Common use of Excluded Parties Clause in Contracts

Excluded Parties. ‌ 24 Provider is prohibited from paying with funds received under this Contract for goods and 25 services furnished, ordered, or prescribed by excluded individuals and entities SSA section 26 1903(i)(2) of the Act; 42 CFR 455.104, 455.106 and 1001.1901(b). 27 28 Provider shall monitor for excluded individuals and entities by: 30 7.11.1 Screening Provider and subcontractor’s employees and individuals and entities 31 with an ownership or control interest for excluded individuals and entities prior to 32 entering into a contractual or other relationship where the individual or entity 33 would benefit directly or indirectly from funds received under this Contract. 34 7.11.2 Screening monthly newly added Provider and subcontractor’s employees and 35 individuals and entities with an ownership or control interest for excluded 36 individuals and entities that would benefit directly or indirectly from funds 37 received under this Contract. 38 7.11.3 Screening monthly Provider and subcontractor’s employees and individuals and 39 entities with an ownership or control interest that would benefit from funds 40 received under this Contract for newly added excluded individuals and entities. 1 Report to North Sound BH-ASO: 3 7.11.4 Any excluded individuals and entities discovered in the screening within 10 4 business days; 5 7.11.5 Any payments made by Provider that directly or indirectly benefit excluded 6 individuals and entities and the recovery of such payments; 7 7.11.6 Any actions taken by Provider to terminate relationships with Provider and 8 subcontractor’s employees and individuals with an ownership or control interest 9 discovered in the screening; 10 7.11.7 Any Provider and subcontractor’s employees and individuals with an ownership or 11 control interest convicted of any criminal or civil offense described in SSA section 12 1128 within 10 business days of Provider becoming aware of the conviction; 13 7.11.8 Any subcontractor terminated for cause within 10 business days of the effective 14 date of termination to include full details of the reason for termination; 15 7.11.9 Any Provider and subcontractor’s individuals and entities with an ownership or 16 control interest. 18 Provider must provide a list with details of ownership and control no later than 30 days from 19 the date of ratification and shall keep the list up-to-date thereafter. 21 Provider will not make any payments for goods or services that directly or indirectly benefit 22 any excluded individual or entity. Provider will immediately recover any payments for goods 23 and services that benefit excluded individuals and entities it discovers. 25 Provider will immediately terminate any employment, contractual and control relationships 26 with an excluded individual and entity it discovers. 28 Civil monetary penalties may be imposed against Provider if it employs or enters into a 29 contract with an excluded individual or entity to provide goods or services to enrollees (SSA 30 section 1128A(a)(6) and 42 CFR 1003.102(a)(2)). 32 An individual or entity is considered to have an ownership or control interest if they have 33 direct or indirect ownership of five percent (5%) or more, or are a managing employee (i.e., a 34 general manager, business manager, administrator, or director) who exercises operational or 35 managerial control or who directly or indirectly conducts day-to-day operations (SSA section 36 1126(b), 42 CFR 455.104(a) and 1001.1001(a)(1)). 38 In addition, if North Sound BH-ASO/MCO/HCA notifies Provider that an individual or entity is 39 excluded from participation by HCA, Provider shall terminate all beneficial, employment, 40 contractual and control relationships with the excluded individual or entity immediately. 41 42 The list of excluded individuals will be found at: xxxx://xxxxxxxxxx.xxx.xxx.xxx/. 43 44 SSA section 1128 will be found at: xxxx://xxx.xxx.xxx/OP_Home/ssact/title11/1128.htm.

