Prohibited Affiliations with Individuals Debarred by Federal Agencies. The MCO may not have a director, officer, principal, partner, agent, managing employee, or other person with ownership or control interest of five percent or more in the MCO and who: Has been convicted of a criminal offense as described in sections 1128(a) and 1128(b) (1), (2), or (3), of the Social Security Act; Has had civil money penalties or assessments imposed under section 1128A of the Social Security Act; or Has been excluded, suspended, or debarred from participation in Medicare or any state health care programs. The MCO must submit information as described above, for any person who was formerly described as a director, officer, principal, partner, agent, managing employee, or other person with ownership or control interest of five percent or more in the MCO, but is no longer so described because of a transfer of ownership or control interest to an immediate family member or a member of the person’s household, in anticipation of or following a conviction, assessment of a civil monetary penalty, or imposition of an exclusion. The MCO is prohibited from having a consulting or any other agreement with an excluded, debarred or suspended person for the provision of items or services that are significant and material to the MCO’s contractual obligation with the State. The MCO must immediately inform BMS of any circumstances that are grounds for its exclusion, or the exclusion of its contracted providers, from participation in the Medicaid program, in accordance with 42 CFR 1001.1001 and 42 CFR 1001.1051. At the time of contract and contract renewal or upon written request by BMS, the MCO must submit information on any person who is a director, officer, principal, partner, agent, managing employee, or other person with ownership or control interest of five percent or more in the MCO and who 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, as required in 42 CFR 455.106. If BMS finds that the MCO is not in compliance with this provision, BMS: (1) will notify the Secretary of the Department of Health and Human Services of such noncompliance; (2) may discontinue the existing agreement with the MCO if so directed by the Secretary (in consultation with the Inspector General of the Department of Health and Human Services); and
Prohibited Affiliations with Individuals Debarred by Federal Agencies. The MCO may not have a director, officer, principal, partner, agent, managing employee, or other person with ownership or control interest of five percent (5%) or more in the MCO and who: • Has been convicted of a criminal offense as described in sections 1128(a) and 1128(b) (1), (2), or (3), of the Social Security Act; • Has had civil money penalties or assessments imposed under section 1128A of the Social Security Act; or • Has been excluded, suspended, or debarred from participation in Medicare or any state health care programs. The MCO must submit information as described above, for any person who was formerly described as a director, officer, principal, partner, agent, managing employee, or other person with ownership or control interest of five percent (5%) or more in the MCO, but is no longer so described because of a transfer of ownership or control interest to an immediate family member or a member of the person’s household, in anticipation of or following a conviction, assessment of a civil monetary penalty, or imposition of an exclusion. The MCO is prohibited from having a consulting, employment, or other agreement with an excluded, debarred or suspended person for the provision of items or services that are significant and material to the MCO’s contractual obligation with the State. Likewise, the MCO may not have a relationship with an affiliate of any person described above. Entities that meet any of the following criteria must be excluded from participation:
Prohibited Affiliations with Individuals Debarred by Federal Agencies. In accordance with 42 CFR 438.610, the MCO cannot knowingly have a relationship with any of the following:
Prohibited Affiliations with Individuals Debarred by Federal Agencies. 13.4.1 The Contractor shall not knowingly have a relationship with the following:
Prohibited Affiliations with Individuals Debarred by Federal Agencies. General Requirement As per 42 CFR §438.610(a) and (b), a CCN may not knowingly have a relationship with the following:
Prohibited Affiliations with Individuals Debarred by Federal Agencies. It is expressly agreed that Contractor or any subcontractor involved in the performance of this Agreement shall act in an independent capacity and not as an agent, officer, employee, partner, or associate of the State of Rhode Island. Contractor staff will not hold themselves out as nor claim to be officers or employees of the State of Rhode Island by reason hereto. It is further expressly agreed that this Agreement shall not be construed as a partnership or joint venture between Contractor or any subcontractor and the State.
Prohibited Affiliations with Individuals Debarred by Federal Agencies
