Common use of FDR Agreement Provisions Clause in Contracts

FDR Agreement Provisions. The MCOP must ensure all FDR agreements include the following enforceable provisions: i. A description of the administrative services to be provided by the FDR and any requirements for the FDR to report information to the MCOP; ii. The beginning date and expiration date or automatic renewal clause for the arrangement, as well as applicable methods of extension, renegotiation, and termination; iii. Identification of the service area and Medicaid population the FDR will serve; iv. A provision stating that the FDR must release to the MCOP and ODM any information necessary for the MCOP to perform any of its obligations under the MCOP's provider agreement with ODM, including compliance with reporting and quality assurance requirements; v. A provision that the FDR's applicable facilities and records will be open to inspection by the MCOP, ODM, ODM's designee, or other entities as specified under the MCOP's provider agreement with ODM or in OAC rule; vi. A provision that the agreement is governed by and construed in accordance with all applicable state or federal laws, regulations, and contractual obligations of the MCOP; and that the agreement is automatically amended to conform to any changes in laws, regulations, and MCOP contractual obligations to ODM without the necessity for written amendment; vii. A provision that Medicaid-eligible members and ODM are not liable for any cost, payment, co-payment, cost-sharing, down payment, or similar charge, refundable or otherwise for services performed, including in the event the FDR or the MCOP cannot or will not pay for the administrative services. This provision does not prohibit waiver entities from collecting patient liability payments from MCOP members as specified in OAC rule 5160:1-6-07.1; viii. The procedures to be employed upon the ending, nonrenewal, or termination of the agreement, including, at a minimum, to promptly supply any documentation necessary for the settlement of any outstanding claims or services; ix. A provision that the FDR must abide by the MCOP's written policies regarding the False Claims Act and the detection and prevention of fraud, waste, and abuse; x. A provision that requires the FDR to adhere to all screening and disclosure requirements as described in Appendix I, Program Integrity; xi. A provision that the FDR and all employees of the FDR are subject to the applicable provider qualifications in OAC rule 5160-26-05; xii. For an FDR providing administrative services that result in direct contact with a Medicaid-eligible member, a provision that the FDR must meet the member information requirements as stated in this Agreement and identify, and where indicated, arrange pursuant to the mutually agreed upon policies and procedures between the MCOP and FDR for the following at no cost to the member or ODM: 1. Sign language services; 2. Oral interpretation; and 3. Auxiliary aids and services. xiii. For an FDR providing administrative services that result in the selection of providers, a provision that the MCOP retains the right to approve, suspend, or terminate any such selection; xiv. A provision that permits ODM or the MCOP to seek revocation of the MCOP's contractor with the FDR or other remedies as applicable if ODM or the MCOP determines that the FDR has not performed satisfactorily, or the arrangement is not in the best interest of the MCOP's members; xv. A provision stating that all provisions in an FDR agreement must conform to and be consistent with all of the provisions of the MCOP's provider agreement with ODM; xvi. A provision that all of the provisions applicable to the FDR under the MCOP's provider agreement with ODM supersede all applicable provisions in the FDR agreement. If a provision in an FDR agreement contradicts or is incompatible with any applicable provision in the MCOP's provider agreement with ODM, the applicable provision in the FDR agreement is rendered null and void, unenforceable, and without effect; xvii. A provision stating that all FDRs must fully assist and cooperate with the MCOP in fulfilling the MCOP's obligations under this Agreement; xviii. A provision that allows the MCOP, ODM, and XXX's designee to obtain and gather data, documents, and information from FDRs for purposes of an audit, evaluation, or inspection of its premises, physical facilities, equipment, books, records, contracts, computer or other electronic systems relating to its Medicaid members; and states that the right to audit will exist through ten years from the final date of the contract period or from the date of completion of any audit, whichever is later, for the purpose of any audit conducted by Ohio Auditor of State, pursuant to ORC Chapter 117; xix. A provision that requires FDRs to provide all data and information to the MCOP needed for the MCOP to provide complete reporting to ODM for the requirements and standards set forth in Appendix N, Compliance Actions; and xx. A provision stating that FDRs must provide any information that ODM requests for purposes of compliance assessments as described in Appendix N, Compliance Actions.

