Common use of HOOSIER HEALTHWISE SCOPE OF WORK Clause in Contracts

HOOSIER HEALTHWISE SCOPE OF WORK. provide shall monitor the financial stability of subcontractor(s) whose payments are equal to or greater than five percent (5%) of premium/revenue. The Contractor shall obtain the following information from the subcontractor at least quarterly and use it to monitor the subcontractor’s performance:  A statement of revenues and expenses  A balance sheet  Cash flows and changes in equity/fund balance  IBNR estimates At least annually, the Contractor must obtain the following additional information from the subcontractor and use this information to monitor the subcontractor’s performance: audited financial statements including statement of revenues and expenses, balance sheet, cash flows and changes in equity/fund balance and an actuarial opinion of the IBNR estimates. The Contractor shall make these documents available to OMPP upon request and OMPP reserves the right to review these documents during Contractor site visits. The Contractor shall comply with 42 CFR 438.230 and the following subcontracting requirements:  The Contractor shall obtain the approval of FSSA before subcontracting any portion of the project’s requirements. Subcontractors may include, but are not limited to a transportation broker, behavioral health organizations (BHOs) and Physician Hospital Organizations (PHOs). The Contractor shall give FSSA a written request and submit a draft contract or model provider agreement at least sixty (60) calendar days prior to the use of a subcontractor. If the Contractor makes subsequent changes to the duties included in the subcontractor contract, it shall notify FSSA sixty (60) calendar days prior to the revised contract effective date and submit the amendment for review and approval. FSSA must approve changes in vendors for any previously approved subcontracts.  The Contractor shall evaluate prospective subcontractors’ abilities to perform delegated activities prior to contracting with the subcontractor to perform services associated with the Hoosier Healthwise program.  The Contractor shall have a written agreement in place that specifies the subcontractor’s responsibilities and provides an option for revoking delegation or imposing other sanctions if performance is inadequate. The written agreement shall be in compliance with all the State of Indiana statutes, and will be subject to the provisions thereof. The subcontract cannot extend beyond the term of the State’s Contract with the Contractor.  The Contractor shall collect performance and financial data from its subcontractors and monitor delegated performance on an ongoing basis and conduct formal, periodic and random reviews, as directed by OMPP. The Contractor shall incorporate all subcontractors’ data into the Contractor’s performance and financial data for a comprehensive evaluation of the Contractor’s performance compliance and identify areas for its subcontractors’ improvement when appropriate. The Contractor shall take corrective action if deficiencies are identified during the review.

HOOSIER HEALTHWISE SCOPE OF WORK. provide shall monitor the financial stability of subcontractor(s) whose payments are equal to or greater than five percent (5%) of premium/revenue. The Contractor shall obtain the following information from the subcontractor at least quarterly and use it to monitor the subcontractor’s performance:  ▪ A statement of revenues and expenses  ▪ A balance sheet  ▪ Cash flows and changes in equity/fund balance  IBNR ▪ XXXX estimates At least annually, the Contractor must obtain the following additional information from the subcontractor and use this information to monitor the subcontractor’s performance: audited financial statements including statement of revenues and expenses, balance sheet, cash flows and changes in equity/fund balance and an actuarial opinion of the IBNR estimates. The Contractor shall make these documents available to OMPP upon request and OMPP reserves the right to review these documents during Contractor site visits. The Contractor shall comply with 42 CFR 438.230 and the following subcontracting requirements:  ▪ The Contractor shall obtain the approval of FSSA before subcontracting any portion of the project’s requirements. Subcontractors may include, but are not limited to a transportation broker, behavioral health organizations (BHOs) and Physician Hospital Organizations (PHOs). The Contractor shall give FSSA a written request and submit a draft contract or model provider agreement at least sixty (60) calendar days prior to the use of a subcontractor. If the Contractor makes subsequent changes to the duties included in the subcontractor contract, it shall notify FSSA sixty (60) calendar days prior to the revised contract effective date and submit the amendment for review and approval. FSSA must approve changes in vendors for any previously approved subcontracts.  ▪ The Contractor shall evaluate prospective subcontractors’ abilities to perform delegated activities prior to contracting with the subcontractor to perform services associated with the Hoosier Healthwise program.  ▪ The Contractor shall have a written agreement in place that specifies the subcontractor’s responsibilities and provides an option for revoking delegation or imposing other sanctions if performance is inadequate. The written agreement shall be in compliance with all the State of Indiana statutes, and will be subject to the provisions thereof. The subcontract cannot extend beyond the term of the State’s Contract with the Contractor.  ▪ The Contractor shall collect performance and financial data from its subcontractors and monitor delegated performance on an ongoing basis and conduct formal, periodic and random reviews, as directed by OMPP. The Contractor shall incorporate all subcontractors’ data into the Contractor’s performance and financial data for a comprehensive evaluation of the Contractor’s performance compliance and identify areas for its subcontractors’ improvement when appropriate. The Contractor shall take corrective action if deficiencies are identified during the review.