§ 9.745. Responsible applicant.

 (a)  To be certified by the Department, an applicant for certification to perform UR shall be a responsible person.

   (1)  To make this determination, the Department may review and verify the credentials of any officer, director or member of the management staff of the applicant.

   (2)  The Department may consider whether any of the officers, directors or management personnel have ever:

     (i)   Been involved in a bankruptcy proceeding as an officer, director or senior manager of a corporation.

     (ii)   Been convicted of a state or Federal offense related to health care.

     (iii)   Been listed by a state or Federal agency as debarred, excluded or otherwise ineligible for state or Federal program participation.

     (iv)   Been convicted of a criminal offense which would call in to question the individual’s ability to operate a CRE.

     (v)   Had a history of malpractice or civil suits, penalties or judgments against them.

 (b)  To be determined a responsible person, an applicant shall demonstrate to the Department that it has the ability to perform URs and grievance reviews based on medical necessity and appropriateness, without bias.

Cross References

   This section cited in 28 Pa. Code §  9.741 (relating to applicability).



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