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Fingerprint Criminal Background Check Overview
Effective March 30, 2017, the Department of Social Services (DSS) has implemented a mandatory fingerprint-based background check (FCBC), for specific providers, as part of the Connecticut Medical Assistance Program (CMAP) provider enrollment/re-enrollment process. DSS has implemented this change to be in compliance with the enhanced enrollment screening provisions contained in the Affordable Care Act (ACA).

As defined in 42 CFR 455.434, fingerprint-based background checks will be applied to individuals who have indicated a 5 percent or greater direct or indirect ownership in a provider or supplier identified as "high" risk.

"High" risk providers (as defined in 42 CFR 424.518(c) and 42 CFR 455.450(e)) include the following: 1) newly enrolling home health agencies; 2) newly enrolling durable medical equipment, prosthetics, orthotics, and supplies providers (including hearing aid dealers); and 3) providers and suppliers who have been elevated to the high risk category in accordance with enhanced screening requirements.

For durable medical equipment (DME) suppliers and home health agencies (HHAs), the fingerprint-based background check will be completed on all individuals with a 5 percent or greater ownership interest. A 5 percent or greater owner is any individual that has any partnership (general or limited) in a DME supplier or HHA.

Fingerprint-based background checks are also required for any provider that has been elevated to the high risk category for any of the following reasons:

  • CT Medicaid has imposed a payment suspension within the last 10 years.
  • The provider has been excluded from Medicaid by the Office of Inspector General (OIG).
  • Has been subject to any final adverse action in the previous 10 years.
  • Has been terminated or is otherwise precluded from billing Medicaid.
Notification of the fingerprint requirements will be mailed from the CT Department of Social Services (DSS) to each individual with a 5 percent or greater ownership interest that is associated to an affected provider. The notification letter will be mailed to the correspondence's address. Generally, an individual will be required to be fingerprinted only once, but CT DSS reserves the right to request additional fingerprints as deemed necessary.

Individuals selected by DSS for FCBC will have 30 days from the date on the notification letter to be fingerprinted. The location and contact information will be provided in the notification letter. Selected individuals are required to contact the fingerprinting site prior to showing up. Failure to comply within 30 days of notification will result in the provider, DME supplier or HHA being ineligible to be an approved CT Medicaid provider.

In addition, individuals who are required to undergo the fingerprint-based background check will incur the cost of having their fingerprints taken.

All fingerprint data will be stored according to Federal requirements.

You can review 42 CFR 424.518(c) by selecting this link: Federal Regulations.

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