10a ncac 13p .0223       REQUIRED DISCLOSURE ANd RePORTING INFORMATION

(a)  Applicants for initial and renewal EMS Provider licensing shall disclose the following background information:

(1)           any prior name(s) used for providing emergency medical services in North Carolina or any other state;

(2)           any felony criminal charges and convictions, under Federal or State law, and any civil actions taken against the applicant or any of its owners or officers in North Carolina or any other state;

(3)           any misdemeanor or felony conviction, under Federal or State law, relating to the unlawful manufacture, distribution, prescription, or dispensing of a controlled substance;

(4)           any misdemeanor or felony conviction, under Federal or State law, related to theft, fraud, embezzlement, breach of fiduciary duty, or other financial misconduct in connection with the delivery of EMS care or service;

(5)           any current or prior investigations, including outcomes, for alleged Medicare, Medicaid, or other insurance fraud, tax evasion, and fraud;

(6)           any revocation or suspension of accreditation; and

(7)           any revocation or suspension by any State licensing authority of a license to provide EMS.

(b)  Within 30 days of occurrence, a licensed EMS provider shall disclose any changes in the information set forth in Paragraph (a) of this Rule that was provided to the OEMS in its most recent application.

History Note:        Authority G.S. 131E-155.1(c); 131E-159; 143-508(d)(1); 143-508(d)(5);

Eff. January 1, 2017.