Excluded Parties. ‌ 24 16 Provider is prohibited from paying with funds received under this Contract for goods and 25 17 services furnished, ordered, or prescribed by excluded individuals and entities SSA section 26 18 1903(i)(2) of the Act; 42 CFR 455.104, 455.106 and 1001.1901(b). 27 28 19 20 Provider shall monitor for excluded individuals and entities by: 30 22 7.11.1 Screening Provider and subcontractor’s employees and individuals and entities 31 with 23 an ownership or control interest for excluded individuals and entities prior to 32 24 entering into a contractual or other relationship where the individual or entity 33 25 would benefit directly or indirectly from funds received under this Contract. 34 26 7.11.2 Screening monthly newly added Provider and subcontractor’s employees and 35 27 individuals and entities with an ownership or control interest for excluded 36 28 individuals and entities that would benefit directly or indirectly from funds 37 received 29 under this Contract. 38 30 7.11.3 Screening monthly Provider and subcontractor’s employees and individuals and 39 31 entities with an ownership or control interest that would benefit from funds 40 32 received under this Contract for newly added excluded individuals and entities. 1 34 Report to North Sound BH-ASO: 3 36 7.11.4 Any excluded individuals and entities discovered in the screening within 10 4 business 37 days; 5 38 7.11.5 Any payments made by Provider that directly or indirectly benefit excluded 6 39 individuals and entities and the recovery of such payments; 7 40 7.11.6 Any actions taken by Provider to terminate relationships with Provider and 8 41 subcontractor’s employees and individuals with an ownership or control interest 9 42 discovered in the screening; 10 1 7.11.7 Any Provider and subcontractor’s employees and individuals with an ownership or 11 2 control interest convicted of any criminal or civil offense described in SSA section 12 3 1128 within 10 business days of Provider becoming aware of the conviction; 13 4 7.11.8 Any subcontractor terminated for cause within 10 business days of the effective 14 5 date of termination to include full details of the reason for termination; 15 6 7.11.9 Any Provider and subcontractor’s individuals and entities with an ownership or 16 7 control interest. 18 9 Provider must provide a list with details of ownership and control no later than 30 days from 19 10 the date of ratification and shall keep the list up-to-date thereafter. 21 12 Provider will not make any payments for goods or services that directly or indirectly benefit 22 13 any excluded individual or entity. Provider will immediately recover any payments for goods 23 14 and services that benefit excluded individuals and entities it discovers. 25 16 Provider will immediately terminate any employment, contractual and control relationships 26 17 with an excluded individual and entity it discovers. 28 19 Civil monetary penalties may be imposed against Provider if it employs or enters into a 29 20 contract with an excluded individual or entity to provide goods or services to enrollees (SSA 30 21 section 1128A(a)(6) and 42 CFR 1003.102(a)(2)). 32 23 An individual or entity is considered to have an ownership or control interest if they have 33 24 direct or indirect ownership of five percent (5%) or more, or are a managing employee (i.e., a 34 25 general manager, business manager, administrator, or director) who exercises operational or 35 26 managerial control or who directly or indirectly conducts day-to-day operations (SSA section 36 27 1126(b), 42 CFR 455.104(a) and 1001.1001(a)(1)). 38 29 In addition, if North Sound BH-ASO/MCO/HCA ASO notifies Provider that an individual or entity is 39 excluded 30 from participation by HCAan authorized authority, Provider shall terminate all beneficial, 31 employment, 40 contractual and control relationships with the excluded individual or entity 32 immediately. 41 42 34 The list of excluded individuals will be found at: xxxx://xxxxxxxxxx.xxx.xxx.xxx/. 43 44 36 SSA section 1128 will be found at: xxxx://xxx.xxx.xxx/OP_Home/ssact/title11/1128.htm. 38 7.12 DECLARATION THAT INDIVIDUALS UNDER THE MEDICAID AND OTHER BEHAVIORAL HEALTH‌ 39 PROGRAMS ARE NOT THIRD-PARTY BENEFICIARIES UNDER THIS CONTRACT 40 Although North Sound BH-ASO, Provider and subcontractors mutually recognize that services 41 under this Contract may be provided by Provider and subcontractors to individuals under the 42 Medicaid program, RCW 71.05 and 71.34 and the Community Behavioral Health Services Act, 43 RCW 71.24, it is not the intention of either North Sound BH-ASO or Provider, that such 44 individuals, or any other persons, occupy the position of intended third-party beneficiaries of 1 the obligations assumed by either party to this Contract. Such third parties shall have no right 2 to enforce this Contract.

