| This policy prohibits employment of any individual, in any capacity, whether clinical or non-clinical, who is excluded, suspended, debarred, or otherwise made ineligible to provide services under federally funded health care programs.
This policy avoids imposition of Civil Monetary Penalty (CMP) on the County and ensures compliance with federal and State regulations regarding employment of excluded and/or suspended individuals.
This policy ensures that sanction screening is performed during the credentialing process for new hires and monthly for the Department’s current employees.
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| Civil Monetary Penalty (CMP): Any penalty, fine, or other sanction that is for a specific monetary amount or has a maximum amount provided by federal law; is assessed or enforced by an agency pursuant to federal law; and is assessed or enforced pursuant to an administrative proceeding or a civil action in the federal courts. (Public Law 101-410 Section 3(2))
Direct Service: Health and mental health care service provided for or to a client.
Employees: Any individual, paid or non-paid, whose work is under direct control of DMH, including but not limited to, full-time, part-time, temporary, and permanent staff, interns, and volunteers.
Exclusion: A determination made by a federal governing body (e.g., HHS-OIG) that an individual or entity is ineligible to render services or receive payment under any federally funded health care programs for goods and services furnished, ordered, or prescribed. This includes overhead functions (administrative and management) not directly related to client care that are a necessary component of providing services to federal program beneficiaries. This determination continues to apply if there is change from one health care profession to another while excluded. -
There is no automatic reinstatement for exclusion. The excluded individual or entity shall remain ineligible until such time as all specified reinstatement procedures are completed, regardless of whether or not the period of exclusion has ended. Completion of the reinstatement process is subject to the sanctioning agency’s approval. Indirect Service: Administrative or management service not directly related to client care but is a necessary component of proving services to clients, including but not limited to, management, finance, human resources, information technology, legal, general administration, and facilities support.
Sanction List: Federal, State, and County Sanction Lists used to screen all individuals and entities to ensure they are not currently excluded, suspended, debarred, or otherwise made ineligible from participation in federally funded health care programs including, but not limited to, Medicare and Medi-Cal.
Suspension: A determination made by a State governing body (e.g., DHCS) that an individual or entity is ineligible to render services or receive payment under any federally funded health care programs for goods and services furnished, ordered, or prescribed. This includes overhead functions (administrative and management) not directly related to client care that are a necessary component of providing services to federal program beneficiaries. This determination continues to apply to an individual or entity if there is change from one health care profession to another while suspended -
There is no automatic reinstatement for suspension. The suspended individual or entity shall remain ineligible until such time as all specified reinstatement procedures are completed, regardless of whether or not the period of suspension has ended. Completion of the reinstatement process is subject to the sanctioning agency’s approval. Withhold Claims: A hold placed on claims submitted by potentially excluded or suspended individuals and entities. This action allows the claims to be submitted to DMH claiming system but requires that claims be held back from being forwarded to the State for approval and payment.
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| DMH shall not knowingly hire or continue to employ individuals who have been recently convicted of a criminal offense related to health care or are excluded, suspended, debarred, or otherwise ineligible to provide services under any federally funded health care programs.
DMH shall review federal, State and County Sanction Lists monthly to validate that employees have not been excluded, suspended, debarred, or otherwise made ineligible to provide services under federally funded health care programs (See Authorities Section).
All employees shall attest that they are eligible to provide direct and indirect services under federally funded health care programs by signing the Statement of Ability to Provide Services under Federally Funded Health Care Programs form upon new hire or interdepartmental transfer, and on a yearly basis thereafter. -
Refusal to sign the Statement of Ability to Provide Services under Federally Funded Health Care Programs form is cause for denial of a request for new employment, interdepartmental transfer, and/or for termination of employment with DMH. It is the responsibility of the employee to immediately disclose to their Program Manager or supervisor in writing should the employee become excluded, suspended, or debarred from providing direct or indirect services under any federally funded health care program during the course of their employment.
It is the responsibility of the employee to notify their Program Manager or supervisor should the employee become aware that another employee has become excluded, suspended, or debarred, or has been charged with a criminal offense related to health care.
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