§1320a–3 — Title 42 The Public Health and Welfare | U.S. Code

Summary

Health care organizations that take part in or have contracts under the programs in subchapters V, XVIII, and XIX must give the government who owns or controls them and related information under rules the Secretary makes. Covered organizations include providers (not funds), independent labs, renal disease facilities, managed care organizations, HMOs, entities that arrange services (not individual doctors), and carriers or agents that act as payment intermediaries. A person has an ownership or control interest if they own 5% or more directly or indirectly, hold a mortgage or similar interest equal to 5% or more of the entity’s property, or are an officer/director of a corporation or a partner in a partnership. Nursing and skilled nursing facilities must keep and report extra details about ownership, governing board members, officers, managing employees, other parties that control or serve the facility, and how those parties are organized and related. They had to have those records available starting March 23, 2010, and must report in a standardized format once final rules take effect. The Secretary must issue final rules no later than two years after March 23, 2010, and those rules take effect 90 days after publication. Facilities may use IRS Form 990 or SEC filings if they contain the required details. The Secretary will help States adopt the format, facilities must certify their reports are accurate to get paid, and existing reporting rules stay in place. Definitions in the law include brief labels for additional disclosable party, facility (skilled nursing or nursing), managing employee, and organizational structure.

Title 42, §1320a–3

The Public Health and Welfare — Source: USLM XML via OLRC

(a)(1)The Secretary shall by regulation or by contract provision provide that each disclosing entity (as defined in paragraph (2)) shall—

(A)as a condition of the disclosing entity’s participation in, or certification or recertification under, any of the programs established by subchapters V, XVIII, and XIX, or

(B)as a condition for the approval or renewal of a contract or agreement between the disclosing entity and the Secretary or the appropriate State agency under any of the programs established under subchapters V, XVIII, and XIX,

(2)As used in this section, the term “disclosing entity” means an entity which is—

(A)a provider of services (as defined in section 1395x(u) of this title, other than a fund), an independent clinical laboratory, a renal disease facility, a managed care entity, as defined in section 1396u–2(a)(1)(B) of this title, or a health maintenance organization (as defined in section 300e(a) of this title);

(B)an entity (other than an individual practitioner or group of practitioners) that furnishes, or arranges for the furnishing of, items or services with respect to which payment may be claimed by the entity under any plan or program established pursuant to subchapter V or under a State plan approved under subchapter XIX; or

(C)a carrier or other agency or organization that is acting as a fiscal intermediary or agent with respect to one or more providers of services (for purposes of part A or part B of subchapter XVIII, or both, or for purposes of a State plan approved under subchapter XIX) pursuant to (i) an agreement under section 1395h of this title, (ii) a contract under section 1395u of this title, or (iii) an agreement with a single State agency administering or supervising the administration of a State plan approved under subchapter XIX.

(3)As used in this section, the term “person with an ownership or control interest” means, with respect to an entity, a person who—

(A)(i)has directly or indirectly (as determined by the Secretary in regulations) an ownership interest of 5 per centum or more in the entity; or

(ii)is the owner of a whole or part interest in any mortgage, deed of trust, note, or other obligation secured (in whole or in part) by the entity or any of the property or assets thereof, which whole or part interest is equal to or exceeds 5 per centum of the total property and assets of the entity; or

(B)is an officer or director of the entity, if the entity is organized as a corporation; or

(C)is a partner in the entity, if the entity is organized as a partnership.

(b)To the extent determined to be feasible under regulations of the Secretary, a disclosing entity shall also include in the information supplied under subsection (a)(1), with respect to each person with an ownership or control interest in the entity, the name of any other disclosing entity with respect to which the person is a person with an ownership or control interest.

(c)(1)A facility shall have the information described in paragraph (2) available—

(A)during the period beginning on March 23, 2010, and ending on the date such information is made available to the public under section 6101(b) of the Patient Protection and Affordable Care Act for submission to the Secretary, the Inspector General of the Department of Health and Human Services, the State in which the facility is located, and the State long-term care ombudsman in the case where the Secretary, the Inspector General, the State, or the State long-term care ombudsman requests such information; and

(B)beginning on the effective date of the final regulations promulgated under paragraph (3)(A), for reporting such information in accordance with such final regulations.

(2)(A)The following information is described in this paragraph:

(i)The information described in subsections (a) and (b), subject to subparagraph (C).

(ii)The identity of and information on—

(I)each member of the governing body of the facility, including the name, title, and period of service of each such member;

(II)each person or entity who is an officer, director, member, partner, trustee, or managing employee of the facility, including the name, title, and period of service of each such person or entity; and

(III)each person or entity who is an additional disclosable party of the facility.