Excluded Parties. ‌ 24 16 Provider is prohibited from paying with funds received under this Contract for goods and 25 17 services furnished, ordered, or prescribed by excluded individuals and entities SSA section 26 18 1903(i)(2) of the Act; 42 CFR 455.104, 455.106 and 1001.1901(b). 27 28 19 20 Provider shall monitor for excluded individuals and entities by: 30 22 7.11.1 Screening Provider and subcontractor’s employees and individuals and entities 31 with 23 an ownership or control interest for excluded individuals and entities prior to 32 24 entering into a contractual or other relationship where the individual or entity 33 would 25 benefit directly or indirectly from funds received under this Contract. 34 26 7.11.2 Screening monthly newly added Provider and subcontractor’s employees and 35 27 individuals and entities with an ownership or control interest for excluded 36 individuals 28 and entities that would benefit directly or indirectly from funds 37 received under this 29 Contract. 38 30 7.11.3 Screening monthly Provider and subcontractor’s employees and individuals and 39 31 entities with an ownership or control interest that would benefit from funds 40 received 32 under this Contract for newly added excluded individuals and entities. 1 34 Report to North Sound BH-ASO: 3 36 7.11.4 Any excluded individuals and entities discovered in the screening within 10 4 business 37 days; 5 38 7.11.5 Any payments made by Provider that directly or indirectly benefit excluded 6 39 individuals and entities and the recovery of such payments; 7 40 7.11.6 Any actions taken by Provider to terminate relationships with Provider and 8 41 subcontractor’s employees and individuals with an ownership or control interest 9 42 discovered in the screening; 10 1 7.11.7 Any Provider and subcontractor’s employees and individuals with an ownership or 11 2 control interest convicted of any criminal or civil offense described in SSA section 12 3 1128 within 10 business days of Provider becoming aware of the conviction; 13 4 7.11.8 Any subcontractor terminated for cause within 10 business days of the effective 14 date 5 of termination to include full details of the reason for termination; 15 6 7.11.9 Any Provider and subcontractor’s individuals and entities with an ownership or 16 7 control interest. 18 9 Provider must provide a list with details of ownership and control no later than 30 days from 19 10 the date of ratification and shall keep the list up-to-date thereafter. 21 12 Provider will not make any payments for goods or services that directly or indirectly benefit 22 13 any excluded individual or entity. Provider will immediately recover any payments for goods 23 14 and services that benefit excluded individuals and entities it discovers. 25 16 Provider will immediately terminate any employment, contractual and control relationships 26 17 with an excluded individual and entity it discovers. 28 19 Civil monetary penalties may be imposed against Provider if it employs or enters into a 29 20 contract with an excluded individual or entity to provide goods or services to enrollees (SSA 30 21 section 1128A(a)(6) and 42 CFR 1003.102(a)(2)). 32 23 An individual or entity is considered to have an ownership or control interest if they have 33 24 direct or indirect ownership of five percent (5%) or more, or are a managing employee (i.e., a 34 25 general manager, business manager, administrator, or director) who exercises operational or 35 26 managerial control or who directly or indirectly conducts day-to-day operations (SSA section 36 27 1126(b), 42 CFR 455.104(a) and 1001.1001(a)(1)). 38 29 In addition, if North Sound BH-ASO/MCO/HCA notifies Provider that an individual or entity is 39 30 excluded from participation by HCA, Provider shall terminate all beneficial, employment, 40 31 contractual and control relationships with the excluded individual or entity immediately. 41 42 33 The list of excluded individuals will be found at: xxxx://xxxxxxxxxx.xxx.xxx.xxx/. 43 44 34 35 SSA section 1128 will be found at: xxxx://xxx.xxx.xxx/OP_Home/ssact/title11/1128.htm. 37 7.12 DECLARATION THAT INDIVIDUALS UNDER THE MEDICAID AND OTHER BEHAVIORAL HEALTH‌ 38 PROGRAMS ARE NOT THIRD-PARTY BENEFICIARIES UNDER THIS CONTRACT 39 Although North Sound BH-ASO, Provider and subcontractors mutually recognize that services 40 under this Contract may be provided by Provider and subcontractors to individuals under the 41 Medicaid program, RCW 71.05 and 71.34 and the Community Behavioral Health Services Act, 42 RCW 71.24, it is not the intention of either North Sound BH-ASO or Provider, that such 43 individuals, or any other persons, occupy the position of intended third-party beneficiaries of 1 the obligations assumed by either party to this Contract. Such third parties shall have no right 2 to enforce this Contract.