FDR Agreement Provisions. The MCOP MCP must ensure all FDR agreements include the following enforceable provisions: i. A description of the administrative services to be provided by the FDR and any requirements for the FDR to report information to the MCOPMCP; ii. The beginning date and expiration date or automatic renewal clause for the arrangement, as well as applicable methods of extension, renegotiation, and termination; iii. Identification of the service area and Medicaid population population, either "non-dual" or "non- dual and dual" the FDR will serve; iv. A provision stating that the FDR must release to the MCOP MCP and ODM any information necessary for the MCOP MCP to perform any of its obligations under the MCOP's MCP’s provider agreement with ODM, including compliance with reporting and quality assurance requirements; v. A provision that the FDR's applicable facilities and records will be open to inspection by the MCOPMCP, ODM, ODM's designee, or other entities as specified under the MCOP's MCP’s provider agreement with ODM or in OAC rule; vi. A provision that the agreement is governed by and construed in accordance with all applicable state or federal laws, regulations, and contractual obligations of the MCOPMCP; and that the agreement is automatically amended to conform to any changes in laws, regulations, and MCOP MCP contractual obligations to ODM without the necessity for written amendment; vii. A provision that Medicaid-eligible members and ODM are not liable for any cost, payment, co-payment, cost-sharing, down payment, or similar charge, refundable or otherwise for services performed, including in the event the FDR or the MCOP MCP cannot or will not pay for the administrative services. This provision does not prohibit waiver entities from collecting patient liability payments from MCOP MCP members as specified in OAC rule 5160:1-6-07.1; viii. The procedures to be employed upon the ending, nonrenewal, or termination of the agreement, including, at a minimum, to promptly supply any documentation necessary for the settlement of any outstanding claims or services; ix. A provision that the FDR must abide by the MCOP's MCP’s written policies regarding the False Claims Act and the detection and prevention of fraud, waste, and abuse; x. A provision that requires the FDR to adhere to all screening and disclosure requirements as described in Appendix I, Program Integrity; xi. A provision that the FDR and all employees of the FDR are subject to the applicable provider qualifications in OAC rule 5160-26-05; xii. For an FDR providing administrative services that result in direct contact with a Medicaid-eligible member, a provision that the FDR must meet the member information requirements as stated in this Agreement appendix and identify, and where indicated, arrange pursuant to the mutually agreed upon policies and procedures between the MCOP MCP and FDR for the following at no cost to the member or ODM: 1. Sign language services; 2. Oral interpretation; and 3. Auxiliary aids and services. xiii. For an FDR providing administrative services that result in the selection of providers, a provision that the MCOP MCP retains the right to approve, suspend, or terminate any such selection; xiv. A provision that permits ODM or the MCOP MCP to seek revocation of the MCOP's MCP’s contractor with the FDR or other remedies as applicable if ODM or the MCOP MCP determines that the FDR has not performed satisfactorily, or the arrangement is not in the best interest of the MCOP's MCP’s members; xv. A provision stating that all provisions in an FDR agreement must conform to and be consistent with all of the provisions of the MCOP's MCP’s provider agreement with ODM; xvi. A provision that all of the provisions applicable to the FDR under the MCOP's MCP’s provider agreement with ODM supersede all applicable provisions in the FDR agreement. If a provision in an FDR agreement contradicts or is incompatible with any applicable provision in the MCOP's MCP’s provider agreement with ODM, the applicable provision in the FDR agreement is rendered null and void, unenforceable, and without effect; xvii. A provision stating that all FDRs must fully assist and cooperate with the MCOP MCP in fulfilling the MCOP's MCP’s obligations under this the Ohio Medical Assistance Provider Agreement;; and xviii. A provision that allows the MCOPMCP, ODM, and XXX's designee to obtain and gather data, documents, and information from FDRs for purposes of an audit, evaluation, or inspection of its premises, physical facilities, equipment, books, records, contracts, computer or other electronic systems relating to its Medicaid members; and states that the right to audit will exist through ten years from the final date of the contract period or from the date of completion of any audit, whichever is later, for the purpose of any audit conducted by Ohio Auditor of State, pursuant to ORC Chapter 117; xix. A provision that requires FDRs to provide all data and information to the MCOP needed for the MCOP to provide complete reporting to ODM for the requirements and standards set forth in Appendix N, Compliance Actions; and xx. A provision stating that FDRs must provide any information that ODM requests for purposes of compliance assessments as described in Appendix N, Compliance Actions.

