103 Disclosure of Ownership and Control Interests

Disclosures from…

Are due at any of the following times…

Providers

Disclosing entities

• When submitting the provider application.

• When executing the provider application.

• Upon request of AHCCCS.

• Within the timeframe for reporting changes as defined in the AHCCCS Medical Policy Manual Chapter 610

Managed care entities

• When submitting the proposal in accordance with AHCCCS’ procurement process.

• When executing the contract with AHCCCS.

• Upon renewal or extension of the contract.

• Within the timeframe for reporting changes as defined in the AHCCCS Medical Policy Manual Chapter 610

Term

Definition

Agent

Any person who has been given the authority to act on behalf of a provider.
 

Board of Directors

Chief Executive Officer

Chief Financial Officer

Chief Information Officer

Chief Operating Officer

Considered individuals with a controlling or ownership interest if the entity is a corporation.

Corporate – Charitable 501(c)(3)

Non-profit entities, that are organized as corporations. If a non-profit corporation has “trustees” instead of officers or directors, these trustees must be disclosed.

Corporate – Non Charitable

A legal entity that's separate from its owners. The corporation can make a profit, be taxed, and can be held legally liable. Does not have 501(c)(3) filing status with the IRS.

Corporate – Not Publicly Traded

Same as Corporate – Non Charitable, but shareholders may own a percentage of the corporation, but it is not traded on the stock exchange.

Corporate – Publicly Traded

Same as Corporate – Non Charitable, but shareholders may own a percentage of the corporation, and it is traded on the stock exchange.

Disclosing entity

A Medicaid provider or a fiscal agent. 

Other disclosing entity

Any other Medicaid disclosing entity and any entity that does not participate in Medicaid but is required to disclose certain ownership and control information because of participation in any of the programs established under title V, XVIII, or XX of the Act. This includes: 

• Any hospital, skilled nursing facility, home health agency, independent clinical laboratory, renal disease facility, rural health clinic, or health maintenance organization that participates in Medicare (title XVIII); 

• Any Medicare intermediary or carrier; and 

• Any entity that furnishes, or arranges for the furnishing of, health-related services for which it claims payment under any plan or program established under title V or title XX of the Act.

Foreign, Nonresident Alien

A corporation or LLC that was formed or created in a state or country other than Arizona. Entities created under federal or Indian tribal law are also considered foreign entities.

Government – City

A city owned entity.

Government – County

A county owned entity.

Government – Federal

A federally owned entity.

Government – State

A state owned entity.

Holding Company

A parent company, usually a corporation or LLC, whose purpose is to buy and control the ownership interests of other companies.

Indirect ownership interest

An ownership interest in an entity that has an ownership interest in the disclosing entity. This term includes an ownership interest in any entity that has an indirect ownership interest in the disclosing entity.

Individual/Sole Proprietor

Any individual furnishing Medicaid services under an agreement with the Medicaid agency.

Limited Liability Company

A company owned by its members. Managers can also be members, but are not required to be. Owners are protected from personal liability for the company’s debts and liabilities.

Managed care entity (MCE)

Managed Care Organizations (MCOs), Prepaid inpatient health plans (PIHPs), Prepaid ambulatory health plans (PAHPs), Primary care case managers (PCCMs), and Health Insuring Organizations (HIOs).

Managing employee

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.

Ownership interest

The possession of equity in the capital, stock, or profits of the disclosing entity.

Partnership

Limited partnerships have only one general partner with unlimited liability, and all other partners have limited liability. The partners with limited liability also tend to have limited control over the company, which is documented in a partnership agreement. Profits are passed through to personal tax returns, and the general partner — the partner without limited liability — must also pay self-employment taxes.

Person with an ownership or control interest

A person that:

• Has a direct, indirect, or combination of direct and indirect ownership interest totaling 5 percent or more in a disclosing entity;

• Owns an interest of 5 percent or more in any mortgage, deed of trust, note, or other obligation secured by the disclosing entity if that interest equals at least 5 percent of the value of the property or assets of the disclosing entity;

• Is an officer or director of a disclosing entity that is organized as a corporation; or

• Is a partner in a disclosing entity that is organized as a partnership.

Subcontractor

An individual, agency, or organization in which a disclosing entity has contracted or delegated some of its management functions or responsibilities of providing medical care to its patients.

OR

An individual, agency, or organization with which a fiscal agent has entered into a contract, agreement, purchase order, or lease (or leases of real property) to obtain space, supplies, equipment, or services provided under the Medicaid agreement.

Termination

Action taken by AHCCCS to revoke the provider’s billing privileges, and the provider has exhausted all applicable appeal rights or the timeline for appeal has expired.