Excluded Parties. ‌ 24 16 Provider is prohibited from paying with funds received under this Contract for goods and 25 17 services furnished, ordered, or prescribed by excluded individuals and entities SSA section 26 18 1903(i)(2) of the Act; 42 CFR 455.104, 455.106 and 1001.1901(b). 27 28 19 20 Provider shall monitor for excluded individuals and entities by: 30 22 7.11.1 Screening Provider and subcontractor’s employees and individuals and entities 31 with 23 an ownership or control interest for excluded individuals and entities prior to 32 24 entering into a contractual or other relationship where the individual or entity 33 would 25 benefit directly or indirectly from funds received under this Contract. 34 26 7.11.2 Screening monthly newly added Provider and subcontractor’s employees and 35 27 individuals and entities with an ownership or control interest for excluded 36 individuals 28 and entities that would benefit directly or indirectly from funds 37 received under this 29 Contract. 38 30 7.11.3 Screening monthly Provider and subcontractor’s employees and individuals and 39 31 entities with an ownership or control interest that would benefit from funds 40 received 32 under this Contract for newly added excluded individuals and entities. 1 34 Report to North Sound BH-ASO: 3 36 7.11.4 Any excluded individuals and entities discovered in the screening within 10 4 business 37 days; 5 38 7.11.5 Any payments made by Provider that directly or indirectly benefit excluded 6 39 individuals and entities and the recovery of such payments; 7 40 7.11.6 Any actions taken by Provider to terminate relationships with Provider and 8 41 subcontractor’s employees and individuals with an ownership or control interest 9 42 discovered in the screening; 10 1 7.11.7 Any Provider and subcontractor’s employees and individuals with an ownership or 11 2 control interest convicted of any criminal or civil offense described in SSA section 12 3 1128 within 10 business days of Provider becoming aware of the conviction; 13 4 7.11.8 Any subcontractor terminated for cause within 10 business days of the effective 14 date 5 of termination to include full details of the reason for termination; 15 6 7.11.9 Any Provider and subcontractor’s individuals and entities with an ownership or 16 7 control interest. 18 9 Provider must provide a list with details of ownership and control no later than 30 days from 19 10 the date of ratification and shall keep the list up-to-date thereafter. 21 If the provider is a 11 government entity this requirement does not apply. 13 Provider will not make any payments for goods or services that directly or indirectly benefit 22 14 any excluded individual or entity. Provider will immediately recover any payments for goods 23 15 and services that benefit excluded individuals and entities it discovers. 25 17 Provider will immediately terminate any employment, contractual and control relationships 26 18 with an excluded individual and entity it discovers. 28 20 Civil monetary penalties may be imposed against Provider if it employs or enters into a 29 21 contract with an excluded individual or entity to provide goods or services to enrollees (SSA 30 22 section 1128A(a)(6) and 42 CFR 1003.102(a)(2)). 32 24 An individual or entity is considered to have an ownership or control interest if they have 33 25 direct or indirect ownership of five percent (5%) or more, or are a managing employee (i.e., a 34 26 general manager, business manager, administrator, or director) who exercises operational or 35 27 managerial control or who directly or indirectly conducts day-to-day operations (SSA section 36 28 1126(b), 42 CFR 455.104(a) and 1001.1001(a)(1)). 38 30 In addition, if North Sound BH-ASO/MCO/HCA notifies Provider that an individual or entity is 39 31 excluded from participation by HCA, Provider shall terminate all beneficial, employment, 40 32 contractual and control relationships with the excluded individual or entity immediately. 41 42 34 The list of excluded individuals will be found at: xxxx://xxxxxxxxxx.xxx.xxx.xxx/. 43 44 36 SSA section 1128 will be found at: xxxx://xxx.xxx.xxx/OP_Home/ssact/title11/1128.htm. 38 7.12 DECLARATION THAT INDIVIDUALS UNDER THE MEDICAID AND OTHER BEHAVIORAL HEALTH‌ 39 PROGRAMS ARE NOT THIRD-PARTY BENEFICIARIES UNDER THIS CONTRACT 40 Although North Sound BH-ASO, Provider and subcontractors mutually recognize that services 41 under this Contract may be provided by Provider and subcontractors to individuals under the 42 Medicaid program, RCW 71.05 and 71.34 and the Community Behavioral Health Services Act, 43 RCW 71.24, it is not the intention of either North Sound BH-ASO or Provider, that such 44 individuals, or any other persons, occupy the position of intended third-party beneficiaries of 1 the obligations assumed by either party to this Contract. Such third parties shall have no right 2 to enforce this Contract.