FDR Agreement Provisions. The MCOP must ensure all FDR agreements include the following enforceable provisions: i. A description of the administrative services to be provided by the FDR and any requirements for the FDR to report information to the MCOP; ii. The beginning date and expiration date or automatic renewal clause for the arrangement, as well as applicable methods of extension, renegotiation, and termination; iii. Identification of the service area and Medicaid population the FDR will serve; iv. A provision stating that the FDR must release to the MCOP and ODM any information necessary for the MCOP to perform any of its obligations under the MCOP's provider agreement with ODM, including compliance with reporting and quality assurance requirements; v. A provision that the FDR's applicable facilities and records will be open to inspection by the MCOP, ODM, ODM's designee, or other entities as specified under the MCOP's provider agreement with ODM or in OAC rule; vi. A provision that the agreement is governed by and construed in accordance with all applicable state or federal laws, regulations, and contractual obligations of the MCOP; and that the agreement is automatically amended to conform to any changes in laws, regulations, and MCOP contractual obligations to ODM without the necessity for written amendment; vii. A provision that Medicaid-eligible members and ODM are not liable for any cost, payment, co-co- payment, cost-sharing, down payment, or similar charge, refundable or otherwise for services performed, including in the event the FDR or the MCOP cannot or will not pay for the administrative services. This provision does not prohibit waiver entities from collecting patient liability payments from MCOP members as specified in OAC rule 5160:1-6-07.1; viii. The procedures to be employed upon the ending, nonrenewal, or termination of the agreement, including, at a minimum, to promptly supply any documentation necessary for the settlement of any outstanding claims or services; ix. A provision that the FDR must abide by the MCOP's written policies regarding the False Claims Act and the detection and prevention of fraud, waste, and abuse; x. A provision that requires the FDR to adhere to all screening and disclosure requirements as described in Appendix I, Program Integrity; xi. A provision that the FDR and all employees of the FDR are subject to the applicable provider qualifications in OAC rule 5160-26-05; xii. For an FDR providing administrative services that result in direct contact with a Medicaid-eligible member, a provision that the FDR must meet the member information requirements as stated in this Agreement and identify, and where indicated, arrange pursuant to the mutually agreed upon policies and procedures between the MCOP and FDR for the following at no cost to the member or ODM: 1. Sign language services; 2. Oral interpretation; and 3. Auxiliary aids and services. xiii. For an FDR providing administrative services that result in the selection of providers, a provision that the MCOP retains the right to approve, suspend, or terminate any such selection; xiv. A provision that permits ODM or the MCOP to seek revocation of the MCOP's contractor with the FDR or other remedies as applicable if ODM or the MCOP determines that the FDR has not performed satisfactorily, or the arrangement is not in the best interest of the MCOP's members; xv. A provision stating that all provisions in an FDR agreement must conform to and be consistent with all of the provisions of the MCOP's provider agreement with ODM; xvi. A provision that all of the provisions applicable to the FDR under the MCOP's provider agreement with ODM supersede all applicable provisions in the FDR agreement. If a provision in an FDR agreement contradicts or is incompatible with any applicable provision in the MCOP's provider agreement with ODM, the applicable provision in the FDR agreement is rendered null and void, unenforceable, and without effect; xvii. A provision stating that all FDRs must fully assist and cooperate with the MCOP in fulfilling the MCOP's obligations under this Agreement;; and xviii. A provision that allows the MCOP, ODM, and XXX's designee to obtain and gather data, documents, and information from FDRs for purposes of an audit, evaluation, or inspection of its premises, physical facilities, equipment, books, records, contracts, computer or other electronic systems relating to its Medicaid members; and states that the right to audit will exist through ten years from the final date of the contract period or from the date of completion of any audit, whichever is later, for the purpose of any audit conducted by Ohio Auditor of State, pursuant to ORC Chapter 117; xix. A provision that requires FDRs to provide all data and information to the MCOP needed for the MCOP to provide complete reporting to ODM for the requirements and standards set forth in Appendix N, Compliance Actions; and xx. A provision stating that FDRs must provide any information that ODM requests for purposes of compliance assessments as described in Appendix N, Compliance Actions.