Common use of Financial Accounting Requirements Clause in Contracts

Financial Accounting Requirements. The Contractor shall maintain separate accounting records for the Hoosier Healthwise line of business that incorporates performance and financial data of subcontractors, as appropriate, particularly risk-bearing subcontractors. The Contractor’s accounting records shall be maintained in accordance with the IDOI requirements. If the Contractor does not provide Hoosier Healthwise-specific information, FSSA may terminate the Contract. The Contractor shall provide documentation that its accounting records are compliant with IDOI standards. The Contractor shall make full disclosure, and the State shall review, ownership and control information for the Contractor and any subcontracting entities or providers as required by 42 CFR 455.100-106, as directed in the Hoosier Healthwise MCE Policies and Procedures Manual and as required by 42 CFR 438.604(a)(6), 42 CFR 438.606, 42 CFR 455.104(b)(1)(i)-(iii), 42 CFR 455.104(b)(2)-(4), 42 CFR 438.230, and 42 CFR 438.608(c)(2). The Contractor shall notify FSSA of any person or corporation with five percent (5%) or more of ownership or controlling interest in the Contractor and shall submit financial statements for these individuals or corporations. The Contractor shall submit the date of birth and Social Security Number (SSN) of any individual with an ownership or controlling interest in the Contractor and its subcontractors. The Contractor shall submit other tax identification number of any corporation with an ownership or controlling interest in the Contractor and any subcontractor in which the Contractor has a five percent (5%) or more controlling interest. The Contractor shall submit the name and address of any person (individual or corporation) with an ownership or control interest in the Contractor. The address for corporate entities must include as applicable primary business address, every business location, and P.O. Box address. Annual audits shall include an actuarial opinion of the Contractor’s incurred but not received claims (IBNR) specific to the Hoosier Healthwise program. Authorized representatives or agents of the State and the federal government shall have access to the Contractor’s accounting records and the accounting records of its subcontractors upon reasonable notice and at reasonable times during the performance and/or retention period of the Contract for purposes of review, analysis, inspection, audit and/or reproduction. In addition, the Contractor shall file with the State Insurance Commissioner the financial and other information required by the IDOI. Copies of any accounting records pertaining to the Contract shall be made available by the Contractor within ten (10) calendar days of receiving a written request from the State for specified records. If such original documentation is not made available as requested, the Contractor shall provide transportation, lodging and subsistence at no cost, for all state and/or federal representatives to carry out their audit functions at the principal offices of the Contractor or other locations of such records. FSSA, IDOI, OMPP and other state and federal agencies and their respective authorized representatives or agents shall have access to all accounting and financial records of any individual, partnership, firm or corporation insofar as they relate to transactions with any department, board, commission, institution or other state or federal agency connected with the Contract. The Contractor shall maintain financial records pertaining to the Contract, including all claims records, for three (3) years following the end of the federal fiscal year during which the Contract is terminated, or when all state and federal audits of the Contract have been completed, whichever is later, in accordance with 42 CFR § 431.17, which sets retention and access requirements for records. Financial records should address matters of ownership, organization and operation of the Contractor's financial, medical and other record keeping systems. However, accounting records pertaining to the Contract shall be retained until final resolution of all pending audit questions and for one (1) year following the termination of any litigation relating to the Contract if the litigation has not terminated within the three (3) year period. In addition, FSSA requires Contractors to produce the following financial information, upon request: ▪ Tangible Net Equity (TNE) or Risk Based Capital at balance sheet date ▪ Cash and Cash Equivalents ▪ Claims payment, IBNR, reimbursement, fee for service claims, provider contracts by line of business ▪ Appropriate insurance coverage for medical malpractice, general liability, property, workers’ compensation and fidelity bond, in conformance with state and federal regulations ▪ Revenue Sufficiency by line of business/group ▪ Renewal Rates or Proposed Rates by line of business ▪ Corrective Action Plan Documentation and Implementation ▪ Financial, Cash Flow and Medical Expense Projections by line of business ▪ Underwriting Plan and Policy by line of business ▪ Premium Receivable Analysis by line of business ▪ Affiliate and Inter-company Receivables ▪ Current Liability Payables by line of business ▪ Medical Liabilities by line of business ▪ Copies of any correspondence to and from the IDOI

