9407.1 Each disclosing entity, fiscal agent, and managed care entity shall disclose, at the time of application, the following information in accordance with 42 CFR § 455.104(a)-(e):

1. (a) The name and address of any individual or corporation with an ownership or control interest in the disclosing entity, fiscal agent, or managed care entity. The address for corporate entities shall include as applicable primary business address, every business location, and P.O. Box address;
2. (b) Date of birth and Social Security Number (SSN) of any individual with an ownership or control interest in the disclosing entity, fiscal agent, or managed care entity;
3. (c) Other tax identification number of any corporation with an ownership or control interest in the disclosing entity (or fiscal agent or managed care entity) or in any subcontractor in which the disclosing entity (or fiscal agent or managed care entity) has a five percent (5%) or more interest;
4. (d) Whether the individual or corporation with an ownership or control interest in the disclosing entity (or fiscal agent or managed care entity) is related to another individual with ownership or controlling interest in the disclosing entity (or fiscal agent or managed care entity) as a spouse, parent, child, or sibling; or whether the individual or corporation with an ownership or control interest in any subcontractor in which disclosing entity (or fiscal agent or managed care entity) has a five percent (5%) or more interest is related to another individual with ownership or control interest in the disclosing entity (or fiscal agent or managed care entity) as a spouse, parent, child, or sibling;
5. (e) The name of any other disclosing entity (or fiscal agent or managed care entity) in which an owner of the disclosing entity (or fiscal agent or managed care entity) has an ownership or control interest; and
6. (f) The name, address, date of birth, and SSN of any managing employee of the disclosing entity (or fiscal agent or managed care entity).

9407.2 In addition to the disclosures required in § 9407.1, each entity described in § 9407.1 shall disclose at the time of application whether any individual with an ownership or control interest in the entity is an employee of the District government or is related to an employee of the District government as a spouse,

parent, child, or sibling, and whether any individual employed by the provider is an employee of the District government.

9407.3 Disclosing entities shall also provide the disclosures and documentation required under §§ 9407.1 and 9407.2 at any of the following times:

(a) Upon submission of the application;

(b) Upon execution of the provider agreement;

(c) Upon request of DHCF during the revalidation of enrollment process; and

(d) Within thirty-five (35) calendar days following any change in ownership of the disclosing entity.

9407.4 Fiscal agents and managed care entities shall also provide the disclosures and documentation required under §§ 9407.1 and 9407.2 at any of the following times:

(a) Upon submission of a proposal in accordance with the District’s procurement process;

(b) Upon execution, renewal, or extension of a contract with the District; and

(c) Within thirty-five (35) calendar days following any change in ownership of the fiscal agent or managed care entity.

SOURCE: Final Rulemaking published at 60 DCR 10041 (July 12, 2013); as amended by Final Rulemaking published at 68 DCR 4255 (April 23, 2021).