Background Checks and Screenings. 3.10.6.1 The MCO shall perform criminal history record checks on its owners, directors, and managing employees, as such terms are defined in 42 CFR Section 455.101 and clarified in applicable subregulatory guidance such as the Medicaid Provider Enrollment Compendium.
3.10.6.2 The MCO shall conduct monthly background checks on all directors, officers, employees, contractors or Subcontractors to ensure that it does not employ or contract with any individual or entity:
3.10.6.2.1 Convicted of crimes described in Section 1128(b)(8)(B) of the Social Security Act;
3.10.6.2.2 Debarred, suspended, or excluded from participating in procurement activities under the FAR or from participating in non-procurement activities under regulation issued under Executive Order No. 12549 or under guidelines implementing Executive Order No. 12549; and/or
3.10.6.2.3 Is excluded from participation in any federal health care program under Section 1128 or 1128A of the Social Security Act. [[42 CFR 438.808(a); 42 CFR 438.808(b)(1); 42 CFR 431.55(h); section 1903(i)(2) of the Social Security Act; 42 CFR 1001.1901(c); 42 CFR 1002.3(b)(3); SMDL 6/12/08; SMDL 1/16/09; SMDL #09-001; 76 Fed. Reg. 5862, 5897 (February 2, 2011)]
3.10.6.3 In addition, the MCO shall conduct screenings of its directors, officers, employees, contractors and Subcontractors to ensure that none of them appear on:
3.10.6.3.1 HHS-OIG’s List of Excluded Individuals/Entities;
3.10.6.3.2 The System of Award Management;
3.10.6.3.3 The Social Security Administration Death Master File;
3.10.6.3.4 The list maintained by the Office of Foreign Assets Control; and/or
3.10.6.3.5 To the extent applicable, NPPES (collectively, these lists are referred to as the “Exclusion Lists”).
3.10.6.4 The MCO shall conduct screenings of all of its directors, officers, employees, contractors and Subcontractors monthly to ensure that none of the foregoing appear on any of the Exclusion Lists and that it continues to comply with Section 3.10.3 (Ownership and Control Disclosures) above. [SMDL #09-001; 76 Fed. Reg. 5862, 5897 (February 2, 2011)]
3.10.6.5 The MCO shall certify to DHHS annually that it performs monthly screenings against the Exclusion Lists and that it does not have any director or officer or employ or contract, directly or indirectly, with:
3.10.6.5.1 Any individual or entity excluded from participation in the federal health care program;
3.10.6.5.2 Any entity for the provision of such health care, utilization review, medical socia...