Financial Accounting Requirements. The Contractor shall maintain separate accounting records for the Hoosier Healthwise line of business that incorporates performance and financial data of subcontractors, as appropriate, particularly risk-bearing subcontractors. The Contractor’s accounting records shall be maintained in accordance with the IDOI requirements. If the Contractor does not provide Hoosier Healthwise-specific information, FSSA may terminate the Contract. The Contractor shall provide documentation that its accounting records are compliant with IDOI standards. The Contractor shall make full disclosure, and the State shall review, ownership and control information for the Contractor and any subcontracting entities or providers as required by 42 CFR 455.100-106, as directed in the Hoosier Healthwise MCE Policies and Procedures Manual and as required by 42 CFR 438.604(a)(6), 42 CFR 438.606, 42 CFR 455.104(b)(1)(i)-(iii455.104(b)(1), 42 CFR 455.104(b)(2)-(4455.104(b)(2)- (4), 42 CFR 438.230, and 42 CFR 438.608(c)(2438.608(c). The Contractor shall notify FSSA of any person or corporation with five percent (5%) or more of ownership or controlling interest in the Contractor and shall submit financial statements for these individuals or corporations. The Contractor shall submit the date of birth and Social Security Number (SSN) of any individual with an ownership or controlling interest in the Contractor and its subcontractors. The Contractor shall submit other tax identification number of any corporation with an ownership or controlling interest in the Contractor and any subcontractor in which the Contractor has a five percent (5%) or more controlling interest. The Contractor shall submit the name and address of any person (individual or corporation) with an ownership or control interest in the Contractor. The address for corporate entities must include as applicable primary business address, every business location, and P.O. Box address. Annual audits shall include an actuarial opinion of the Contractor’s incurred but not received claims (IBNR) specific to the Hoosier Healthwise program. Authorized representatives or agents of the State and the federal government shall have access to the Contractor’s accounting records and the accounting records of its subcontractors upon reasonable notice and at reasonable times during the performance and/or retention period of the Contract for purposes of review, analysis, inspection, audit and/or reproduction. In addition, the Contractor shall file with the State Insurance Commissioner the financial and other information required by the IDOI. Copies of any accounting records pertaining to the Contract shall be made available by the Contractor within ten (10) calendar days of receiving a written request from the State for specified records. If such original documentation is not made available as requested, the Contractor shall provide transportation, lodging and subsistence at no cost, for all state and/or federal representatives to carry out their audit functions at the principal offices of the Contractor or other locations of such records. FSSA, IDOI, OMPP and other state and federal agencies and their respective authorized representatives or agents shall have access to all accounting and financial records of any individual, partnership, firm or corporation insofar as they relate to transactions with any department, board, commission, institution or other state or federal agency connected with the Contract. The Contractor shall maintain financial records pertaining to the Contract, including all claims records, for three (3) years following the end of the federal fiscal year during which the Contract is terminated, or when all state and federal audits of the Contract have been completed, whichever is later, in accordance with 42 45 CFR § 431.1775.361, which sets retention and access requirements for records. Financial records should address matters of ownership, organization and operation of the Contractor's financial, medical and other record keeping systems. However, accounting records pertaining to the Contract shall be retained until final resolution of all pending audit questions and for one (1) year following the termination of any litigation relating to the Contract if the litigation has not terminated within the three (3) year period. In addition, FSSA requires Contractors to produce the following financial information, upon request: ▪ • Tangible Net Equity (TNE) or Risk Based Capital at balance sheet date ▪ • Cash and Cash Equivalents ▪ • Claims payment, IBNR, reimbursement, fee for service claims, provider contracts by line of business ▪ • Appropriate insurance coverage for medical malpractice, general liability, property, workers’ compensation and fidelity bond, in conformance with state and federal regulations ▪ • Revenue Sufficiency by line of business/group ▪ • Renewal Rates or Proposed Rates by line of business ▪ • Corrective Action Plan Documentation and Implementation ▪ • Financial, Cash Flow and Medical Expense Projections by line of business ▪ • Underwriting Plan and Policy by line of business ▪ • Premium Receivable Analysis by line of business ▪ • Affiliate and Inter-company Receivables ▪ • Current Liability Payables by line of business ▪ • Medical Liabilities by line of business ▪ • Copies of any correspondence to and from the IDOI

