Manage Owner or Authorized Person Roles

Revised: August 1, 2024

· Select Owner/Authorized Person Role

· Manage Owner/Authorized Person Role

Overview

The Department of Human Services (DHS) requires that you disclose all individual owners with a direct or indirect ownership or control interest of five percent or more, managing employees, board members and officers. You may be required to disclose additional role types depending on your enrollment record type.

Each person the organization discloses as an owner or authorized person is required to be assigned at least one role type. Their assigned role type(s) will define the individual’s relationship with your organization.

Use this page to manage owner or authorized person role types. You can only edit the information on this page if you are in an MPSE Request.

Owner/Authorized Person Name

The Owner/Authorized Person Name section displays the name of the owner or authorized person whose role types you are currently managing. This field cannot be edited and is for informational purposes only.

Owners/Authorized Person Roles

The Owners/Authorized Person Roles section lists all the role types that have been added for the owner or authorized person whose name is shown in the Owner/Authorized Person Name section. If the owner or authorized person has not yet had any role types assigned to them, this section will not have any information to display.

View/Edit
Click View/Edit to go to the Manage Owner/Authorized Person Role page. From this page, you can review and edit the information for that role type.

Delete
Click Delete to delete the role type. You can only deleted a role type when it was added during the current MPSE request.

View
Click View to go to the Manage Owner/Authorized Person Role page. From this page, you can view the information for that role type. You will not be able to make any changes while in view mode.

Add a Role Type

Click Add a Role Type to go to the Select Owner/Authorized Person Role page.

Continue

Click Continue to go to the next page.

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Select Owner/Authorized Person Role

Overview

On this page, you can select the role type for the owner or authorized person.

Owner/Authorized Person Name

The Owner/Authorized Person Name section displays the name of the owner or authorized person whose role types are currently being managed.

Owner/Authorized Person Role Type

In the Owner/Authorized Person Role Type section, select a role type for the owner or authorized person whose name appears in the Owner/Authorized Person Name section.

Role Type

Select a role type from the Role Type drop-down list.

The available role types to select from are:

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

· Board Member or Officer: Any person who is a board member or officer of the enrolling organization.

· Credentialing Contact: A person who Provider Eligibility and Compliance may contact to address questions about your enrollment information.

· Designated Biller: A person who is responsible for billing on behalf of the organization.

· Managing Employee: A person (not CEO, CFO, COO, CTO) who exercises operational or managerial control over, or who directly or indirectly conducts or manages the day-to-day operations of an institution, organization, agency or school, such as a general manager, business manager, administrator or director.

· Non-Owner/Non-Manager: A professional employee who is not an owner or a managing employee.

· Other: An individual who does not fit into any of the other role types.

· Owner Managing Interest: Any person, business or organization with direct ownership of five percent or more in the disclosing entity.

· Owner and Manager: Any person who is an owner and also holds a managing employee role.

· Qualified Professional: Qualified professionals supervise personal care assistance (PCA) services. Your qualified professional works for your PCA provider agency. Qualified professionals may be registered nurses, licensed social workers, mental health professionals or qualified designated coordinator.

· 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.

Continue

Click Continue to save your changes and go to the next page.

Cancel

Click Cancel to go back to the previous page.

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Manage Owner/Authorized Person Role

Owner/Authorized Person Name and Role Type

The Owner/Authorized Person Name section displays the name and role type of the owner or authorized person whose role types are currently being managed.

Owner/Authorized Person Role Information

In the Owner/Authorized Person Role Information section, provide information on the role type that is shown in the Owner/Authorized Person Name and Role Type section.

The information you are required to provide in this section is determined by the role type you selected and is marked by an asterisk (*).

Other Role Description

Type a description of the role type in 50 characters or less in the Other Role Description field. This field only appears if your selected role type is Other.

Start Date

Enter the date that the owner or authorized person started in this role in the Start Date field.

End Date

Enter the end date for this role in the End Date field, if applicable. Only enter an end date when the person no longer holds that role. Adding future end dates may cause errors in your request.

Ownership Managing Control Type

Select the ownership or managing control type from the Ownership Managing Control Type drop-down list.

The options you have to select from are:

· 5% or more direct ownership – Select if the owner or authorized person directly owns five percent or more of the business.

· 5% or more indirect ownership – Select if the owner or authorized person indirectly owns five percent or more of the business.

· 5% or more mortgage ownership – Select if the owner or authorized person owns an interest of five percent or more in any mortgage, deed of trust, note or other obligation secured by the business.

· 5% or more security interest – Select if the owner or authorized person has five percent or more security interest in the business.

Percent Ownership/Managing Interest

Type in the numeric percentage of ownership in the Percent Ownership/Managing Interest field.

The percent of ownership must be greater than or equal to five percent and less than or equal to 100 percent. The sum of the percent of direct ownership for all the direct ownership roles in an organization’s MPSE portfolio must not exceed 100 percent for all persons and businesses that are current owners.

The total percentage of managing interest or indirect ownership may be greater than 100 percent.

Qualified Professional Type

Select the qualified professional type from the Qualified Professional Type drop-down list.

The options you have to select from are:

· Licensed Social Worker

· Mental Health Professional

· Qualified Designated Coordinator (QDC)

· Registered Nurse

License Number

Type the applicable license number for the licensed qualified professional.

The license number comes from either a registered nurse license, licensed social worker license or a mental health professional license. If the qualified professional does not have a license number, skip this field.

Mental Health Professional Type

Type a description of the mental health profession of your qualified professional if your selected qualified professional type is Mental Health Professional. Type the description in 50 characters or less.

Enrollment Record

Select the enrollment record associated with this owner or authorized person role from the Enrollment Record drop-down list.

The drop-down list will contain all of the enrollment records that exist within your profile and are sorted by practice name and enrollment type.

Continue

Click Continue to save your changes and go to the next page.

Cancel

Click Cancel to go back to the previous page.

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