Common use of Audit & Financial Compliance Clause in Contracts

Audit & Financial Compliance. 30 Section 9.01 Record retention and audit........................................................................................................30 Section 9.02 Access to records, books, and documents................................................................................30 Section 9.03 Audits of Services, Deliverables and inspections......................................................................31 Section 9.04 SAO Audit.................................................................................................................................31 Section 9.05 Response/compliance with audit or inspection findings............................................................31 Section 9.06 Notification of Legal and Other Proceedings, and Related Events............................................32 Article 10. Terms & Conditions of Payment...............................................................................................32 Section 10.01 Calculation of monthly Capitation Payment.............................................................................32 Section 10.02 Time and Manner of Payment.................................................................................................32 Section 10.03 Certification of Capitation Rates..............................................................................................32 Section 10.04 Modification of Capitation Rates..............................................................................................32 Section 10.05 STAR and STAR+PLUS Capitation Structure.........................................................................33 Section 10.06 CHIP Capitation Rates Structure.............................................................................................34 Section 10.07 MCO input during rate setting process....................................................................................34 Section 10.08 Adjustments to Capitation Payments......................................................................................35 Section 10.09 Delivery Supplemental Payment for CHIP, CHIP Perinatal and STAR MCOs........................35 Section 10.10 Experience Rebate..................................................................................................................35 Section 10.11 Restriction on assignment of fees...........................................................................................41 Section 10.12 Liability for taxes.....................................................................................................................41 Section 10.13 Liability for employment-related charges and benefits............................................................41 Section 10.14 No additional consideration.....................................................................................................41 Section 10.15 Federal Disallowance..............................................................................................................41 Article 11. Disclosure & Confidentiality of Information...........................................................................41 Section 11.01 Confidentiality..........................................................................................................................41 Section 11.02 Disclosure of HHSC’s Confidential Information.......................................................................42 Section 11.03 Member Records.....................................................................................................................42 Section 11.04 Requests for public information...............................................................................................42 Section 11.05 Privileged Work Product..........................................................................................................42 Section 11.06 Unauthorized acts...................................................................................................................43 Section 11.07 Legal action.............................................................................................................................43 Section 11.08 Information Security................................................................................................................43

Audit & Financial Compliance. 30 34 Section 9.01 Record retention and audit........................................................................................................30 . .......................................................................................................34 Section 9.02 Access to records, books, and documents................................................................................30 . ...............................................................................35 Section 9.03 Audits of Services, Deliverables and inspections......................................................................31 . .....................................................................35 Section 9.04 SAO AuditAudit .................................................................................................................................31 36 Section 9.05 Response/compliance with audit or inspection findings............................................................31 . ...........................................................36 Section 9.06 Notification of Legal and Other Proceedings, and Related Events............................................32 . ...........................................36 Article 10. Terms & Conditions of PaymentPayment ...............................................................................................32 36 Section 10.01 Calculation of monthly Capitation Payment.............................................................................32 . ............................................................................36 Section 10.02 Time and Manner of Payment.................................................................................................32 . ................................................................................................37 Section 10.03 Certification of Capitation Rates..............................................................................................32 . .............................................................................................37 Section 10.04 Modification of Capitation Rates..............................................................................................32 . .............................................................................................37 Section 10.05 STAR and STAR+PLUS Capitation Structure.........................................................................33 . ........................................................................37 Section 10.06 CHIP Capitation Rates Structure.............................................................................................34 . ............................................................................................38 Section 10.07 MCO input during rate setting process....................................................................................34 . ...................................................................................39 Section 10.08 Adjustments to Capitation Payments......................................................................................35 . .....................................................................................39 Section 10.09 Delivery Supplemental Payment for CHIP, CHIP Perinatal and STAR MCOs........................35 . .......................39 Section 10.10 Experience RebateRebate ..................................................................................................................35 40 Section 10.11 Restriction on assignment of fees...........................................................................................41 . ..........................................................................................44 Section 10.12 Liability for taxes.....................................................................................................................41 . ....................................................................................................................44 Section 10.13 Liability for employment-related charges and benefits............................................................41 . ...........................................................44 Section 10.14 No additional consideration.....................................................................................................41 . ....................................................................................................44 Section 10.15 Federal DisallowanceDisallowance ..............................................................................................................41 45 Section 10.16 Supplemental Payments for Medicaid Wrap-Around Services for Outpatient Drugs and Biological Products ........................................................................................................................................45 Article 11. Disclosure & Confidentiality of InformationInformation ...........................................................................41 45 Section 11.01 Confidentiality..........................................................................................................................41 45 Section 11.02 Disclosure of HHSC’s 's Confidential Information.......................................................................42 Section 11.03 Member Records.....................................................................................................................42 Section 11.04 Requests for public information...............................................................................................42 Section 11.05 Privileged Work Product..........................................................................................................42 Section 11.06 Unauthorized acts...................................................................................................................43 Section 11.07 Legal action.............................................................................................................................43 Section 11.08 Information Security................................................................................................................43. ......................................................................46

