CMS Responsibilities. 1.1 Nondiscrimination
1.1.1 The CM shall comply with Applicable Law regarding equal employment opportunity, including ORC Section
1.1.1.1 As required under ORC Section 153.59, the CM agrees to both of the following:
.1 “in the hiring of employees for the performance of work under the contract or any subcontract, no contractor, subcontractor, or any person acting on a contractor’s or subcontractor’s behalf, by reason of race, creed, sex, disability or military status as defined in section 4112.01 of the Revised Code, or color, shall discriminate against any citizen of the state in the employment of labor or workers who is qualified and available to perform the work to which the employment relates;” and
.2 “no contractor, subcontractor, or any person on a contractor’s or subcontractor’s behalf, in any manner, shall discriminate against or intimidate any employee hired for the performance of work under the contract on account of race, creed, sex, disability or military status as defined in section 4112.01 of the Revised Code, or color.”
1.1.1.2 The CM shall cooperate fully with the State’s Equal Opportunity Coordinator (“EOC”), with any other official or agency of the state or federal government that seeks to eliminate unlawful employment discrimination, and with all other state and federal efforts to assure equal employment practices under the Contract.
1.1.1.3 In the event the CM fails to comply with these nondiscrimination clauses, the Contracting Authority shall deduct from the amount payable to the CM a forfeiture of the statutory penalty pursuant to ORC 153.60 for each person who is discriminated against or intimidated in violation of this Section 1.1.1.
1.1.1.4 The Contract may be terminated or suspended in whole or in part by the Contracting Authority and all money to become due hereunder may be forfeited in the event of a subsequent violation of this Section 1.1.1.
CMS Responsibilities. Nondiscrimination
CMS Responsibilities. 1. CMS will develop and maintain the Hub to support activities described in this Agreement.
2. CMS will develop the appropriate form and manner of submission of data to and from the Hub.
3. CMS will develop procedures and conditions through and under which an AE may request information via the Hub from available data sources, which include but arenot limited to CMS, the Internal Revenue Service (IRS), Social Security Administration (SSA), Department of Homeland Security (DHS), Department of Veterans Affairs (VA), Department of Defense (DOD), Peace Corps (PC), Office Personnel Management (OPM), and commercial databases of income and employment, to support eligibilitydeterminations.
4. CMS will develop procedures through which an AE can request information via the Hub to support identity proofing for an Applicant or Application Filer prior to the release of matching data under this Agreement.
5. CMS will not use the Hub to transmit data to an authorized AE to support an eligibility determination, unless specifically authorized in Section IV of this Agreement.
6. CMS will provide Congress and the OMB with advance notice of this matching program and, upon completion of their advanced review period, will publish the required matching notice in the Federal Register.
CMS Responsibilities. 1. CMS will identify paid claims eligible for reimbursement under the Colorado Reinsurance Program (eligible claims) for services provided on or between January 1, 2020 to December 31, 2021. CMS will identify such claims from data submitted to “EDGE Servers” maintained by issuers offering coverage in the State of Colorado. CMS will identify such claims based on the parameters for the Colorado Reinsurance
CMS Responsibilities. 1. CMS agrees to provide USCIS with the following information for the purpose of immigration status or naturalized/derived citizenship verification: Alien Registration Number, I-94 number, or other identifier as defined in the Records Description in Section 6 of this Agreement, as applicable, of the Applicant or Enrollee seeking an Eligibility Determination.
2. If USCIS cannot verify immigration status on initial electronic verification (i.e., first step verification), Administering Entities will be prompted to institute additional verification, at which time the Administering Entity may submit the case for second step verification or may upload an electronic copy of the applicant’s immigration document if in accordance with the rules applicable to the Administering Entity for which the request is being made. If USCIS cannot verify immigration status on additional verification, Administering Entities will be prompted to submit the verification request for third level verification. If third level verification is required, Administering Entities will facilitate the transfer of the Applicant’s or Enrollee’s immigration documentation and the DHS form G-845 to USCIS. The SAVE Program requires copies of immigration documentation in order to conduct third-level verification. Administering Entities may submit such documentation via mail as an attachment to form G-845. See also Section IV(A)(4) regarding denying applications based on failure to verify immigration status.
3. If an Administering Entity is unable to comply with the prompts through the Hub, as described in Section IV(A)(2), the Administering Entity may implement an approved alternative verification method which may require an Administering Entity to review documents that demonstrate the applicants’ immigration status. Alternative verification methods should use the Administering Entities’ independent SAVE access methods to verify immigration and naturalized or derived citizenship status. Alternative access methods that do not use SAVE as an access method to verify immigration and naturalized or derived citizenship status cannot be considered to have received a determination from DHS as to whether the applicant’s information is consistent with information in DHS records. CMS agrees to provide USCIS with written descriptions of any alternative verification procedures, as appropriate, used by Administering Entities.
4. Administering Entities agree not to deny an application covered under this Agreement ba...
CMS Responsibilities. 1. CMS will develop and maintain the Hub to support activities described in this Agreement.
2. CMS will develop the appropriate form and manner of submission of data to and from the Hub.
3. CMS will develop procedures and conditions through and under which an AE may request information via the Hub from available data sources, which include but are not limited to CMS, the Internal Revenue Service (IRS), Social Security Administration (SSA), Department of Homeland Security (DHS), Department of Veterans Affairs (VA), Department of Defense (DOD), Peace Corps, Office Personnel Management (OPM), and commercial databases of income and employment, to support an Eligibility Determination.