(iii)The organizational structure of each additional disclosable party of the facility and a description of the relationship of each such additional disclosable party to the facility and to one another.

(B)To the extent that information reported by a facility to the Internal Revenue Service on Form 990, information submitted by a facility to the Securities and Exchange Commission, or information otherwise submitted to the Secretary or any other Federal agency contains the information described in clauses (i), (ii), or (iii) of subparagraph (A), the facility may provide such Form or such information submitted to meet the requirements of paragraph (1).

(C)In applying subparagraph (A)(i)—

(i)with respect to subsections (a) and (b), “ownership or control interest” shall include direct or indirect interests, including such interests in intermediate entities; and

(ii)subsection (a)(3)(A)(ii) shall include the owner of a whole or part interest in any mortgage, deed of trust, note, or other obligation secured, in whole or in part, by the entity or any of the property or assets thereof, if the interest is equal to or exceeds 5 percent of the total property or assets of the entirety.

(3)(A)Not later than the date that is 2 years after March 23, 2010, the Secretary shall promulgate final regulations requiring, effective on the date that is 90 days after the date on which such final regulations are published in the Federal Register, a facility to report the information described in paragraph (2) to the Secretary in a standardized format, and such other regulations as are necessary to carry out this subsection. Such final regulations shall ensure that the facility certifies, as a condition of participation and payment under the program under subchapter XVIII or XIX, that the information reported by the facility in accordance with such final regulations is, to the best of the facility’s knowledge, accurate and current.

(B)The Secretary shall provide guidance and technical assistance to States on how to adopt the standardized format under subparagraph (A).

(4)Nothing in this subsection shall reduce, diminish, or alter any reporting requirement for a facility that is in effect as of March 23, 2010.

(5)In this subsection:

(A)The term “additional disclosable party” means, with respect to a facility, any person or entity who—

(i)exercises operational, financial, or managerial control over the facility or a part thereof, or provides policies or procedures for any of the operations of the facility, or provides financial or cash management services to the facility;

(ii)leases or subleases real property to the facility, or owns a whole or part interest equal to or exceeding 5 percent of the total value of such real property; or

(iii)provides management or administrative services, management or clinical consulting services, or accounting or financial services to the facility.

(B)The term “facility” means a disclosing entity which is—

(i)a skilled nursing facility (as defined in section 1395i–3(a) of this title); or

(ii)a nursing facility (as defined in section 1396r(a) of this title).

(C)The term “managing employee” means, with respect to a facility, an individual (including a general manager, business manager, administrator, director, or consultant) who directly or indirectly manages, advises, or supervises any element of the practices, finances, or operations of the facility.

(D)The term “organizational structure” means, in the case of—

(i)a corporation, the officers, directors, and shareholders of the corporation who have an ownership interest in the corporation which is equal to or exceeds 5 percent;

(ii)a limited liability company, the members and managers of the limited liability company (including, as applicable, what percentage each member and manager has of the ownership interest in the limited liability company);

(iii)a general partnership, the partners of the general partnership;

(iv)a limited partnership, the general partners and any limited partners of the limited partnership who have an ownership interest in the limited partnership which is equal to or exceeds 10 percent;

(v)a trust, the trustees of the trust;

(vi)an individual, contact information for the individual; and

(vii)any other person or entity, such information as the Secretary determines appropriate.

Notes & Related Subsidiaries

Editorial Notes

References in Text

The Internal Revenue Code of 1986, referred to in subsec. (a)(1), is classified generally to Title 26, Internal Revenue Code. section 6101(b) of the Patient Protection and Affordable Care Act, referred to in subsec. (c)(1)(A), is section 6101(b) of Pub. L. 111–148, which is set out as a note below.

