OWNERSHIP AND CONTROL INTEREST. In accordance with Federal regulations contained in 42 CFR §§ 455.100 through 455.106, 42 CFR § 438.604(a)(6), 42 CFR § 438.608(c)(2) and 42 CFR § 438.610 the Contractor shall disclose all of the following for the Contractor’s owner(s) and managing employee(s), including, but not limited to: • Information on ownership and control (42 CFR § 455.104); • Name, address, date of birth, and Social Security Number of any managing employee; • Information on whether a person or corporation with an ownership or control of five percent (5%) or more interest is related to another person with ownership or control interest in the health plan as a spouse, parent, child or sibling (42 CFR § 438.604(a)(6); 42 CFR § 455.104(b)(2); 42 CFR § 438.608(c)(2)). • Information related to business transactions (42 CFR § 455.105); and, • Information on persons convicted of crimes against Federally related health care programs (42 CFR § 455.106). • The contractor must submit the tax identification number of any corporation with an ownership or control interest in the MCO and any subcontractor in which the MCO has a 5% or more interest. • Information of any other disclosing entity in which an owner of the Contractor has an ownership or control interest. The Contractor shall provide the required information using the Disclosure of Ownership and Control Interest Statement (CMS 1513), included as part of the Contractor Specific Contract Terms and Signature Pages, annually at the time of Contract signing. All disclosures must also be made in the timeframe and manner specified in accordance with 42 CFR§455.104. Additionally, the Contractor shall submit this completed form upon request to the Department within thirty- five (35) calendar days of the Department’s request. The Department will review the ownership and control disclosures submitted by the Contractor and any of the Contractor’s subcontractors in accordance with 42 CFR §§ 438.602(c) and 438.608(c). Failure to disclose the required information accurately, timely, and in accordance with Federal and Contract standards may result in refusal to execute this Contract, sanction as described in Section 10 of this Contract, and/or termination of this Contract by the Department. The Contractor shall maintain such disclosed information in a manner which can be periodically reviewed by the Department. In addition, the Contractor shall comply with all reporting and disclosure requirements of 42 USC § 1396b(m)(4)(A), 42 CFR § 438.610 and 42 CFR ...
OWNERSHIP AND CONTROL INTEREST. A. Please list the information required by subsections 7.37.A.1 and 2 of the contract:
