Common use of Agreements with Providers and Subcontractors Clause in Contracts

Agreements with Providers and Subcontractors. (A) The Contractor shall, at the time the Contractor enters into an agreement with a Provider or a contract with a Subcontractor, inform the Provider or Subcontractor of the following: (1) the Grievance, Appeal, and State Fair Hearing procedures and timeframes as specified in 42 CFR 438.400 through 42 CFR 438.424; (2) the Aggrieved Person’s right to file Grievances and request Appeals and the requirements and timeframes for filing; (3) the availability of assistance with filing Grievances and requesting Appeals; (4) the Aggrieved Person’s right to request a State Fair Hearing after the Contractor has made a determination on the Appeal request that is adverse to the Enrollee; and (5) if the Contractor makes an Adverse Benefit Determination to reduce, suspend or terminate services: (i) the Enrollee, the Enrollee’s legal guardian or other authorized representative has the right to request that the services be continued pending the outcome of the Appeal or State Fair Hearing if the Enrollee requests continuation of services within the required time frame; and (ii) if the Appeal or State Fair Hearing decision is adverse to the Enrollee, that the Enrollee may be required to pay for the continued services to the extent they were furnished solely because of the request for continuation of services. (B) The Contractor shall ensure its Providers and Subcontractors shall not bill Enrollees for Covered Services any amount greater than would be owed if the Provider or Subcontractor provided the Covered Services directly. (C) The Contractor’s written agreements with its Providers and Subcontractors shall contain provisions stating: (1) that if the Provider or Subcontractor becomes insolvent or bankrupt, Enrollees shall not be liable for the debt of the Provider or Subcontractor; and (2) that the Enrollee shall not be held liable for Covered Services provided to the Enrollee for which: (i) the Department does not pay the Contractor, or (ii) the Department or the Contractor does not pay the individual or Provider that furnished the services under a contractual, referral or other arrangement.

Agreements with Providers and Subcontractors. (A) The Contractor shall, Contactor shall inform Providers and Subcontractors at the time the Contractor it enters into an agreement with a Provider or a contract with a Subcontractor, inform the Provider or Subcontractor of the followingabout: (1) the Enrollee Grievance, Appeal, and State Fair Hearing procedures and timeframes as specified in 42 CFR 438.400 through 42 CFR 438.424; (2) the Aggrieved PersonEnrollee’s right to file Grievances and request Appeals and the requirements and timeframes for filing; (3) the availability of assistance to the Enrollee with filing Grievances and requesting Appeals; (4) the Aggrieved PersonEnrollee’s right to request a State Fair Hearing after the Contractor has made a determination on the Enrollee’s Appeal request that which is adverse to the Enrollee; and; (5) if the Contractor makes an Adverse Benefit Determination to reduce, suspend or terminate services: (i) the Enrollee, the Enrollee’s legal guardian or other authorized representative has the right to request continuation of benefits that the services Contractor seeks to reduce or terminate during an Appeal or State Fair Hearing filing, if filed within the allowable timeframes, and that the Enrollee may be liable for the cost of any continued pending the outcome of benefits while the Appeal or State Fair Hearing is pending if the Enrollee requests continuation of services within the required time frame; and (ii) if the Appeal or State Fair Hearing final decision is adverse to the Enrollee, that the Enrollee may be required to pay for the continued services to the extent they were furnished solely because of the request for continuation of services. (B) The Contractor shall ensure that its Subcontractors and Providers and Subcontractors shall not bill Enrollees for Covered Services any amount greater than would be owed if the Subcontractor or Provider or Subcontractor provided the Covered Services directly. (C) The Contractor’s Contractors written agreements with its Subcontractors and Providers and Subcontractors shall contain provisions a provision stating: (1) that if the Provider or Subcontractor becomes insolvent or bankrupt, Enrollees shall not be liable for the debt of the Provider or Subcontractor; and (2) that the Enrollee shall not be held liable for Covered Services provided to the Enrollee for which: (i) the Department does not pay the Contractor, or (ii) the Department or the Contractor does not pay the individual or Provider that furnished the services under a contractual, referral or other arrangement.

Agreements with Providers and Subcontractors. (A) The Contractor shall, shall inform Providers and Subcontractors at the time the Contractor enters they enter into an agreement with a Provider or a contract with a Subcontractor, inform the Provider or Subcontractor of the followingabout: (1) the Grievance, Appeal, and State Fair Hearing procedures and timeframes as specified in 42 CFR 438.400 through 42 CFR 438.424; (2) the Aggrieved Person’s right to file Grievances and request Appeals and the requirements and timeframes for filing; (3) the availability of assistance to the Enrollee with filing Grievances and requesting Appeals; (4) the Aggrieved Person’s right to request a State Fair Hearing after the Contractor has made a determination on the Enrollee’s Appeal request that which is adverse to the Enrollee; and (5) if the Contractor makes an Adverse Benefit Determination Determinations to reduce, suspend suspend, or terminate services: (i) that the Enrollee, the Enrollee’s legal guardian or other authorized representative has the right to request that the services be continued pending the outcome of the Appeal or State Fair Hearing if the Enrollee requests continuation of services within the required time frametimeframe; and (ii) that if the Appeal or State Fair Hearing decision is adverse to the Enrollee, that the Enrollee may be required to pay for the continued services to the extent they were furnished solely because of the request for continuation of services. (B) The Contractor shall ensure that its Subcontractors and Providers and Subcontractors shall not bill Enrollees for Covered Services any amount greater than would be owed if the Subcontractor or Provider or Subcontractor provided the Covered Services directly. (C) The Contractor’s Contractors written agreements with its Subcontractors and Providers and Subcontractors shall contain provisions stating: (1) that if the Provider or Subcontractor becomes insolvent or bankrupt, Enrollees shall not be liable for the debt of the Provider or Subcontractor; and (2) that the Enrollee shall not be held liable for Covered Services provided to the Enrollee for which: (i) the Department does not pay the Contractor, or (ii) the Department or the Contractor does not pay the individual or Provider that furnished the services under a contractual, referral or other arrangement.

Agreements with Providers and Subcontractors. (A) The Contractor shall, Contactor shall inform Providers and Subcontractors at the time the Contractor it enters into an agreement with a Provider or a contract with a Subcontractor, inform the Provider or Subcontractor of the followingabout: (1) the Enrollee Grievance, Appeal, and State Fair Hearing procedures and timeframes as specified in 42 CFR 438.400 through 42 CFR 438.424; (2) the Aggrieved PersonEnrollee’s right to file Grievances and request Appeals and the requirements and timeframes for filing; (3) the The availability of assistance to the Enrollee with filing Grievances and requesting Appeals; (4) the Aggrieved PersonEnrollee’s right to request a State Fair Hearing after the Contractor has made a determination on the Enrollee’s Appeal request that which is adverse to the Enrollee; and; (5) if the Contractor makes an Adverse Benefit Determination to reduce, suspend or terminate services: (i) the Enrollee, the Enrollee’s legal guardian or other authorized representative has the right to request continuation of benefits that the services Contractor seeks to reduce or terminate during an Appeal or State Fair Hearing filing, if filed within the allowable timeframes, and that the Enrollee may be liable for the cost of any continued pending the outcome of benefits while the Appeal or State Fair Hearing is pending if the Enrollee requests continuation of services within the required time frame; and (ii) if the Appeal or State Fair Hearing final decision is adverse to the Enrollee, that the Enrollee may be required to pay for the continued services to the extent they were furnished solely because of the request for continuation of services. (B) The Contractor shall ensure that its Subcontractors and Providers and Subcontractors shall not bill Enrollees for Covered Services any amount greater than would be owed if the Subcontractor or Provider or Subcontractor provided the Covered Services directly. (C) The Contractor’s Contractors written agreements with its Subcontractors and Providers and Subcontractors shall contain provisions stating: (1) a provision stating that if the Subcontractor or Provider or Subcontractor becomes insolvent or bankrupt, Enrollees shall not be liable for the debt of the Provider Subcontractor or Subcontractor; and (2) that the Enrollee shall not be held liable for Covered Services provided to the Enrollee for which: (i) the Department does not pay the Contractor, or (ii) the Department or the Contractor does not pay the individual or Provider that furnished the services under a contractual, referral or other arrangementProvider.

Agreements with Providers and Subcontractors. (A) The Contractor shall, shall inform Providers and Subcontractors at the time the Contractor it enters into an agreement with a Provider or a contract with a Subcontractor, inform the Provider or Subcontractor of the followingabout: (1) the Enrollee Grievance, Appeal, and State Fair Hearing procedures and timeframes as specified in 42 CFR 438.400 through 42 CFR 438.424;and (2) the Aggrieved Person’s right to file Grievances and request Appeals and the requirements and timeframes for filing; (3) the availability of assistance to the Enrollee with filing Grievances and requesting Appeals; (4) the Aggrieved Person’s right to request a State Fair Hearing after the Contractor has made a determination on the Enrollee’s Appeal request that which is adverse to the Enrollee; and; (5) if the Contractor makes an Adverse Benefit Determination to reduce, suspend or terminate services: (i) the Enrollee, the EnrolleeAggrieved Person’s legal guardian or other authorized representative has the right to request continuation of benefits that the services Contractor seeks to reduce or terminate during an Appeal or State Fair Hearing filing, if filed within the allowable time frames, and that the Enrollee may be liable for the cost of any continued pending the outcome of benefits while the Appeal or State Fair Hearing is pending if the Enrollee requests continuation of services within the required time frame; and (ii) if the Appeal or State Fair Hearing final decision is adverse to the Enrollee, that the Enrollee may be required to pay for the continued services to the extent they were furnished solely because of the request for continuation of services. (B) The Contractor shall ensure that its Subcontractors and Providers and Subcontractors shall not bill Enrollees for Covered Services any amount greater than would be owed if the Subcontractor or Provider or Subcontractor provided the Covered Services directly. (C) The Contractor’s written agreements with its Subcontractors and Providers and Subcontractors shall contain provisions a provision stating: (1) that if the Provider or Subcontractor becomes insolvent or bankrupt, Enrollees shall not be liable for the debt of the Provider or Subcontractor; and (2) that the Enrollee shall not be held liable for Covered Services provided to the Enrollee for which: (i) the Department does not pay the Contractor, or (ii) the Department or the Contractor does not pay the individual or Provider that furnished the services under a contractual, referral or other arrangement.

Agreements with Providers and Subcontractors. (A) The Contractor shall, shall inform Providers and Subcontractors at the time the Contractor enters they enter into an a Network Provider agreement with a Provider or a contract with a Subcontractor, inform the Provider or Subcontractor of the followingSubcontract about: (1) the Grievance, Appeal, and State Fair Hearing procedures and timeframes as specified in 42 CFR § 438.400 through 42 CFR § 438.424; (2) the Aggrieved PersonEnrollee’s right to file Grievances and request Appeals and the requirements and timeframes for filing; (3) the availability of assistance to the Enrollee with filing Grievances and requesting Appeals; (4) the Aggrieved PersonEnrollee’s right to request a State Fair Hearing after the Contractor has made a determination on the Appeal request that if it is adverse to the Enrollee; and (5) if the Contractor makes an Adverse Benefit Determination to reduce, suspend or terminate services: (i) that the Enrollee, the Enrollee’s 's legal guardian guardian, or other authorized representative has the right to request that the services be continued pending the outcome of the Appeal or State Fair Hearing if the Enrollee requests continuation of services within the required time frametimeframe; and (ii) that if the Appeal or State Fair Hearing decision is adverse to the Enrollee, that the Enrollee may be required to pay for the continued services to the extent they were furnished solely because of the request for continuation of services. (B) The Contractor shall ensure its Providers and Subcontractors shall not bill Enrollees for Covered Services any amount greater than would be owed if the Provider or Subcontractor provided the Covered Services directly. (C) The Contractor’s written agreements with its Providers and Subcontractors shall contain provisions stating: (1) that if the Provider or Subcontractor becomes insolvent or bankrupt, Enrollees shall not be liable for the debt of the Provider or Subcontractor; and (2) that the Enrollee shall not be held liable for Covered Services provided to the Enrollee for which: (i) the Department does not pay the Contractor, ; or (ii) the Department or the Contractor does not pay the individual or Provider that furnished the services under a contractual, referral or other arrangement.

Agreements with Providers and Subcontractors. (A) The Contractor shall, shall inform Providers and Subcontractors at the time the Contractor enters they enter into an agreement with a Provider or a contract with a Subcontractor, inform the Provider or Subcontractor of the followingabout: (1) the Grievance, Appeal, and State Fair Hearing procedures and timeframes as specified in 42 CFR 438.400 through 42 CFR 438.424; (2) the Aggrieved Person’s right to file Grievances and request Appeals and the requirements and timeframes for filing; (3) the availability of assistance to the Enrollee with filing Grievances and requesting Appeals; (4) the Aggrieved Person’s right to request a State Fair Hearing after the Contractor has made a determination on the Enrollee’s Appeal request that which is adverse to the Enrollee; and (5) if the Contractor makes an Adverse Benefit Determination Determinations to reduce, suspend suspend, or terminate services: (i) that the Enrollee, the Enrollee’s legal guardian or other authorized representative has the right to request that the services be continued pending the outcome of the Appeal or State Fair Hearing if the Enrollee requests continuation of services within the required time frametimeframe; and (ii) that if the Appeal or State Fair Hearing decision is adverse to the Enrollee, that the Enrollee may be required to pay for the continued services to the extent they were furnished solely because of the request for continuation of services. (B) The Contractor shall ensure that its Subcontractors and Providers and Subcontractors shall not bill Enrollees for Covered Services any amount greater than would be owed if the Subcontractor or Provider or Subcontractor provided the Covered Services directly. (C) The Contractor’s Contractors written agreements with its Subcontractors and Providers and Subcontractors shall contain provisions a provision stating: (1) that if the Provider or Subcontractor becomes insolvent or bankrupt, Enrollees shall not be liable for the debt of the Provider or Subcontractor; and (2) that the Enrollee shall not be held liable for Covered Services provided to the Enrollee for which: (i) the Department does not pay the Contractor, or (ii) the Department or the Contractor does not pay the individual or Provider that furnished the services under a contractual, referral or other arrangement.