---
kind: "section"
citation: "42 C.F.R. § 438.808"
title: "42"
number: "438.808"
heading: "Exclusion of entities."
url: "https://uscodex.org/cfr/42/438.808"
---

# §438.808. Exclusion of entities.

- (a) **General rule.** FFP is available in payments under MCO contracts or PIHP, PAHP, PCCM, or PCCM entity contracts under a section 1915(b)(1) of the Act waiver only if the State excludes from the contracts any entities described in [paragraph (b)](#b) of this section.
- (b) **Entities that must be excluded.**
  - (1) An entity that could be excluded under section 1128(b)(8) of the Act as being controlled by a sanctioned individual.
  - (2) An entity that has a substantial contractual relationship as defined in [§ 431.55(h)(3)](/cfr/42/431.55.md?p=h-3) of this chapter, either directly or indirectly, with an individual convicted of certain crimes as described in section 1128(b)(8)(B) of the Act or an individual described in § [438.610(a)](/cfr/42/438.610.md?p=a) and [(b)](/cfr/42/438.610.md?p=b).
  - (3) An entity that employs or contracts, directly or indirectly, for the furnishing of health care, utilization review, medical social work, or administrative services, with one of the following:
    - (i) Any individual or entity described in § [438.610(a)](/cfr/42/438.610.md?p=a) and [(b)](/cfr/42/438.610.md?p=b).
    - (ii) Any individual or entity that would provide those services through an individual or entity described in § [438.610(a)](/cfr/42/438.610.md?p=a) and [(b)](/cfr/42/438.610.md?p=b).

## Notes

### Source

Source: 81 FR 27853, May 6, 2016, unless otherwise noted.

### Authority

Authority: 42 U.S.C. 1302.

### Source

Source: 67 FR 41095, June 14, 2002, unless otherwise noted.