Dental Plan Program Standards. 3. Section 2.13 (B)(ii), Encounter Data Reporting- General Requirements, is amended by INSERTING the following paragraph after the first paragraph of this section: “The Contractor will comply with the requirements of Section 6507 of the Patient Protection and Affordable Care Act of 2010 (P.L. 111-148), regarding “Mandatory State Use of National Correct Coding Initiatives,” including all applicable rules, regulations, and methodologies, as amended or modified, in accordance with EOHHS policy.”
Dental Plan Program Standards. 2.1 GENERAL This article describes the operational and financial standards with which Contractor must comply in full. The standards have been set to allow plans flexibility in their approach to meeting program objectives, while ensuring that the special needs of these populations are addressed. EOHHS and the Contractor will work collaboratively to build a successful program that will achieve the stated goals and requirements of EOHHS. EOHHS and the Contractor will engage in a planning period initiating at the start of this contract to address opportunities for program improvements. EOHHS agrees to purchase, and Contractor agrees to fulfill all requirements and to furnish or arrange for the delivery of, the scope of services as specified in this Article. In return for Capitation Payments (as defined in Sections 1.9 and 2.15 of this Agreement), the Contractor agrees to provide eligible members with the dental care and services described in this Article II and Attachment A hereto. Contractor shall furnish or arrange for the personnel, facilities, equipment, supplies, pharmaceuticals, and other items and expertise necessary for, or incidental to, the provision of dental care services specified below, at locations including, but not limited to, the entire State of Rhode Island, to Members covered by this agreement and enrolled with Contractor. In accordance with 42 CFR § 438.6, Contractor will provide or arrange for the provision of Covered Services under this Risk Contract. Contractor’s legal responsibility to EOHHS is to assure that all activities specified in this contract are carried out and will not be altered if a service is arranged by Contractor or provided by a subcontractor.
Dental Plan Program Standards
