Insolvency Protection. The CONTRACTOR shall comply with and is subject to all applicable State and federal statutes and regulations, including those regarding solvency and risk standards. In addition to requirements imposed by State or federal law, the CONTRACTOR shall be required to meet specific Medicaid financial requirements and to present to HCA or its agent any information and records deemed necessary to determine its financial condition. The response to requests for information and records shall be delivered to HCA at no cost to HCA, in reasonable time from the date of request or as specified herein. The CONTRACTOR must be licensed or certified by the State as a risk-bearing entity. The CONTRACTOR shall establish and maintain a restricted insolvency protection account with a federally guaranteed financial institution licensed to do business in the State of New Mexico. The CONTRACTOR shall deposit, in the form of cash or securities or investments consistent with applicable state insurance laws, an amount equal to ninety percent (90%) of the total Capitation Payments paid to the CONTRACTOR in the first month of the contract year as determined by HCA. This provision shall remain in effect as long as the CONTRACTOR continues to contract with HCA. The insolvency protection account must be restricted to the CONTRACTOR's Turquoise Care program. The CONTRACTOR must satisfy this requirement no later than sixty (60) Calendar Days after notification by HCA of the deposit amount required. Thereafter, the CONTRACTOR shall maintain this account such that the balance is equal to no less than ninety (90%) percent of the average monthly capitation paid to the CONTRACTOR in the most recent quarter as determined by HCA. The CONTRACTOR shall provide a statement of the account balance to HCA within fifteen (15) Calendar Days after the most recent quarter end. If the account balance falls below the required amounts as determined by HCA, the CONTRACTOR has thirty (30) Calendar Days, after notification from HCA to increase the account balance to an amount no less than the required amount specified by HCA direction in 4.19.2.1.3 of this Agreement. The CONTRACTOR is permitted to withdraw interest or amounts in excess of the required account balance as determined by HCA from this account so long as the account balance after the withdrawal is not less than required amount as specified by HCA. The CONTRACTOR shall notify HCA in writing prior to withdrawal of funds from this account. Withdrawals may be made only with the prior written approval of HCA. The CONTRACTOR is prohibited from leveraging the insolvency account for another loan or creating other creditors by using this account as security. The CONTRACTOR shall deposit the assets with any organization or trustee, acceptable to the Superintendent of Insurance, through which a custodial or controlled account is utilized. In the event that a determination is made by HCA that the CONTRACTOR is insolvent under applicable state insurance law, HCA may draw upon the insolvency protection account. Funds may be disbursed to meet financial obligations incurred by the CONTRACTOR under this Agreement. A statement of account balance shall be provided by the CONTRACTOR within fifteen (15) Calendar Days of request of HCA. If the Agreement is terminated, expired or not continued, the account balance shall be released by HCA to the CONTRACTOR upon receipt of proof of satisfaction of all outstanding obligations incurred under this Agreement. In the event the Agreement is terminated or not renewed and the CONTRACTOR is insolvent, HCA may draw upon the insolvency protection account to pay any outstanding debts the CONTRACTOR owes HCA including but not limited to: Overpayments made to the CONTRACTOR, monetary penalties imposed under the Agreement, or a final order related to State requirements (e.g., overturned Appeal). In addition, if the Agreement is terminated or not renewed and the CONTRACTOR is unable to pay all of its outstanding debts to Providers, HCA and the CONTRACTOR agree to the court appointment of an impartial receiver for the purpose of administering and distributing the funds contained in the insolvency protection account. An appointed receiver shall give outstanding debts owed to HCA priority over other Claims subject to applicable state insurance law. HCA shall adjust this reserve requirement quarterly, as needed. The reserve account may be accessed by the CONTRACTOR solely for payment for Covered Services to the CONTRACTOR's Members in the event that the CONTRACTOR becomes insolvent. Funds in the insolvency protection account remains the property of the CONTRACTOR, including any interest earned, provided the requirement under Section 4.19.2.1 of this Agreement is satisfied. The CONTRACTOR shall be permitted to invest its funds in the account consistent with applicable state insurance regulations and guidelines. Failure to maintain the insolvency protection account as directed above will result in financial penalties equal to twenty-five percent (25%) of the shortfall in the account each month. The CONTRACTOR shall maintain, at all times, in the form of cash, investments that mature in less than one hundred eighty (180) Calendar Days and allowable as admitted assets by the CONTRACTOR's domiciliary State regulator and restricted funds of deposits controlled by HCA (including the CONTRACTOR's insolvency protection account), a surplus amount equal to the greater of one million five hundred thousand dollars ($1,500,000), ten percent (10%) of total liabilities or two percent (2%) of the annualized amount of the CONTRACTOR's capitation revenues. In the event that the CONTRACTOR's surplus falls below the amount specified in this paragraph, HCA shall prohibit the CONTRACTOR from engaging in community Outreach activities, shall cease to process new enrollments until the required balance is achieved, or may terminate the Agreement.
