Code of Massachusetts Regulations › 130 CMR - DIVISION OF MEDICAL ASSISTANCE › Title 130 CMR 450.000 - Administrative and Billing Regulations › Section 450.221 - Provider Contract: Definitions

Current through Register 1525, July 5, 2024
(A)
Defined Terms
. For the purposes of
			 130 CMR
			 450.222 through 450.228, the following words
			 and expressions have the indicated definitions. These definitions as they are
			 applied in
			 130 CMR
			 450.222 through 450.228 are adopted pursuant
			 to the provisions of 42 U.S.C. §§ 1320a-3, 1320a-5, 1396a(a)(38),
			 1396b(i)(2), and regulations at
			 42 CFR
			 455.100
etseq.
Agent
- any person who has been
				delegated the authority to obligate or act on behalf of a provider.
Convicted
- a judgment of conviction
				has been entered by a federal, state, or local court, regardless of whether an
				appeal from that judgment is pending.
Disclosing Entity
- a provider or
				fiscal agent.
Other Disclosing Entity
- any other
				disclosing entity and any entity that does not participate in MassHealth, 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 Social Security Act. This includes
(1) any hospital, nursing facility, home
			 health agency, independent clinical laboratory, renal disease facility, rural
			 health clinic, or managed care organization that participates in
			 Medicare;
(2) any Medicare
			 intermediary or carrier; and
(3)
			 any entity (other than an individual practitioner or group practice that
			 provides, or arranges for the provision of, health-related services for which
			 it claims payment under any plan or program established under Title V or XX of
			 the Social Security Act).
Fiscal Agent
- a contractor that
				processes or pays for provider claims on behalf of the MassHealth
				agency.
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.
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, the stock, or the profits of the disclosing
				entity.
Person with an Ownership or Control
				Interest
.
(1) a person or
			 corporation that
(a) has an ownership interest
			 totaling 5% or more in a disclosing entity;
(b) has an indirect ownership interest equal
			 to 5% or more in a disclosing entity;
(c) has a combination of direct and indirect
			 ownership interests equal to 5% or more in a disclosing entity;
(d) owns an interest of 5% or more in any
			 mortgage, deed of trust, note, or other obligation secured by the disclosing
			 entity if that interest equals at least 5% of the value of the property or
			 assets of the disclosing entity;
(e) is an officer or director of a disclosing
			 entity that is organized as a corporation;
(f) is a partner in a disclosing entity that
			 is organized as a partnership; or
(g) owns directly or indirectly an interest
			 of 5% or more in any real property leased to a disclosing entity for use as a
			 nursing facility, rest home, or hospital.
(2) For the purpose of 130 CMR 450.221:
Person with an Ownership or Control Interest
, an
			 individual is deemed to own any beneficial interest owned directly or
			 indirectly by or for his or her minor children or spouse.
Significant Business Transaction
-any
				business transaction or series of transactions that, during any one fiscal
				year, exceed the lesser of $25,000 or 5% of a provider's total operating
				expenses.
Secretary
- the Secretary of the U.S.
				Department of Health and Human Services.
Subcontractor
.
(1) an individual, agency, or organization to
			 which a disclosing entity has contracted or delegated some of its management
			 functions or responsibilities of providing medical care to its patients;
			 or
(2) 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 MassHealth agreement.
Supplier
- an individual, agency, or
				organization from which a provider purchases goods and services used in
				carrying out its responsibilities under MassHealth (for example, a commercial
				laundry, a manufacturer of hospital beds, or a pharmaceutical firm).
Wholly Owned Supplier
- a supplier
				whose total ownership interest is held by a provider or by a person, persons,
				or other entity with an ownership or control interest in a provider.