Financial Accounting Requirements. The Contractor shall maintain separate accounting records for the Hoosier Healthwise PathWays line of business that incorporates performance and financial data of subcontractors, as appropriate, particularly risk-bearing subcontractors. The Contractor’s accounting records shall be maintained in accordance with the IDOI requirements. If the Contractor does not provide Hoosier HealthwisePathWays-specific information, FSSA may terminate the Contract. The Contractor shall provide documentation that its accounting records are compliant with IDOI standards. The Contractor shall make full disclosure, and the State shall review, ownership and control information for the Contractor and Contractor, any subcontracting entities or providers as required by 42 CFR 455.100-106, 455.100 through 455.106 as directed in the Hoosier Healthwise MCE Policies and Procedures Manual and as required by 42 CFR 438.604(a)(6), 42 CFR 438.606, 42 CFR 455.104(b)(1)(i)-(iii455.104(b)(1), and 42 CFR 455.104(b)(2)-(4), 42 CFR 438.230, and 42 CFR 438.608(c)(2438.608(c). The Contractor shall notify FSSA of any person or corporation with five percent (5%) or more of ownership or controlling interest in the Contractor and shall submit financial statements for these individuals or corporations. The Per 42 CFR 455.104, the Contractor shall submit the date of birth and Social Security Number (SSN) of any individual with an ownership or controlling interest in the Contractor and its subcontractors. The Contractor shall submit other tax identification number of any corporation with an ownership or controlling interest in the Contractor and any subcontractor in which the Contractor has a five percent (5%) or more controlling interest. The Contractor shall submit the name and address of any person (individual or corporation) with an ownership or control interest in the Contractor. The address for corporate entities must include as applicable primary business address, every business location, and P.O. Box post office box address. Annual Additionally, annual audits shall include an annual actuarial opinion of the Contractor’s incurred but not received claims (IBNR) specific to the Hoosier Healthwise PathWays program. Authorized representatives or agents of the State and the federal government shall have access to the Contractor’s accounting records and the accounting records of its subcontractors upon reasonable notice and at reasonable times during the performance and/or retention period of the Contract for purposes of review, analysis, inspection, audit and/or reproduction. In addition, the Contractor shall file with the State Insurance Commissioner the financial and other information required by the IDOI. Copies of any accounting records pertaining to the Contract shall be made available by the Contractor within ten (10) calendar days of receiving a written request from the State for specified records. If such original documentation is not made available as requested, the Contractor shall provide transportation, lodging lodging, and subsistence at no cost, for all state and/or federal representatives to carry out their audit functions at the principal offices of the Contractor or other locations of such records. FSSA, IDOI, OMPP OMPP, and other state and federal agencies and their respective authorized representatives or agents shall have access to all accounting and financial records of any individual, partnership, firm or corporation insofar as they relate to transactions with any department, board, commission, institution or other state or federal agency connected with the Contract. The Contractor shall must maintain financial records pertaining to the Contract, including all claims records, for three (3) years following the end of the federal fiscal year during which the Contract is terminated, or when all state and federal audits of the Contract have been completed, whichever is later, in accordance with 42 CFR § 431.1775.361, which sets retention and access requirements for records. Financial records should address matters of ownership, organization organization, and operation of the Contractor's financial, medical and other record keeping systems. However, accounting records pertaining to the Contract shall be retained until final resolution of all pending audit questions and for one (1) year following the termination of any litigation relating to the Contract if the litigation has not terminated within the three (3) year period. In addition, FSSA requires Contractors to produce the following financial information, information upon request: ▪ o Tangible Net Equity (TNE) or Risk Based Capital at balance sheet date ▪ o Cash and Cash Equivalents ▪ o Claims payment, IBNRXXXX, reimbursement, fee for service claims, provider contracts by line of business ▪ o Appropriate insurance coverage for medical malpractice, general liabilityliability , property, workers’ compensation and fidelity bond, in conformance with state and federal regulations ▪ o Revenue Sufficiency by line of business/group ▪ o Renewal Rates or Proposed Rates by line of business ▪ o Corrective Action Plan Documentation and Implementation ▪ o Financial, Cash Flow Flow, and Medical Expense Projections by line of business ▪ o Underwriting Plan and Policy by line of business ▪ o Premium Receivable Analysis by line of business ▪ o Affiliate and Inter-company Receivables ▪ o Current Liability Payables by line of business ▪ o Medical Liabilities by line of business ▪ o Copies of any correspondence to and from the IDOI