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Samples: Medicaid Managed Care Services Agreement, Medicaid Managed Care Services Agreement, Medicaid Managed Care Services Agreement
Insolvency Protection. The CONTRACTOR shall comply with and is subject to all applicable State and federal statutes and regulations, including those regarding solvency and risk standards. In addition to requirements imposed by State or federal law, the CONTRACTOR shall be required to meet specific Medicaid financial requirements and to present to HCA HSD or its agent any information and records deemed necessary to determine its financial condition. The response to requests for information and records shall be delivered to HCA HSD, at no cost to HCAHSD, in a reasonable time from the date of request or as specified herein. The CONTRACTOR must be licensed or certified by the State as a risk-bearing entity. The CONTRACTOR shall establish and maintain a restricted insolvency protection account with a federally guaranteed financial institution licensed to do business in the State of New Mexico. The CONTRACTOR shall deposit, in the form of cash or securities or investments consistent with applicable state insurance laws, an amount equal to ninety percent (90%) of the total Capitation Payments paid to the CONTRACTOR in the first month of the contract year as determined by HCAHSD. This provision shall remain in effect as long as the CONTRACTOR continues to contract with HCAHSD. The insolvency protection account must be restricted to the CONTRACTOR's Turquoise Care program. The CONTRACTOR must satisfy this requirement no later than sixty (60) Calendar Days after notification by HCA HSD of the deposit amount required. Thereafter, the CONTRACTOR shall maintain this account such that the balance is equal to no less than ninety (90%) percent of the average monthly capitation paid to the CONTRACTOR in the most recent quarter as determined by HCAHSD. The CONTRACTOR shall provide a statement of the account balance to HCA HSD within fifteen (15) Calendar Days after the most recent quarter end. If the account balance falls below the required amounts as determined by HCAHSD, the CONTRACTOR has thirty (30) Calendar Days, after notification from HCA HSD, to increase the account balance to an amount no less than the required amount specified by HCA direction in HSD and Section 4.19.2.1.3 of this Agreement. The CONTRACTOR is permitted to withdraw interest or amounts in excess of the required account balance as determined by HCA HSD from this account so long as the account balance after the withdrawal is not less than required amount as specified by HCAHSD. The CONTRACTOR shall notify HCA HSD in writing prior to withdrawal of funds from this account. Withdrawals may be made only with the prior written approval of HCAHSD. The CONTRACTOR is prohibited from leveraging the insolvency account for another loan or creating other creditors by using this account as security. The CONTRACTOR shall deposit the assets with any organization or trustee, acceptable to the Superintendent of Insurance, through which a custodial or controlled account is utilized. In the event that a determination is made by HCA HSD that the CONTRACTOR is insolvent under applicable state insurance law, HCA HSD may draw upon the insolvency protection account. Funds may be disbursed to meet financial obligations incurred by the CONTRACTOR under this Agreement. A statement of account balance shall be provided by the CONTRACTOR within fifteen (15) Calendar Days of request of HCAHSD. If the Agreement is terminated, expired or not continued, the account balance shall be released by HCA HSD to the CONTRACTOR upon receipt of proof of satisfaction of all outstanding obligations incurred under this Agreement. In the event the Agreement is terminated or not renewed and the CONTRACTOR is insolvent, HCA HSD may draw upon the insolvency protection account to pay any outstanding debts the CONTRACTOR owes HCA HSD, including but not limited to: Overpayments made to the CONTRACTOR, monetary penalties imposed under the Agreement, or a final order related to State requirements (e.g., overturned Appeal). In addition, if the Agreement is terminated or not renewed renewed, and the CONTRACTOR is unable to pay all of its outstanding debts to Providers, HCA HSD, and the CONTRACTOR agree to the court appointment of an impartial receiver for the purpose of administering and distributing the funds contained in the insolvency protection account. An appointed receiver shall give outstanding debts owed to HCA HSD priority over other Claims subject to applicable state insurance law. HCA HSD shall adjust this reserve requirement quarterly, as needed. The reserve account may be accessed by the CONTRACTOR solely for payment for Covered Services to the CONTRACTOR's Members in the event that the CONTRACTOR becomes insolvent. Funds in the insolvency protection account remains the property of the CONTRACTOR, including any interest earned, provided the requirement under Section 4.19.2.1 of this Agreement is satisfied. The CONTRACTOR shall be permitted to invest its funds in the account consistent with applicable state insurance regulations and guidelines. Failure to maintain the insolvency protection account as directed above will result in financial penalties equal to twenty-five percent (25%) of the shortfall in the account each month. The CONTRACTOR shall maintain, at all times, in the form of cash, investments that mature in less than one hundred eighty (180) Calendar Days and allowable as admitted assets by the CONTRACTOR's domiciliary State regulator and restricted funds of deposits controlled by HCA HSD (including the CONTRACTOR's insolvency protection account), a surplus amount equal to the greater of one million five hundred thousand dollars ($1,500,000), ten percent (10%) of total liabilities or two percent (2%) of the annualized amount of the CONTRACTOR's capitation revenues. In the event that the CONTRACTOR's surplus falls below the amount specified in this paragraph, HCA HSD shall prohibit the CONTRACTOR from engaging in community Outreach activities, shall cease to process new enrollments until the required balance is achieved, or may terminate the Agreement.
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