Common use of Additional Network Provider Requirements Clause in Contracts

Additional Network Provider Requirements. (A) In accordance with Article 6.6, if the Contractor has a physician incentive plan with a physician or physician group, the Contractor shall ensure the Network Providers abide by the requirements of Section 1877(E)(3)(B) of the Social Security Act. (B) The Contractor shall ensure that Network Providers and staff are knowledgeable about methods to detect domestic violence, about mandatory reporting laws when domestic violence is suspected, and about resources in the community to which patients can be referred. (C) All of the Contractor’s Network Providers shall be aware of the Contractor’s Quality Assessment and Performance Improvement Plan (QAPIP) and activities. All of the Contractor’s agreements with Network Providers shall include a requirement securing cooperation with the Contractor’s QAPIP and activities and shall allow the Contractor access to the medical records of Enrollees being treated by Network Providers. (D) All physicians who provide services under this Contract shall have a unique identifier in accordance with the system established under Section 1173(b) of the Social Security Act and in accordance with the Health Insurance Portability and Accountability Act. (E) The Contractor shall ensure its Network Providers are either enrolled with the Department as a Medicaid Fee-for-Service provider or are enrolled with the Department as a “Managed Care Only provider.”

Additional Network Provider Requirements. (A) In accordance with Article 6.6, if the Contractor has a physician incentive plan Physician Incentive Plan with a physician or physician group, the Contractor shall ensure the these Network Providers abide by the requirements of Section 1877(E)(3)(B) of the Social Security Act. (B) The Contractor shall ensure that Network Providers and staff are knowledgeable about methods to detect domestic violence, about mandatory reporting laws when domestic violence is suspected, and about resources in the community to which patients can be referred. (C) All of the Contractor’s The Contractor shall ensure all Network Providers shall be are aware of the Contractor’s Quality Assessment and Performance Improvement Plan (QAPIP) and activities. All of the Contractor’s agreements with Network Providers shall include a requirement securing cooperation with the Contractor’s QAPIP and activities and shall allow the Contractor access to the medical records of Enrollees being treated by Network Providers. (D) All physicians who provide services under this Contract shall have a unique identifier in accordance with the system established under Section 1173(b) of the Social Security Act and in accordance with the Health Insurance Portability and Accountability Act. (E) The Contractor shall ensure its Network Providers are either enrolled with the Department as a Medicaid Fee-for-Service FFS provider or are enrolled with the Department as a “Managed Care Only full or limited Medicaid provider.”

Additional Network Provider Requirements. (A) In accordance with Article 6.6, if the Contractor has a physician incentive plan with a physician or physician group, the Contractor shall ensure the Network Providers abide by the requirements of Section 1877(E)(3)(B) of the Social Security Act. (B) The Contractor shall ensure that Network Providers and staff are knowledgeable about methods to detect domestic violence, about mandatory reporting laws when domestic violence is suspected, and about resources in the community to which patients can be referred. (C) All of the Contractor’s The Contract shall ensure all Network Providers shall be are aware of the Contractor’s Quality Assessment and Performance Improvement Plan (QAPIP) and activities. All of the Contractor’s agreements with Network Providers shall include a requirement securing cooperation with the Contractor’s QAPIP and activities and shall allow the Contractor access to the medical records of Enrollees being treated by Network Providers. (D) All physicians who provide services under this Contract shall have a unique identifier in accordance with the system established under Section 1173(b) of the Social Security Act and in accordance with the Health Insurance Portability and Accountability Act. (E) The Contractor shall ensure its Network Providers are either enrolled with the Department as a Medicaid Fee-for-Service FFS provider or are enrolled with the Department as a “Managed Care Only full or limited Medicaid provider.”