per cent or more in the disclosing
provider;
(b)
Has an indirect ownership interest equal to five per
cent or more in the disclosing provider;
(c)
Has a
combination of direct and indirect ownership interest equal to five per cent or
more in the disclosing provider;
(d)
Owns an interest
of five per cent or more in any mortgage, deed of trust, note, or other
obligation secured by the disclosing entity if that interest equals at least
five per cent of the value of the property or assets of the disclosing
provider;
(e)
Is an officer or director of the disclosing provider
that is organized as a corporation or non-profit; or
(f)
Is a partner in
the disclosing provider that is organized as a partnership or limited liability
company.
(5)
"Significant business transaction" means any business
transaction or series of transactions that, during any one fiscal year, exceed
the lesser of twenty-five thousand dollars and five per cent of a provider's
total operating expenses.
(6)
"Indirect ownership interest" means an ownership
interest in an entity that has direct or indirect ownership in the disclosing
provider.
(B)
Disclosing providers shall disclose the following
information to the department:
(1)
The name and address of any person (individual or
corporation) with an ownership or control interest in the disclosing
provider.
(a)
In the case of an individual, date of birth and social security
number.
(b)
In the case of a corporation, other tax identification
number with an ownership or control interest in the disclosing provider or in
any subcontractor in which the disclosing provider has a five percent or more
interest.
(2)
Whether the person (individual or corporation) with an
ownership or control interest in the disclosing provider is related to another
person with ownership or control interest in the disclosing provider as a
spouse, parent, child, or sibling.
(3)
Whether the
person (individual or corporation) with an ownership or control interest in any
subcontractor in which the disclosing provider has a five percent or more
interest is related to another person with ownership or control interest in the
disclosing provider as a spouse, parent, child, or sibling.
(4)
The name of any
disclosing provider in which an owner of the disclosing provider has an
ownership or control interest.
(5)
The name,
address, date of birth, and social security number of any managing employee of
the disclosing provider.
(6)
The identity of any person who has ownership or
control interest in the provider, or is an agent or managing employee of the
provider and has been convicted of a criminal offense related to that person's
involvement in any program under medicare, medicaid, or the title XX services
program since the inception of those programs.
(7)
The ownership of
any subcontractor with whom the provider has had business transactions totaling
more than twenty-five thousand dollars during the twelve-month period ending on
the date the disclosure is due.
(8)
Any significant
business transaction between the provider and any wholly owned supplier, or
between the provider and any subcontractor, during the five-year period ending
on the date the disclosure is due.
(C)
Disclosures
shall be due at any of the following times:
(1)
Prior to
entering into a medicaid provider agreement or contract, during a procurement
process, or as part of a request for proposal.
(2)
Prior to
revalidating a medicaid provider agreement, or the renewal or extension of the
contract.
(3)
Within thirty-five days after any change in
ownership.
(4)
At any time within thirty-five days upon written
request from the department.
(D)
Failure by the
disclosing provider to disclose information in accordance with this rule may
result in the denial, suspension, or termination of the medicaid provider
agreement or contract.
Replaces: 5160-1- 17.3
Notes
Promulgated Under: 119.03
Statutory Authority: 5164.02
Rule Amplifies: 5164.02
Prior Effective Dates: 4/7/77, 12/30/77, 1/1/79, 3/23/79, 8/31/79, 11/1/79, 7/1/80, 7/7/80, 10/1/87, 5/30/02, 8/11/05, 05/23/2007
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