Wis. ForwardHealth Online Handbook, Hospice, Topic #14317

ForwardHealth adopted terminology due to the ACA (Affordable Care Act), which is included in the following table. This

terminology is useful to providers during the provider enrollment and revalidation processes. Providers may refer to the Medicaid

rule 42 C.F.R. § s. 455.101 for more information.

Terminology Definition

Agent Any person who has been delegated the authority to obligate or act on behalf of a provider.

Disclosing entity A Medicaid provider (other than an individual practitioner or group of practitioners) or a fiscal agent.

Federal health care

programs

Federal health care programs include Medicare, Medicaid, Title XX, and Title XXI.

Other disclosing

agent

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, XVII, or XX of the Act. This includes:

• Any hospital, skilled nursing facility, home health agency, independent clinical laboratory, renal

disease facility, rural health clinic, or HMO that participates in Medicare (Title XVIII)

Note: Providers should note that the federal CMS (Centers for Medicare and Medicaid Services) requires revalidation at least

every five years. However, Wisconsin Medicaid revalidates providers every three years.

• Any Medicare intermediary or carrier

• 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 XX of the Act

Indirect ownership 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 in the disclosing entity.

Managing employee 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.

Ownership interest The possession of equity in the capital, the stock, or the profits of the disclosing entity.

Person with an

ownership or control

interest

A person or corporation for which one or more of the following applies:

• Has an ownership interest totaling 5% or more in a disclosing entity

• Has an indirect ownership interest equal to 5% or more in a disclosing entity

• Has a combination of direct and indirect ownership interest equal to 5% or more in a disclosing

entity

• Owns an interest of 5% or more in any mortgage, deed of trust, note, or other obligation secured

by the disclosing entity if that interest equals at least 5% of the value of the property or asset of the

disclosing entity

• Is an officer or director of a disclosing entity that is organized as a corporation

• Is a person in a disclosing entity that is organized as a partnership

Subcontractor • An individual, agency, or organization to which a disclosing entity has contracted or delegated some

of its management functions or responsibilities of providing medical care to its patients; or,

• An individual, agency, or organization with which a fiscal agent has entered into a contract,

agreement, purchase order, or lease (or leases of real property) to obtain space, supplies,

equipment, or services provided under the Medicaid agreement.

Re-enrollment Re-enrollment of a provider whose Medicaid enrollment has ended for any reason other than sanctions or

failure to revalidate may be re-enrolled as long as all licensure and enrollment requirements are met.

Providers should note that when they re-enroll, application fees and screening activities may apply. Re-enrollment was formerly known as re-instate.

Revalidation All enrolled providers are required to revalidate their enrollment information every three years to continue

their participation with Wisconsin Medicaid. Revalidation was formerly known as recertification.