CONTRACTOR/HHS RESPONSIBILITY Sample Clauses
The CONTRACTOR/HHS RESPONSIBILITY clause defines the respective duties and obligations of the contractor and the Department of Health and Human Services (HHS) under the contract. It typically outlines which party is responsible for specific tasks, deliverables, or compliance requirements, such as reporting, quality assurance, or regulatory adherence. By clearly delineating these responsibilities, the clause helps prevent misunderstandings and disputes, ensuring that both parties understand their roles and can be held accountable for their respective obligations.
CONTRACTOR/HHS RESPONSIBILITY. 1. The Contractor will not be responsible for the costs of covered health insurance claims filed by enrollees in the high risk pool program or for the administrative expenses of operating those programs to the extent that those claims and administrative expenses are in excess of the premiums collected by the high risk pool program. The Contractor will be responsible for operating the high risk pool program in accordance with the terms of the contract. HHS will pay or reimburse the Contractor for claims for covered services and for administrative expenses that are in excess of the premiums collected by the Contractor. Contractor agrees to use its best efforts, in consultation with HHS, to limit the amount of anticipated expenses to the amounts identified in this contract or any modification thereto, for Contractor’s operation of the high risk pool program.
2. The Contractor acknowledges that HHS, as are all Government agencies, is bound by certain laws limiting the available funds for programs and, in particular the appropriation set out in section 1101 of the Affordable Care Act, as may be amended from time to time. For this reason the Contractor has the following responsibilities:
(a) The Contractor shall notify HHS within 5 business days of reaching a number of active high risk pool enrollees that equals or exceeds 75% of the enrollment projected for the current time period in Table 2 of the Cost Proposal.
(b) As part of each monthly report, the Contractor will notify HHS if its available claims data indicate that the projected claims for the year to date would result in the Contractor exceeding the per member per month claims amounts projected in Table 2 of the Cost Proposal..
(c) The Contractor shall notify HHS within 5 business days of learning of any potential future development or event that is likely to cause the Contractor to exceed 75% of the projected enrollment, or is likely to cause the Contractor to project that Total Claims Against the Federal Fund Allotment would exceed the amounts as projected in Table 2 of the Cost Proposal.
3. In the event an action is brought against the Contractor in any court or administrative forum regarding the operation or performance of this Contract, the Contractor shall immediately, as described in paragraph G.18 of this Contract, notify HHS and provide a copy of the complaint and summons or other documentation to HHS. HHS will, upon notification and after consultation with the U.S. Department of Justice, determ...
CONTRACTOR/HHS RESPONSIBILITY. 1. The Contractor will not be responsible for the costs of covered health insurance claims filed by (or on behalf of) enrollees in the high risk pool program or for the administrative expenses of operating those programs to the extent that those claims and administrative expenses are in excess of the premiums collected by the high risk pool program. The Contractor will be responsible for operating the high risk pool program in accordance with the terms of the contract. HHS will pay or reimburse the Contractor for claims for covered services and for administrative expenses that are in excess of the premiums collected by the Contractor. Contractor agrees to use its best efforts, in consultation with HHS, to limit the amount of anticipated expenses to the amounts identified in this contract or any modification thereto, for Contractor’s operation of the high risk pool program.
2. The Contractor acknowledges that HHS, as are all Government agencies, is bound by certain laws limiting the available funds for programs and, in particular the appropriation set out in section 1101 of the Affordable Care Act, as may be amended from time to time. For this reason the Contractor has the following responsibilities:
(a) The Contractor must terminate coverage within 45 calendar days if notice to do so is provided by HHS. The Contractor shall not change the benefits provided to enrollees or the cost-sharing requirements for enrollees upon receipt of such notice, absent guidance provided by HHS.
(b) As part of each monthly report, the Contractor will provide HHS with an estimate of incurred liability through the most recent prior month of performance. The Contractor shall also notify HHS if its available claims data indicate that the projected claims for the option period to date would result in the Contractor exceeding the costs projected in the most recent Table 2 of the Cost Proposal.
3. In the event an action is brought against the Contractor in any court or administrative forum regarding the operation or performance of this Contract, the Contractor shall immediately, as described in section G.18 of this Contract, notify HHS and provide a copy of the complaint and summons or other documentation to HHS. HHS will, upon notification and after consultation with the U.S. Department of Justice, determine whether it will intervene in, or otherwise defend, the action brought against the Contractor and promptly notify the Contractor of this decision in writing.
4. The Contractor w...