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Fingerprint-based Criminal Background Check (FCBC) must be completed when required to do so under state law or by the applicable level of screening.
Providers that meet the criteria for criminal background checks as a “High” risk to the State Medicaid Program include the following:
Individual “High” risk providers (PEPM102 Risk Levels)
Owners of “High” risk provider types
A person with a 5 percent or more direct or indirect ownership interest in a “High” risk provider
Executive Directors and Chief Executive Officers of “High” risk nonprofit organizations
All managing employees of municipalities
Providers that meet the criteria for criminal background checks as a high-risk to the State Medicaid Program include the following:
Individual high-risk providers (such as individual Non-Emergency Medical Transportation providers),
A person with a 5 percent or more direct or indirect ownership interest in a high-risk provider, and
All Directors, Executive Directors, Chief Executive Officers, and Presidents listed publicly on the Arizona Corporation Commission Entity Information page under the Principal Information Section.
Non-profit organizations may utilize the options below for further identifying individuals to be fingerprinted:
If an existing nonprofit organization uploads their most recent IRS Form 990 Return of Organization Exempt from Income Tax, and a list of the names of their Principal Officer, Executive Director, Chief Executive Officer, and/or President, only those individuals identified shall be required to undergo the FCBC process in lieu of any directors listed publicly on the ACC Entity Information page under the Principal Information Section.
If a newly established nonprofit organization uploads to APEP their IRS Determination Letter, only the individual addressed in the letter shall be required to go through the FCBC process, in lieu of all the directors listed on the ACC Information page under the Principal Information Section. AHCCCS has the discretion to request the completion of FCBC by any provider, employee of a provider, owner of a provider, contractor of provider, or any other individual named in this policy.
Providers must disclose to AHCCCS if any individual meets both conditions:
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.
Any set aside convictions must be disclosed. The provider must upload documentation to the AHCCCS Provider Enrollment Portal (APEP) for each conviction which contains the following:
The city, county, and state the conviction occurred in,
The crime the individual was convicted of,
The misdemeanor or felony class of the crime,
The date of conviction, and
The sentence.
AHCCCS will notify the Department of Health and Human Services’ (DHHS) Office of the Inspector General (OIG) within 20 working days of receiving the information.
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Office of the Inspector General (OIG) |
Department of Health and Human Services’ Office of the Inspector General |
If the provider or any owner has submitted fingerprints to AHCCCS within the past three years, new fingerprints are usually not needed. AHCCCS has the option to use the previous results or request a new fingerprint submission. If a new owner is added, fingerprints are required of those individuals.
The FCBC requirements must be followed. The provider must follow all timeframes mentioned in the FCBC notice. Fingerprints must be submitted to AHCCCS within 30 days of the request from AHCCCS.
42 CFR 455.434
42 CFR 455.106
42 CFR 455.416