ADDITIONAL REQUIREMENTS FOR AN INTEGRATED DELIVERY SYSTEM Sample Clauses

ADDITIONAL REQUIREMENTS FOR AN INTEGRATED DELIVERY SYSTEM. If Provider is an Integrated Delivery System (“IDS”), as defined in 28 Pa. Code § 9.602, the following additional provisions shall apply pursuant to 28 Pa. Code §§ 9.724 and 9.725 and 31 Pa. Code § 301.314. 4.1. Provider acknowledges and agrees that under no circumstance shall provision of Covered Services to Covered Persons be delayed, reduced, denied or otherwise hindered because of the financial or contractual relationship between Health Plan or Subcontractor and Provider or between Provider and the health care providers that participate in Provider’s IDS. 4.2. Provider acknowledges and agrees that only those IDS participating health care providers who meet Health Plan’s credentialing and provider contracting standards may participate and provide services to Covered Persons and that the ultimate authority to approve or terminate IDS health care providers is retained by Health Plan. 4.3. Provider acknowledges and agrees that Health Plan is required to establish, operate and maintain a health care services delivery system, quality assurance system, provider credentialing system, Covered Person complaint and grievance system, and other systems meeting DOH standards and that Health Plan is directly accountable to DOH for the standards and for provision of quality, cost-effective care to Covered Persons. Nothing in the Agreement or this Appendix does or shall be construed to limit Health Plan’s authority or responsibility to meet such standards or to take prompt corrective action to address a quality of care problem, resolve a Covered Person compliant or grievance, or to comply with a regulatory requirement of DOH. 4.4. Provider agrees to provide Health Plan and DOH with access to medical and other records concerning the provision of services to Covered Persons by the IDS through its participating health care providers. Provider agrees to permit and cooperate with onsite reviews by DOH for purposes of monitoring the effectiveness of Provider’s performance of any Health Plan or Subcontractor delegated functions. 4.5. Provider agrees that any delegation of authority or responsibility, in part or in full, for provider credentialing and relations, quality assessment, utilization review (“UR”) and other plan functions to Provider shall be subject to performance monitoring by Health Plan, Subcontractor and DOH, and subject to independent validation by Health Plan, Subcontractor, DOH, or an independent quality review organization or Certified Utilization Review Ent...