{"cite":"42 CFR 455.101","available":true,"heading":"§ 455.101 Definitions.","text":"Additional disclosable party means, with respect to a nursing facility defined in section 1919(a) of the Act, any person or entity who—\n(1) 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;\n(2) 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\n(3) Provides management or administrative services, management or clinical consulting services, or accounting or financial services to the facility.\nAffiliation means, for purposes of applying § 455.107, any of the following:\n(1) A 5 percent or greater direct or indirect ownership interest that an individual or entity has in another organization.\n(2) A general or limited partnership interest (regardless of the percentage) that an individual or entity has in another organization.\n(3) An interest in which an individual or entity exercises operational or managerial control over, or directly or indirectly conducts, the day-to-day operations of another organization (including, for purposes of this paragraph (3), sole proprietorships), either under contract or through some other arrangement, regardless of whether or not the managing individual or entity is a W-2 employee of the organization.\n(4) An interest in which an individual is acting as an officer or director of a corporation.\n(5) Any payment assignment relationship under § 447.10(g) of this chapter.\nAgent means any person who has been delegated the authority to obligate or act on behalf of a provider.\nDisclosable event means, for purposes of § 455.107, any of the following:\n(1) Currently has an uncollected debt to Medicare, Medicaid, or CHIP, regardless of—\n(i) The amount of the debt;\n(ii) Whether the debt is currently being repaid (for example, as part of a repayment plan); or\n(iii) Whether the debt is currently being appealed;\n(2) Has been or is subject to a payment suspension under a federal health care program (as that latter term is defined in section 1128B(f) of the Act), regardless of when the payment suspension occurred or was imposed;\n(3) Has been or is excluded by the OIG from participation in Medicare, Medicaid, or CHIP, regardless of whether the exclusion is currently being appealed or when the exclusion occurred or was imposed; or\n(4) Has had its Medicare, Medicaid, or CHIP enrollment denied, revoked or terminated, regardless of—\n(i) The reason for the denial, revocation, or termination;\n(ii) Whether the denial, revocation, or termination is currently being appealed; or\n(iii) When the denial, revocation, or termination occurred or was imposed.\nDisclosing entity means a Medicaid provider (other than an individual practitioner or group of practitioners), or a fiscal agent.\nOther disclosing entity means any other Medicaid disclosing entity and any entity that does not participate in Medicaid, 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 Act. This includes:\n(a) Any hospital, skilled nursing facility, home health agency, independent clinical laboratory, renal disease facility, rural health clinic, or health maintenance organization that participates in Medicare (title XVIII);\n(b) Any Medicare intermediary or carrier; and\n(c) Any entity (other than an individual practitioner or group of practitioners) that furnishes, or arranges for the furnishing of, health-related services for which it claims payment under any plan or program established under title V or title XX of the Act.\nFiscal agent means a contractor that processes or pays vendor claims on behalf of the Medicaid agency.\nGroup of practitioners means two or more health care practitioners who practice their profession at a common location (whether or not they share common facilities, common supporting staff, or common equipment).\nHealth insuring organization (HIO) has the meaning specified in § 438.2.\nIndirect ownership interest means 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.\nManaged care entity (MCE) means managed care organizations (MCOs), PIHPs, PAHPs, PCCMs, and HIOs.\nManaging employee means—\n(1) 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, either under contract or through some other arrangement, whether or not the individual is a W-2 employee of the institution, organization, or agency; or\n(2) With respect to the additional requirements at § 455.104(e) for a nursing facility defined in section 1919(a) of the Act, 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.\nOrganizational structure means, with respect to a nursing facility defined in section 1919(a) of the Act, in the case of any of the following:\n(1) 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.\n(2) 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.\n(3) A general partnership. The partners of the general partnership.\n(4) A limited partnership. The general partners and any limited partners of the limited partnership who have an ownership inter","truncated":true,"as_of":"2026-10-21","amendment_dates":["2017-01-01","2019-09-10","2019-11-04","2024-01-16"],"latest_amendment":"2024-01-16","sha256_of_xml":"14a03cea18eb821d41bdfdfdba6eec7982a452a1de147838777160892eae7a98","ecfr_url":"https://www.ecfr.gov/current/title-42/section-455.101","read_at":"2026-10-24T18:23:39.557705+00:00","note":"The eCFR is an editorial compilation maintained by the Office of the Federal Register and GPO; it is updated daily and is not the official legal edition (the annual Code of Federal Regulations is). Text printed here is as the eCFR served it on the read date."}