Financial Accounting Requirements. The Contractor shall maintain separate accounting records for the Hoosier Healthwise PathWays line of business that incorporates performance and financial data of subcontractors, as appropriate, particularly risk-bearing subcontractors. The Contractor’s accounting records shall be maintained in accordance with the IDOI requirements. If the Contractor does not provide Hoosier HealthwisePathWays-specific information, FSSA may terminate the Contract. The Contractor shall provide documentation that its accounting records are compliant with IDOI standards. The Contractor shall make full disclosure, and the State shall review, ownership and control information for the Contractor and Contractor, any subcontracting entities or providers as required by 42 CFR 455.100-106, 455.100 through 455.106 as directed in the Hoosier Healthwise MCE Policies and Procedures Manual and as required by 42 CFR 438.604(a)(6), 42 CFR 438.606, 42 CFR 455.104(b)(1)(i)-(iii455.104(b)(1), and 42 CFR 455.104(b)(2)-(4), 42 CFR 438.230, and 42 CFR 438.608(c)(2438.608(c). The Contractor shall notify FSSA of any person or corporation with five percent (5%) or more of ownership or controlling interest in the Contractor and shall submit financial statements for these individuals or corporations. The Per 42 CFR 455.104, the Contractor shall submit the date of birth and Social Security Number (SSN) of any individual with an ownership or controlling interest in the Contractor and its subcontractors. The Contractor shall submit other tax identification number of any corporation with an ownership or controlling interest in the Contractor and any subcontractor in which the Contractor has a five percent (5%) or more controlling interest. The Contractor shall submit the name and address of any person (individual or corporation) with an ownership or control interest in the Contractor. The address for corporate entities must include as applicable primary business address, every business location, and P.O. Box post office box address. Annual Additionally, annual audits shall include an annual actuarial opinion of the Contractor’s incurred but not received claims (IBNR) specific to the Hoosier Healthwise PathWays program. Authorized representatives or agents of the State and the federal government shall have access to the Contractor’s accounting records and the accounting records of its subcontractors upon reasonable notice and at reasonable times during the performance and/or retention period of the Contract for purposes of review, analysis, inspection, audit and/or reproduction. In addition, the Contractor shall file with the State Insurance Commissioner the financial and other information required by the IDOI. Copies of any accounting records pertaining to the Contract shall be made available availabl e by the Contractor within ten (10) calendar days of receiving a written request from the State for specified records. If such original documentation is not made available as requested, the Contractor shall provide transportation, lodging lodging, and subsistence at no cost, for all state and/or federal representatives to carry out their audit functions at the principal offices of the Contractor or other locations of such records. FSSA, IDOI, OMPP OMPP, and other state and federal agencies and their respective authorized representatives or agents shall have access to all accounting and financial records of any individual, partnership, firm or corporation insofar as they relate to transactions with any department, board, commission, institution or other state or federal agency connected with the Contract. The Contractor shall must maintain financial records pertaining to the Contract, including all claims records, for three (3) years following the end of the federal fiscal year during which the Contract is terminated, or when all state and federal audits of the Contract have been completed, whichever is later, in accordance with 42 CFR § 431.1775.361, which sets retention and access requirements for records. Financial records should address matters of ownership, organization organization, and operation of the Contractor's financial, medical and other record keeping systems. However, accounting records pertaining to the Contract shall be retained until final resolution of all pending audit questions and for one (1) year following the termination of any litigation relating to the Contract if the litigation has not terminated within the three (3) year period. In addition, FSSA requires Contractors to produce the following financial information, information upon request: ▪ o Tangible Net Equity (TNE) or Risk Based Capital at balance sheet date ▪ o Cash and Cash Equivalents ▪ o Claims payment, IBNRXXXX, reimbursement, fee for service claims, provider contracts by line of business ▪ o Appropriate insurance coverage for medical malpractice, general liability, property, workers’ compensation and fidelity bond, in conformance with state and federal regulations ▪ o Revenue Sufficiency by line of business/group ▪ o Renewal Rates or Proposed Rates by line of business ▪ o Corrective Action Plan Documentation and Implementation ▪ o Financial, Cash Flow Flow, and Medical Expense Projections by line of business ▪ o Underwriting Plan and Policy by line of business ▪ o Premium Receivable Analysis by line of business ▪ o Affiliate and Inter-company Receivables ▪ o Current Liability Payables by line of business ▪ o Medical Liabilities by line of business ▪ o Copies of any correspondence to and from the IDOI

