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Requires states to exclude from Medicaid participation any individual or entity if such individual or entity owns, controls, or manages an entity that: has unpaid overpayments; is suspended, excluded, or terminated from participation; or is affiliated with an individual or entity that has been suspended, excluded, or terminated from participation.
Prior to January 2013, the Medicare and Medicaid Extenders Act of 2010 (MMEA), P.L. 111-309, repealed new section 1902(a)(78) of the Act, as originally added by section 6502 of the ACA. See the September 23, 2011 CMS transmittal that addressed the repeal of such provision. A history of the brief life of this provision is available here.
SEC. 6502. MEDICAID EXCLUSION FROM PARTICIPATION RELATING TO CERTAIN OWNERSHIP, CONTROL, AND MANAGEMENT AFFILIATIONS. Section 1902(a) of the Social Security Act (42 U.S.C. 1396a(a)), as amended by section 6401(b), is amended by inserting after paragraph (77) the following: ‘‘(78) provide that the State agency described in paragraph (9) exclude, with respect to a period, any individual or entity from participation in the program under the State plan if such individual or entity owns, controls, or manages an entity that (or if such entity is owned, controlled, or managed by an individual or entity that)— ‘‘(A) has unpaid overpayments (as defined by the Secretary) under this title during such period determined by the Secretary or the State agency to be delinquent; ‘‘(B) is suspended or excluded from participation under or whose participation is terminated under this title during such period; or ‘‘(C) is affiliated with an individual or entity that has been suspended or excluded from participation under this title or whose participation is terminated under this title during such period;’’.
(202) 309-0796
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