Amendments

2010—Subsec. (c). Pub. L. 111–148 added subsec. (c). 1997—Subsec. (a)(1). Pub. L. 105–33, § 4313(a), inserted before period at end of concluding provisions “and supply the Secretary with the both the employer identification number (assigned pursuant to section 6109 of the Internal Revenue Code of 1986) and social security account number (assigned under section 405(c)(2)(B) of this title) of the disclosing entity, each person with an ownership or control interest (as defined in subsection (a)(3)), and any subcontractor in which the entity directly or indirectly has a 5 percent or more ownership interest.” The insertion was made to reflect the probable intent of Congress, in the absence of closing quotations designating the provisions to be inserted. Subsec. (a)(2)(A). Pub. L. 105–33, § 4707(c), inserted “a managed care entity, as defined in section 1396u–2(a)(1)(B) of this title,” after “renal disease facility,”. 1987—Subsec. (a)(3)(A)(ii). Pub. L. 100–93 struck out “$25,000 or” after “exceeds”. 1981—Subsec. (a)(1). Pub. L. 97–35, § 2353(i)(1), substituted in subpars. (A) and (B) “and XIX” for “XIX, and XX”. Subsec. (a)(2)(D). Pub. L. 97–35, § 2353(i)(2)(C), struck out subpar. (D) which included within term “disclosing entity” an entity, other than an individual practitioner or group of practitioners, that furnishes, or arranges for the furnishing of, health related services with respect to which payment may be claimed by the entity under a State plan or program approved under subchapter XX of this chapter. 1980—Subsec. (a)(3)(A)(ii). Pub. L. 96–499 substituted “of a whole or part interest” for “(in whole or in part) of an interest of 5 per centum or more” and inserted “, which whole or part interest is equal to or exceeds $25,000 or 5 per centum of the total property and assets of the entity”.

Statutory Notes and Related Subsidiaries

Effective Date

of 1997 Amendment Pub. L. 105–33, title IV, § 4313(e), Aug. 5, 1997, 111 Stat. 389, provided that: “(1) Disclosure requirements.—The amendment made by subsection (a) [amending this section] shall apply to the application of conditions of participation, and entering into and renewal of contracts and agreements, occurring more than 90 days after the date of submission of the report under subsection (d) [set out as a note below]. “(2) Other providers.—The

Amendments

made by subsection (b) [amending section 1320a–3a of this title] shall apply to payment for items and services furnished more than 90 days after the date of submission of such report.” Amendment by section 4707(c) of Pub. L. 105–33 effective Aug. 5, 1997, and applicable to contracts entered into or renewed on or after Oct. 1, 1997, see section 4710 of Pub. L. 105–33, set out as a note under section 1396b of this title.

Effective Date

of 1987 AmendmentAmendment by Pub. L. 100–93 effective at end of fourteen-day period beginning Aug. 18, 1987, and inapplicable to administrative proceedings commenced before end of such period, see section 15(a) of Pub. L. 100–93, set out as a note under section 1320a–7 of this title.

Effective Date

of 1981 AmendmentAmendment by Pub. L. 97–35 effective Oct. 1, 1981, except as otherwise explicitly provided, see section 2354 of Pub. L. 97–35, set out as an

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note under section 1397 of this title.

Effective Date

Pub. L. 95–142, § 3(e), Oct. 25, 1977, 91 Stat. 1179, provided that: “The amendment made by subsection (a)(1) [enacting this section] shall apply with respect to certifications and recertifications made (and participation in the programs established by titles V, XVIII, XIX, and XX of the Social Security Act [42 U.S.C. 701 et seq., 1395 et seq., 1396 et seq., 1397 et seq.] pursuant to certifications and recertifications made), and fiscal intermediary or agent agreements or contracts entered into or renewed, on and after the date of the enactment of this Act [Oct. 25, 1977]. The remaining

Amendments

made by this section [amending section 1395x and 1395cc of this title] shall take effect on the date of the enactment of this Act [Oct. 25, 1977]; except that the

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made by subsections (c) and (d) [amending section 1396a, 1396b, 1397a, and 1397b of this title] shall become effective January 1, 1978.” Public Availability of Information Pub. L. 111–148, title VI, § 6101(b), Mar. 23, 2010, 124 Stat. 702, provided that: “Not later than the date that is 1 year after the date on which the final

Regulations

promulgated under section 1124(c)(3)(A) of the Social Security Act [42 U.S.C. 1320a–3(c)(3)(A)], as added by subsection (a), are published in the Federal Register, the Secretary of Health and Human Services shall make the information reported in accordance with such final

Regulations

available to the public in accordance with procedures established by the Secretary.” Report on Confidentiality of Social Security Account Numbers Pub. L. 105–33, title IV, § 4313(d), Aug. 5, 1997, 111 Stat. 389, provided that: “Before the

Amendments

made by this section [amending this section and section 1320a–3a of this title] may become effective, the Secretary of Health and Human Services shall submit to Congress a report on steps the Secretary has taken to assure the confidentiality of social security account numbers that will be provided to the Secretary under such

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.”

§1320a–3 Disclosure of ownership and related information; procedure; definitions; scope of requirements

Summary

Title 42, §1320a–3

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