4. CMS will develop procedures through which an AE can request information via the Hub to support identity proofing for an Applicant or Application Filer prior to the release of matching data under this Agreement.
5. CMS will not use the Hub to transmit data to an authorized AE to support an Eligibility Determination, unless specifically authorized in Section VI of this Agreement.
CMS Responsibilities. 1. CMS will identify paid claims eligible for reimbursement under the PA-RE program (eligible claims) for services provided on or between January 1, 2021 to December 31, 2025. CMS will identify such claims from data submitted to “EDGE Servers” maintained by issuers offering coverage in the Commonwealth of Pennsylvania. CMS will identify such claims based on the parameters for the Commonwealth of PA-RE Program as described in the state’s section 1332 waiver application approved on July 24, 2020, and as confirmed by PID as described under paragraph V.B.1 below.
2. CMS will calculate the total reinsurance payment due to an issuer on account of each eligible claim CMS identifies. CMS will provide PID a monthly report detailing the reinsurance payments on a cumulative basis to date owed to specific issuers under the PA-RE Program criteria by the 30th of the month.
3. CMS will perform development, implementation, maintenance, operations, and customer support work for the state for the activities outlined in section V.A.
4. The parties acknowledge and agree that CMS is not performing services under this Agreement in its capacity as a HIPAA covered entity. PID further acknowledges that no data or information CMS evaluates under this Agreement will constitute protected health information as defined by the Health Insurance Portability and Accountability Act of 1996 (HIPAA) or will otherwise constitute information protected by any Commonwealth of Pennsylvania law that would require CMS to comply with privacy and information security requirements or standards that are more onerous or stringent than the standards with which CMS complies as described in section XIII of this Agreement.
CMS Responsibilities. 1. Submission of Data (from an Administering Entity)
a. Prior to submitting a request to IRS, CMS must validate the social security number (SSN) of each Applicant, Medicaid/CHIP Beneficiary, Enrollee, or Relevant Taxpayer with the Social Security Administration (SSA) or through documentation of SSN provided by the Applicant, Medicaid/CHIP Beneficiary, Enrollee, or Relevant Taxpayer. Unvalidated SSNs will not be included in the request to IRS.
b. To submit a request for Household Income and Family Size to the IRS through the Hub, an Administering Entity must include the Relevant Taxpayer’s name, SSN, and the taxpayer relationship (primary, spouse, or dependent) to any Applicant, Enrollee, or Medicaid/CHIP Beneficiaries listed on an application.
c. As part of the initial application for Insurance Affordability Programs, the Administering Entity will give Applicants, Enrollees and/or Medicaid/CHIP Beneficiaries the option to obtain Return Information as part of the annual Redetermination and Renewal processes, for a period not to exceed 5 years based on a single authorization. Such option will be provided on the single-streamlined application for Eligibility Determinations. Applicants, Enrollees and Medicaid/CHIP Beneficiaries may also discontinue, change, or renew their authorization. Current Medicaid/CHIP Beneficiaries renewing coverage will be provided the option to obtain Return Information as part of the renewal Eligibility Determination. CMS must ensure Administering Entities maintain records that properly account for the option elected by each Applicant, Enrollee or Medicaid/CHIP Beneficiary, and will not obtain Return Information for use in annual Redeterminations for years in which the Applicant, Enrollee or Medicaid/CHIP Beneficiary did not authorize use of Return Information.
d. For each Enrollee or Medicaid/CHIP Beneficiary, at the time of their annual or periodic eligibility Redetermination or Renewal, the Relevant Taxpayer’s name, SSN, and the taxpayer relationship to any Applicants, Enrollees, or Medicaid/CHIP Beneficiaries on the application (primary, spouse, or dependent) must be submitted to IRS through the Hub.
e. Each Administering Entity must be uniquely identified when requesting Return Information so that authorization to receive Return Information is validated by IRS prior to disclosure to CMS. Administering Entities are authorized to receive Return Information via the Hub pursuant to this matching Agreement and through separately exec...
CMS Responsibilities. 2 See xxxxx://xxx.xxxxxxxxxxxxxxx.xxx/public-inspection/2021-20509/patient-protection-and-affordable-care-act- updating-payment-parameters-section-1332-waiver
1. CMS will identify paid claims eligible for reimbursement under the Commonwealth Health Reinsurance Program (eligible claims) for services provided each calendar year on or between January 1 of the calendar year to December 31 of that calendar year for the period January 1, 2023 to December 31, 2027. CMS will identify such claims from data submitted to “EDGE Servers” maintained by issuers offering coverage in the individual market in the State of Virginia. CMS will identify such claims based on the applicable calendar year parameters for the Commonwealth Health Reinsurance Program as described in the State’s section 1332 waiver application approved on May 18, 2022 , and as confirmed by the State as described under paragraph V.B.1
CMS Responsibilities. CMS will use the FCC-submitted electronic file(s) to conduct a data match in Medicaid and Children’s Health Insurance Program (CHIP) Business Information Solution (MACBIS) against Medicaid enrollment records maintained in the Transformed Medicaid Statistical Information System (T-MSIS) SOR, and return either a positive CMS match of enrollees, or a no-match-found response to FCC.
