42 C.F.R. § 1007.15 Applications, certification and recertification.
Title 42 - Public Health
(a) Initial application. In order to receive FFP under this part, the unit must submit to the Secretary, an application approved by the Governor, containing the following information and documentation— (1) A description of the applicant's organization, structure, and location within State government, and an indication of whether it seeks certification under §1007.7 (a), (b), or (c); (2) A statement from the State Attorney General that the applicant has authority to carry out the functions and responsibilities set forth in this part. If the applicant seeks certification under §1007.7(b), the statement must also specify either that— (i) There is no State agency with the authority to exercise Statewide prosecuting authority for the violations with which the unit is concerned, or (ii) Although the State Attorney General may have common law authority for Statewide criminal prosecutions, he or she has not exercised that authority; (3) A copy of whatever memorandum of agreement, regulation, or other document sets forth the formal procedures required under §1007.7(b), or the formal working relationship and procedures required under §1007.7(c); (4) A copy of the agreement with the Medicaid agency required under §1007.9; (5) A statement of the procedures to be followed in carrying out the functions and responsibilities of this part; (6) A projection of the caseload and a proposed budget for the 12-month period for which certification is sought; and (7) Current and projected staffing, including the names, education, and experience of all senior professional staff already employed and job descriptions, with minimum qualifications, for all professional positions. (b) Conditions for, and notification of certification. (1) The Secretary will approve an application only if he or she has specifically approved the applicant's formal procedures under §1007.7 (b) or (c), if either of those provisions is applicable, and has specifically certified that the applicant meets the requirements of §1007.7; (2) The Secretary will promptly notify the applicant whether the application meets the requirements of this part and is approved. If the application is not approved, the applicant may submit an amended application at any time. Approval and certification will be for a period of 1 year. (c) Conditions for recertification. In order to continue receiving payments under this part, a unit must submit a reapplication to the Secretary at least 60 days prior to the expiration of the 12-month certification period. A reapplication must— (1) Advise the Secretary of any changes in the information or documentation required under paragraphs (a) (1) through (5) of this section; (2) Provide projected caseload and proposed budget for the recertification period; and (3) Include or reference the annual report required under §1007.17. (d) Basis for recertification. (1) The Secretary will consider the unit's reapplication, the reports required under §1007.17, and any other reviews or information he or she deems necessary or warranted, and will promptly notify the unit whether he or she has approved the reapplication and recertified the unit. (2) In reviewing the reapplication, the Secretary will give special attention to whether the unit has used its resources effectively in investigating cases of possible fraud, in preparing cases for prosecution, and in prosecuting cases or cooperating with the prosecuting authorities.
Title 42: Public Health
PART 1007—STATE MEDICAID FRAUD CONTROL UNITS
§ 1007.15 Applications, certification and recertification.
