Cal. Code Regs. Tit. 17, § 54311 - Disclosure Requirements

(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.

(b) Each applicant or vendor shall submit a new signed and dated DS 1891 (7/2011) to the regional center within 30 days of any change in the information previously submitted pursuant to this section or upon a written request by the regional center for such information.

(c) All current vendors shall submit a signed and dated DS 1891 (7/2011) to the vendoring regional center within 120 days of the effective date of these regulations for review by regional center by June 30, 2012.

(d) In addition to (c) above, the vendor shall supply the information in subsection (a) above upon written request to the vendoring regional center, Department of Developmental Services, the State Medicaid Agency, Department of Health Care Services, any State survey team, the Secretary of the United States Department of Health and Human Services, or any duly authorized representatives of the above-named entities.

Notes

Cal. Code Regs. Tit. 17, § 54311

1. New section filed 12-27-2011 as a deemed emergency pursuant to Welfare and Institutions Code section 4648.12; operative 12-27-2011 (Register 2011, No. 52). A Certificate of Compliance must be transmitted to OAL within 18 months or emergency language will be repealed by operation of law on the following day.
2. Certificate of Compliance as to 12-27-2011 order, including nonsubstantive amendment of subsection (a)(6)(B), transmitted to OAL 2-15-2013 and filed 4-2-2013 (Register 2013, No. 14).

Note: Authority cited: Sections 4648.12(c)(1)(A) and 14043.75, Welfare and Institutions Code; and Section 11152, Government Code. Reference: Sections 4648.12 and 12305.81(a)(2), Welfare and Institutions Code; and Title 42, Code of Federal Regulations, Sections 455.104, 455.105 and 455.106.

1. New section filed 12-27-2011 as a deemed emergency pursuant to Welfare and Institutions Code section 4648.12; operative 12-27-2011 (Register 2011, No. 52). A Certificate of Compliance must be transmitted to OAL within 18 months or emergency language will be repealed by operation of law on the following day.
2. Certificate of Compliance as to 12-27-2011 order, including nonsubstantive amendment of subsection (a)(6)(B), transmitted to OAL 2-15-2013 and filed 4-2-2013 (Register 2013, No. 14).