Financial Accounting Requirements. The Contractor shall maintain separate accounting records for the Hoosier Healthwise PathWays line of business that incorporates performance and financial data of subcontractors, as appropriate, particularly risk-bearing subcontractors. The Contractor’s accounting records shall be maintained in accordance with the IDOI requirements. If the Contractor does not provide Hoosier HealthwisePathWays-specific information, FSSA may terminate the Contract. The Contractor shall provide documentation that its accounting records are compliant with IDOI standards. The Contractor shall make full disclosure, and the State shall review, ownership and control information for the Contractor and Contractor, any subcontracting entities or providers as required by 42 CFR 455.100-106, 455.100 through 455.106 as directed in the Hoosier Healthwise MCE Policies and Procedures Manual and as required by 42 CFR 438.604(a)(6), 42 CFR 438.606, 42 CFR 455.104(b)(1)(i)-(iii455.104(b)(1), and 42 CFR 455.104(b)(2)-(4), 42 CFR 438.230, and 42 CFR 438.608(c)(2438.608(c). The Contractor shall notify FSSA of any person or corporation with five percent (5%) or more of ownership or controlling interest in the Contractor and shall submit financial statements for these individuals or corporations. The Per 42 CFR 455.104, the Contractor shall submit the date of birth and Social Security Number (SSN) of any individual with an ownership or controlling interest in the Contractor and its subcontractors. The Contractor shall submit other tax identification number of any corporation with an ownership or controlling interest in the Contractor and any subcontractor in which the Contractor has a five percent (5%) or more controlling interest. The Contractor shall submit the name and address of any person (individual or corporation) with an ownership or control interest in the Contractor. The address for corporate entities must include as applicable primary business address, every business location, and P.O. Box post office box address. Annual Additionally, annual audits shall include an annual actuarial opinion of the Contractor’s incurred but not received claims (IBNR) specific to the Hoosier Healthwise PathWays program. Authorized representatives or agents of the State and the federal government shall have access to the Contractor’s accounting records and the accounting records of its subcontractors upon reasonable notice and at reasonable times during the performance and/or retention period of the Contract for purposes of review, analysis, inspection, audit and/or reproduction. In addition, the Contractor shall file with the State Insurance Commissioner the financial and other information required by the IDOI. Copies of any accounting records pertaining to the Contract shall be made available by the Contractor within ten (10) calendar days of receiving a written request from the State for specified records. If such original documentation is not made available as requested, the Contractor shall provide transportation, lodging lodging, and subsistence at no cost, for all state and/or federal representatives to carry out their audit functions at the principal offices of the Contractor or other locations of such records. FSSA, IDOI, OMPP OMPP, and other state and federal agencies and their respective authorized representatives or agents shall have access to all accounting and financial records of any individual, partnership, firm or corporation insofar as they relate to transactions with any department, board, commission, institution or other state or federal agency connected with the Contract. The Contractor shall must maintain financial records pertaining to the Contract, including all claims records, for three (3) years following the end of the federal fiscal year during which the Contract is terminated, or when all state and federal audits of the Contract have been completed, whichever is later, in accordance with 42 CFR § 431.1775.361, which sets retention and access requirements for records. Financial records should address matters of ownership, organization organization, and operation of the Contractor's financial, medical and other record keeping systems. However, accounting records pertaining to the Contract shall be retained until final resolution of all pending audit questions and for one (1) year following the termination of any litigation relating to the Contract if the litigation has not terminated within the three (3) year period. In addition, FSSA requires Contractors to produce the following financial information, information upon request: ▪ o Tangible Net Equity (TNE) or Risk Based Capital at balance sheet date ▪ o Cash and Cash Equivalents ▪ o Claims payment, IBNRXXXX, reimbursement, fee for service claims, provider contracts by line of business ▪ o Appropriate insurance coverage for medical malpractice, general liability, property, workers’ compensation and fidelity bond, in conformance with state and federal regulations ▪ o Revenue Sufficiency by line of business/group ▪ o Renewal Rates or Proposed Rates by line of business ▪ o Corrective Action Plan Documentation and Implementation ▪ o Financial, Cash Flow Flow, and Medical Expense Projections by line of business ▪ o Underwriting Plan and Policy by line of business ▪ o Premium Receivable Analysis by line of business ▪ o Affiliate and Inter-company Receivables ▪ o Current Liability Payables by line of business ▪ o Medical Liabilities by line of business ▪ o Copies of any correspondence to and from the IDOI