Common use of Failure to Maintain Reporting Requirements Clause in Contracts

Failure to Maintain Reporting Requirements. In the event the Contractor or a Subcontractor fails to maintain its reporting obligations under this Contract, HCA reserves the right to withhold reimbursements to the Contractor until the obligations are met. Recovery of Costs Claimed in Error If the Contractor claims and HCA reimburses for expenditures under this Contract which HCA later finds were (1) claimed in error or (2) not allowable costs under the terms of the Contract, HCA shall recover those costs and the Contractor shall fully cooperate with the Recovery. Stop Placement HCA may stop the placement of Enrollee in a treatment facility immediately upon finding that the Contractor or a Subcontractor is not in substantial compliance, as determined by HCA, with provisions of the Contract or any WAC related to behavioral health treatment. The treatment facility will be notified by HCA of this decision in writing. Additional Remuneration Prohibited The Contractor shall not charge or accept additional fees from any Enrollee, relative, or any other person, for GFS services provided under this Contract other than those specifically authorized by HCA. The Contractor shall require its Subcontractors to adhere to this requirement. In the event the Contractor or Subcontractor charges or accepts prohibited fees, HCA shall have the right to assert a claim against the Contractor or Subcontractors on behalf of the client, per RCW 74.09. Any violation of this provision shall be deemed a material breach of this Contract. Overpayments or Underpayments If, at HCA’s sole discretion, HCA determines as a result of data errors or inadequacies, policy changes beyond the control of the Contractors, or other causes there are material errors or omissions in the allocation of GFS funds, HCA may make prospective and/or retrospective modifications to the allocations, as necessary. At the explicit written approval of HCA, the Contractor can elect to make a lump sum or similar arrangement for payment. Remedial Actions HCA may initiate remedial action if it is determined that any of the following situations exist: A problem exists that negatively impacts Enrollees receiving services. The Contractor has failed to perform any of the GFS services required in this Contract. The Contractor has failed to develop, produce, and/or deliver to HCA any of the statements, reports, data, data corrections, accountings, claims, and/or documentation described herein, in compliance with all the provisions of this Contract. The Contractor has failed to perform any administrative function required under this Contract. For the purposes of this section, “administrative function” is defined as any obligation other than the actual provision of Behavioral Health services. The Contractor has failed to implement corrective action required by the state and within HCA prescribed timeframes. HCA may impose any of the following remedial actions: Require the Contractor to develop and execute a corrective action plan. Corrective action plans developed by the Contractor must be submitted for approval to HCA within thirty (30) calendar days of notification. Corrective action plans may require modification of any policies or procedures by the Contractor relating to the fulfillment of its obligations pursuant to this Contract. HCA may extend or reduce the time allowed for corrective action depending upon the nature of the situation. Corrective action plans must include: A brief description of the situation requiring corrective action. The specific actions to be taken to remedy the situation. A timetable for completion of the actions. Identification of individuals responsible for implementation of the plan. Corrective action plans are subject to approval by HCA, which may: Accept the plan as submitted. Accept the plan with specified modifications. Request a modified plan. Reject the plan. HCA will withhold up to 5 percent of the next payment and each payment thereafter until the corrective action has achieved resolution. The amount of the withhold will be based on the severity of the situation as detailed in this section. HCA, at its sole discretion, may return a portion or all of any payments withheld once satisfactory resolution has been achieved. Increase withholdings identified above by up to an additional 3 percent for each successive month during which the remedial situation has not been resolved. Deny any incentive payment to which the Contractor might otherwise have been entitled under this Contract. Terminate for Default as described in the General Terms and Conditions. ACCESS TO CARE AND PROVIDER NETWORK

Failure to Maintain Reporting Requirements. In the event the Contractor or a Subcontractor fails to maintain its reporting obligations under this Contract, HCA reserves the right to withhold reimbursements to the Contractor until the obligations are met. Recovery of Costs Claimed in Error If the Contractor claims and HCA reimburses for expenditures under this Contract which HCA later finds were (1) claimed in error or (2) not allowable costs under the terms of the Contract, HCA shall recover those costs and the Contractor shall fully cooperate with the Recovery. Stop Placement HCA may stop the placement of Enrollee in a treatment facility immediately upon finding that the Contractor or a Subcontractor is not in substantial compliance, as determined by HCA, with provisions of the Contract or any WAC related to behavioral health treatment. The treatment facility will be notified by HCA of this decision in writing. Additional Remuneration Prohibited The Contractor shall not charge or accept additional fees from any Enrollee, relative, or any other person, for GFS services provided under this Contract other than those specifically authorized by HCA. The Contractor shall require its Subcontractors to adhere to this requirement. In the event the Contractor or Subcontractor charges or accepts prohibited fees, HCA shall have the right to assert a claim against the Contractor or Subcontractors on behalf of the client, per RCW 74.09. Any violation of this provision shall be deemed a material breach of this Contract. Overpayments or Underpayments If, at HCA’s sole discretion, HCA determines as a result of data errors or inadequacies, policy changes beyond the control of the Contractors, or other causes there are material errors or omissions in the allocation of GFS funds, HCA may make prospective and/or retrospective modifications to the allocations, as necessary. At the explicit written approval of HCA, the Contractor can elect to make a lump sum or similar arrangement for payment. Remedial Actions HCA may initiate remedial action if it is determined that any of the following situations exist: A problem exists that negatively impacts Enrollees receiving services. The Contractor has failed to perform any of the GFS services required in this Contract. The Contractor has failed to develop, produce, and/or deliver to HCA any of the statements, reports, data, data corrections, accountings, claims, and/or documentation described herein, in compliance with all the provisions of this Contract. The Contractor has failed to perform any administrative function required under this Contract. For the purposes of this section, “administrative function” is defined as any obligation other than the actual provision of Behavioral Health services. The Contractor has failed to implement corrective action required by the state and within HCA prescribed timeframes. HCA may impose any of the following remedial actions: Require the Contractor to develop and execute a corrective action plan. Corrective action plans developed by the Contractor must be submitted for approval to HCA within thirty (30) calendar days of notification. Corrective action plans may require modification of any policies or procedures by the Contractor relating to the fulfillment of its obligations pursuant to this Contract. HCA may extend or reduce the time allowed for corrective action depending upon the nature of the situation. Corrective action plans must include: A brief description of the situation requiring corrective action. The specific actions to be taken to remedy the situation. A timetable for completion of the actions. Identification of individuals responsible for implementation of the plan. Corrective action plans are subject to approval by HCA, which may: Accept the plan as submitted. Accept the plan with specified modifications. Request a modified plan. Reject the plan. HCA will withhold up to 5 percent of the next payment and each payment thereafter until the corrective action has achieved resolution. The amount of the withhold will be based on the severity of the situation as detailed in this section. HCA, at its sole discretion, may return a portion or all of any payments withheld once satisfactory resolution has been achieved. Increase withholdings identified above by up to an additional 3 percent for each successive month during which the remedial situation has not been resolved. Deny any incentive payment to which the Contractor might otherwise have been entitled under this Contract. Terminate for Default as described in the General Terms and Conditions. ACCESS TO CARE AND PROVIDER NETWORK.