Audit & Financial Compliance. 30 27 Section 9.01 Record Financial record retention and audit........................................................................................................30 ..........................................................................................27 Section 9.02 Access to records, books, and documents................................................................................30 27 Section 9.03 Audits of Services, Deliverables and inspections......................................................................31 27 Section 9.04 SAO AuditAudit .................................................................................................................................31 28 Section 9.05 Response/compliance with audit or inspection findings............................................................31 Section 9.06 Notification of Legal and Other Proceedings, and Related Events............................................32 . ...........................................................28 Article 10. Terms & Conditions of Payment...............................................................................................32 28 Section 10.01 Calculation of monthly Capitation Payment.............................................................................32 28 Section 10.02 Time and Manner of Payment.................................................................................................32 29 Section 10.03 Certification of Capitation Rates..............................................................................................32 29 Section 10.04 Modification of Capitation Rates..............................................................................................32 29 Section 10.05 STAR and STAR+PLUS Capitation Structure.........................................................................33 ......................................................................................................29 Section 10.05.1STAR+PLUS Capitation Structure. .......................................................................................30 Section 10.06 CHIP Capitation Rates Structure.............................................................................................34 30 Section 10.07 MCO HMO input during rate setting process....................................................................................34 31 Section 10.08 Adjustments to Capitation Payments......................................................................................35 . .....................................................................................31 Section 10.09 Delivery Supplemental Payment for CHIP, CHIP Perinatal and STAR MCOs........................35 HMOs. .......................32 Section 10.10 Administrative Fee for SSI Members.......................................................................................32 Section 10.11 STAR, CHIP, and CHIP Perinatal Experience Rebate..................................................................................................................35 ............................................................33 Section 10.11 10.11.1 STAR+PLUS Experience Rebate.........................................................................................34 Section 10.12 Payment by Members. ............................................................................................................36 Section 10.13 Restriction on assignment of fees...........................................................................................41 . ..........................................................................................36 Section 10.12 10.14 Liability for taxes.....................................................................................................................41 . ....................................................................................................................37 Section 10.13 10.15 Liability for employment-related charges and benefits............................................................41 . ...........................................................37 Section 10.14 10.16 No additional consideration.....................................................................................................41 37 Section 10.15 10.17 Federal Disallowance..............................................................................................................41 37 Section 10.18 Required Pass Through of Physician Rate Increases .............................................................37 Article 11. Disclosure & Confidentiality of InformationInformation ...........................................................................41 37 Section 11.01 Confidentiality..........................................................................................................................41 38 Section 11.02 Disclosure of HHSC’s Confidential Information.......................................................................42 38 Section 11.03 Member Records.....................................................................................................................42 38 Section 11.04 Requests for public information...............................................................................................42 39 Section 11.05 Privileged Work Product..........................................................................................................42 39 Section 11.06 Unauthorized acts...................................................................................................................43 . ..................................................................................................................39 Section 11.07 Legal action.............................................................................................................................43 Section 11.08 Information Security................................................................................................................4339

Audit & Financial Compliance. 30 27 Section 9.01 Record Financial record retention and audit........................................................................................................30 ..........................................................................................27 Section 9.02 Access to records, books, and documents................................................................................30 27 Section 9.03 Audits of Services, Deliverables and inspections......................................................................31 27 Section 9.04 SAO Audit.................................................................................................................................31 Audit ..................................................................................................................................28 Section 9.05 Response/compliance with audit or inspection findings. ............................................................31 Section 9.06 Notification of Legal and Other Proceedings, and Related Events............................................32 28 Article 10. Terms & Conditions of Payment...............................................................................................32 28 Section 10.01 Calculation of monthly Capitation Payment.............................................................................32 28 Section 10.02 Time and Manner of Payment.................................................................................................32 29 Section 10.03 Certification of Capitation Rates..............................................................................................32 29 Section 10.04 Modification of Capitation Rates..............................................................................................32 29 Section 10.05 STAR and STAR+PLUS Capitation Structure.........................................................................33 ......................................................................................................29 Section 10.05.1STAR+PLUS Capitation Structure. ........................................................................................30 Section 10.06 CHIP Capitation Rates Structure.............................................................................................34 30 Section 10.07 MCO HMO input during rate setting process....................................................................................34 31 Section 10.08 Adjustments to Capitation Payments. ......................................................................................35 31 Section 10.09 Delivery Supplemental Payment for CHIP, CHIP Perinatal and STAR MCOsHMOs. ........................35 32 Section 10.10 Administrative Fee for SSI Members.......................................................................................32 Section 10.11 STAR, CHIP, and CHIP Perinatal Experience Rebate..................................................................................................................35 ............................................................33 Section 10.11 10.11.1 STAR+PLUS Experience Rebate.........................................................................................34 Section 10.12 Payment by Members. .............................................................................................................36 Section 10.13 Restriction on assignment of fees. ...........................................................................................41 36 Section 10.12 10.14 Liability for taxes. .....................................................................................................................41 37 Section 10.13 10.15 Liability for employment-related charges and benefits. ............................................................41 37 Section 10.14 10.16 No additional consideration.....................................................................................................41 37 Section 10.15 10.17 Federal Disallowance..............................................................................................................41 37 Section 10.18 Required Pass Through of Physician Rate Increases.............................................................37 Article 11. Disclosure & Confidentiality of Information...........................................................................41 Information ............................................................................37 Section 11.01 Confidentiality..........................................................................................................................41 38 Section 11.02 Disclosure of HHSC’s Confidential Information.......................................................................42 38 Section 11.03 Member Records.....................................................................................................................42 38 Section 11.04 Requests for public information...............................................................................................42 39 Section 11.05 Privileged Work Product..........................................................................................................42 39 Section 11.06 Unauthorized acts. ...................................................................................................................43 39 Section 11.07 Legal action.............................................................................................................................43 Section 11.08 Information Security................................................................................................................4339