Common use of Compliance with ILS Community Network and Managed Care Plan Policies and Procedures Clause in Contracts

Compliance with ILS Community Network and Managed Care Plan Policies and Procedures. Provider shall comply with all policies and procedures of ILS Community Network and Managed Care Plans including, without limitation, written standards for the following: (a) timeliness of access to care and Enrollee services; (b) policies and procedures that allow for individual medical necessity determinations (e.g., coverage rules, practice guidelines, payment policies); (c) Provider consideration of Enrollee input into Provider's proposed treatment plan; and (d) Managed Care Plan's accreditation standards; and (e) Managed Care Plan's compliance program which encourages effective communication between Provider and Managed Care Plan's Compliance Officer and participation by Provider in education and training programs regarding the prevention, correction and detection of fraud, waste and abuse and other initiatives identified by CMS. The aforementioned policies and procedures are identified in ILS Community Network and Managed Care Plan Provider Handbook and related Bulletins which are incorporated herein by reference and may be amended from time to time by ILS Community Network or Managed Care Plan. [42 C.F.R. § 422.112; 422.504(i)(4)(v); 42 C.F.R. § 422.202(b); 42 C.F.R. § 422.504(a)(5); 42 C.F.R. § 422.503(b)(4)(vi)(C) & (D) & (G)(3).]