Excluded Parties. ‌ 24 Provider is prohibited from paying with funds received under this Contract for goods and 25 services furnished, ordered, or prescribed by excluded individuals and entities SSA section 26 1903(i)(2) of the Act; 42 CFR 455.104, 455.106 and 1001.1901(b)). 27 28 Provider shall monitor for excluded individuals and entities by: 30 7.11.1 Screening Provider and subcontractor’s employees and individuals and entities 31 with an ownership or control interest for excluded individuals and entities prior to 32 entering into a contractual or other relationship where the individual or entity 33 would benefit directly or indirectly from funds received under this Contract. 34 7.11.2 Screening monthly newly added Provider and subcontractor’s employees and 35 individuals and entities with an ownership or control interest for excluded 36 individuals and entities that would benefit directly or indirectly from funds 37 received under this Contract. 38 7.11.3 Screening monthly Provider and subcontractor’s employees and individuals and 39 entities with an ownership or control interest that would benefit from funds 40 received under this Contract for newly added excluded individuals and entities. 1 Report to North Sound BH-ASO: 3 7.11.4 Any excluded individuals and entities discovered in the screening within 10 4 business days; 5 7.11.5 Any payments made by Provider that directly or indirectly benefit excluded 6 individuals and entities and the recovery of such payments; 7 7.11.6 Any actions taken by Provider to terminate relationships with Provider and 8 subcontractor’s employees and individuals with an ownership or control interest 9 discovered in the screening; 10 7.11.7 Any Provider and subcontractor’s employees and individuals with an ownership or 11 control interest convicted of any criminal or civil offense described in SSA section 12 1128 within with 10 business days of Provider becoming aware of the conviction; 13 7.11.8 Any subcontractor terminated for cause within 10 business days of the effective 14 date of termination to include full details of the reason for termination; 15 7.11.9 Any Provider and subcontractor’s individuals and entities with an ownership or 16 control interest. 18 Provider must provide a list with details of ownership and control no later than 30 days from 19 the date of ratification and shall keep the list up-to-up to date thereafter. 21 Provider will not make any payments for goods or services that directly or indirectly benefit 22 any excluded individual or entity. Provider will immediately recover any payments for goods 23 and services that benefit excluded individuals and entities it discovers. 25 Provider will immediately terminate any employment, contractual and control relationships 26 with an excluded individual and entity it discovers. 28 Civil monetary penalties may be imposed against Provider if it employs or enters into a 29 contract with an excluded individual or entity to provide goods or services to enrollees (SSA 30 section 1128A(a)(6) and 42 CFR 1003.102(a)(2)). 32 An individual or entity is considered to have an ownership or control interest if they have 33 direct or indirect ownership of five percent (5%) or more, or are a managing employee (i.e., a 34 general manager, business manager, administrator, or director) who exercises operational or 35 managerial control or who directly or indirectly conducts day-to-day operations (SSA section 36 1126(b), 42 CFR 455.104(a) and 1001.1001(a)(1)). 38 In addition, if North Sound BH-ASO/MCO/HCA notifies Provider that an individual or entity is 39 excluded from participation by HCA, Provider shall terminate all beneficial, employment, 40 contractual and control relationships with the excluded individual or entity immediately. 41 42 The list of excluded individuals will be found at: xxxx://xxxxxxxxxx.xxx.xxx.xxx/. 43 44 SSA section 1128 will be found at: xxxx://xxx.xxx.xxx/OP_Home/ssact/title11/1128.htm.