§ 434.80 - Condition for FFP in contracts with HMOs.

Link to an amendment published at 66 FR 6404, Jan. 19, 2001. This amendment was delayed until June 18, 2001, at 66 FR 11546, Feb. 26, 2001. This amendment was delayed until Aug. 17, 2001 at 66 FR 32776, June 18, 2001. This amendment was delayed until Aug. 16, 2002 at 66 FR 43090, Aug. 17, 2001.

(a) Basic rule. FFP in payments to an HMO is available only if the agency excludes from participation as such an entity any entity described in paragraph (b) of this section.

(b) Entities that must be excluded. (1) An entity that could be excluded under section 1128(b)(8) of the Act as being controlled by a sanctioned individual.

(2) An entity that has a substantial contractual relationship as defined in § 431.55(h)(2), either directly or indirectly, with an individual convicted of certain crimes as described in section 1128(b)(8)(B) of the Act.

(3) An entity that employs or contracts, directly or indirectly, with one of the following:

(i) Any individual or entity excluded from Medicaid participation under section 1128 or section 1128A of the Act for the furnishing of health care, utilization review, medical social work, or administrative services.

(ii) Any entity for the provision through an excluded individual or entity of services described in paragraph (b)(3)(i) of this section.

Effective Date Note:

At 66 FR 6404, Jan. 19, 2001, § 434.80 was removed, effective April 19, 2001. At 66 FR 11546, Feb. 26, 2001 the effective date was delayed until June 18, 2001, at 66 FR 32776, June 18, 2001 it was furthered delayed until Aug. 17, 2001, and at 66 FR 43090, Aug. 17, 2001 it was furthered delayed until Aug. 16, 2002.