37.40.325 CHANGE IN PROVIDER DEFINED
(1) Except as provided in (2) , a change in provider will be deemed to have occurred if the events described in any one of the following (1) (a) through (d) occurs:
(a) For sole proprietorship providers, a change in provider occurs where the entire sole proprietorship is sold to an unrelated party and a selling proprietor does not retain a right of control over the business.
(b) For partnership providers, a change in provider occurs where:
(i) a new partner acquires an interest in the partnership greater than 50%;
(ii) the new partner is not a related party to either a current partner or a former partner from whom the new partner acquired all or any portion of the new partner's interest; and
(iii) the current or former partners from whom the new partner acquires an interest do not retain a right of control over the partnership arising from the transferred interest.
(c) For corporation providers, a change in provider occurs where stock and the associated stockholder rights representing an interest of more than 50% in the provider's corporation is acquired by an unrelated party.
(d) For all providers, a change in provider occurs where an unrelated party acquires:
(i) the provider's title or interest in the nursing facility or a leasehold interest in the nursing facility; and
(ii) the right to control and manage the business of the nursing facility.
(2) Regardless of the provisions of (1) through (1) (d) , a change in provider will not be deemed to have occurred if the circumstances indicate that:
(a) a related party will acquire, retain or actually exercise substantial influence over the new entity; or
(b) the occurrence or transaction is undertaken primarily for the purpose of triggering a change in provider under this rule.
(3) For purposes of this rule:
(a) "Provider" means the business entity having the right to control and manage the business of the nursing facility.
(b) "Related party" means:
(i) a person, including a natural person and a corporation, who is an owner, partner or stockholder in the current provider and who has a direct or indirect interest of 5% or more or a power, whether or not legally enforceable to directly or indirectly influence or direct the actions or policies of the entity;
(ii) A spouse, ancestor, descendant, sibling, uncle, aunt, niece, or nephew of a person described in (3)(b)(i) or a spouse of an ancestor, descendant, sibling, uncle, aunt, niece or nephew of a person described in (3)(b)(i); or
(iii) a sole proprietorship, partnership corporation or other entity in which a person described in (3)(b)(i) or (ii) has a direct or indirect interest of 5% or more or a power, whether or not legally enforceable to directly or indirectly influence or direct the actions or policies of the entity.
(c) "Unrelated party" means a person or entity that is not a related party.
(4) In determining whether a change in provider has occurred within the meaning of this rule, the provisions of federal Medicare law, regulation or policy or related caselaw regarding changes in ownership under the Medicare program are not applicable.
(5) As required in ARM 37.40.306, a provider must provide the department with 30 days advance written notice of a change in provider and must file a close out cost report, and new providers must enroll in the Medicaid program in accordance with applicable requirements.
(6) Any change in provider, corporate or other business ownership structure, or operation of the facility that results in a change in the National Provider Identifier (NPI) will require a provider to seek a new Medicaid provider enrollment. If the NPI is transferred with the facility, and this results in a change in the federal tax identification number, the provider will be required to seek a new Medicaid provider enrollment.
History: 53-2-201, 53-6-113, MCA; IMP, 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA; NEW, 1991 MAR p. 2050, Eff. 11/1/91; AMD, 1994 MAR p. 1881, Eff. 7/8/94; AMD, 1995 MAR p. 1227, Eff. 7/1/95; AMD, 1997 MAR p. 76, Eff. 1/17/97; AMD, 1998 MAR p. 1749, Eff. 6/26/98; TRANS, from SRS, 2000 MAR p. 489; AMD, 2000 MAR p. 492, Eff. 2/11/00; AMD, 2001 MAR p. 1108, Eff. 6/22/01; AMD, 2011 MAR p. 1375, Eff. 7/29/11; AMD, 2013 MAR p. 1103, Eff. 7/1/13.