California Code of Regulations › Title 17 - Public Health › Division 2 - Health and Welfare Agency-Department of Developmental Services Regulations › Chapter 3 - Community Services › Subchapter 2 - Vendorization › Article 2 - Vendorization Process › Section 54311 - Disclosure Requirements

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a)
					 The applicant or vendor shall disclose all the information required by Title
					 42, Code of Federal Regulations (CFR), Sections
					 455.104,
					 455.105 and
					 455.106, as of March 25, 2011, and
					 shall complete and submit to the regional center the Applicant/Vendor
					 Disclosure Statement, Form DS 1891 (7/2011), hereby incorporated by reference,
					 which shall include, but not be limited to all of the following:
(1) The name, address, title and percentage
					 of ownership or control interest of each person(s) with an ownership or control
					 interest, as defined in Section
					 54302(b)(5), in
					 the applicant or vendor or in any subcontractor in which the applicant or
					 vendor has direct or indirect ownership of 5 percent of more.
(2) Whether any of the persons named in
					 subsection (a)(1), above, is related to another as spouse, parent, child or
					 sibling.
(3) The name and address
					 of any other disclosing entity as defined in
					 42 CFR Section
					 455.101 with an ownership or control interest
					 in the applicant or vendor. This requirement applies to the extent that the
					 applicant or vendor can obtain this information by requesting it in writing
					 from the disclosing entity. The applicant or vendor shall:
(A) Keep copies of all disclosure information
					 submitted to the regional center at vendorization and upon request.
(B) Make the disclosure information available
					 to the regional center upon request.
(C) Advise the regional center when there is
					 no response to a request.
(4) The name and address of each person(s)
					 with an ownership or control interest in any subcontractor with whom the
					 applicant or vendor has had business transactions totaling more than $25,000
					 during the 12-month period either immediately preceding the date of the vendor
					 application or immediately preceding the date of the regional center request
					 for such information.
(5) Any
					 significant business transactions between the applicant or vendor and any
					 wholly owned supplier, or between the applicant or vendor and any
					 subcontractor, at the time of the application, or during the 5-year period
					 ending on the date of the written request by the regional center for such
					 information.
(6) The name, title
					 and address of any person(s) who, as applicant or vendor, or who has ownership
					 or control interest in the applicant or vendor, or is an agent, director,
					 member of the board of directors, officer, or managing employee of the
					 applicant or vendor, has within the previous ten years:
(A) Been convicted of any felony or
					 misdemeanor involving fraud or abuse in any government program, or related to
					 neglect or abuse of an elder or dependent adult or child, or in any connection
					 with the interference with, or obstruction of, any investigation into health
					 care related fraud or abuse; or
(B)
					 Been found liable in any civil proceeding for fraud or abuse involving any
					 government program; or
(C) Entered
					 into a settlement in lieu of conviction involving fraud or abuse in any
					 government program.