§ 14043.2

(a) Whether or not regulations for certification are adopted under Section 14043.15, in order to be enrolled as a provider, or for enrollment as a provider to continue, an applicant or provider may be required to sign a provider agreement and shall disclose all information as required in federal Medicaid regulations and any other information required by the department. Applicants, providers, and persons with an ownership or control interest, as defined in federal Medicaid regulations, shall submit their date of birth and their social security number or numbers to the department, to the full extent allowed under federal law. Corporations with an ownership or control interest, as defined in federal Medicaid regulations, shall submit their taxpayer identification number and all business address locations and post office box addresses. The director may designate the form of a provider agreement by provider type. Failure to disclose the required information, or the disclosure of false information, shall result in denial of the application for enrollment or shall make the provider subject to temporary suspension from the Medi-Cal program, which shall include temporary deactivation of the provider’s number or numbers, including all business addresses used by the provider to obtain reimbursement from the Medi-Cal program.

(b) The director shall notify the provider of the temporary suspension and deactivation of the provider’s number or numbers, including all business addresses used by the provider, and the effective date thereof.

(c) (1) In addition to the grounds for denial or temporary suspension described in subdivision (a), the department shall deny an application for enrollment or terminate the enrollment of a provider if the applicant or provider discloses an affiliation, as defined in Section 455.101 of Title 42 of the Code of Federal Regulations, within the previous five years with any person or entity that has experienced a disclosable event, as defined in Section 455.101 of Title 42 of the Code of Federal Regulations, if the department determines that the affiliation poses an undue risk of fraud, waste, or abuse to the Medi‑Cal program.

(2) In determining whether an affiliation poses an undue risk of fraud, waste, or abuse to the Medi-Cal program, the department shall apply the factors set forth in Section 455.107(f) of Title 42 of the Code of Federal Regulations. Legally protected health care activity, as defined in Title 1.81.7 (commencing with Section 1798.300) of Part 4 of Division 3 of the Civil Code, shall not, by virtue of the nature of that activity alone, constitute fraud, waste, or abuse to the Medi-Cal program.

(3) In accordance with Section 455.107(h) of Title 42 of the Code of Federal Regulations, the department may take action under this subdivision, up to and including denial or termination, regardless of whether the provider fully and timely discloses the affiliation, if the affiliation poses an undue risk of fraud, waste, or abuse to the Medi-Cal program.

(4) This section shall be implemented only upon receipt of all necessary federal approvals and only to the extent that federal financial participation is available and not otherwise jeopardized.

(d) Notwithstanding Section 100171 of the Health and Safety Code and Section 14123, proceedings after the imposition of sanctions provided for in subdivision (a) or (c) shall be in accordance with Section 14043.65.

(Amended by Stats. 2026, Ch. 252, Sec. 20. (AB 173) Effective September 18, 2026.)