IPA/ACO Sample Clauses

IPA/ACO. Specific Provisions ATTACHMENT C MMP/FIDA REQUIREMENTS 1. HHS, the Comptroller General or their designees shall have the right to audit, evaluate and inspect any pertinent information including books, contracts, records, including medical records, and documentation related to CMS’ contract with Payors for a period of 10 years from the final date of the contract period or the completion of any audit, whichever is later. [42 C.F.R. § 422.504(i)(2)(i) and (ii)]. 2. The Parties will comply with confidentiality and Member record accuracy requirements, including: (1) abiding by all Federal and State laws regarding confidentiality and disclosure of medical records, or other health and enrollment information, (2) ensuring that medical information is released in accordance with applicable Federal or State law, or pursuant to court orders or subpoenas, (3) maintaining the records and information in an accurate and timely manner, and (4) ensuring timely access by Members to the records and information that pertain to them. [42 C.F.R. §§ 422.118 and 422.504(a)(13)]. 3. Members may not be held liable for payment of any fees that are the legal obligation of Payors. [42 C.F.R. §§ 422.504(g)(1)(i) and 422.504(i)(3)(i)]. 4. Members eligible for both Medicare and Medicaid will not be held liable for Medicare Part A and B cost sharing. Medicare Parts A and B services must be provided at zero cost-sharing as part of the integrated package of benefits. [Guidance issued by CMS on March 29, 2012]. 5. Any services or other activities performed by the Parties must be consistent and comply with Payor’s contractual obligations. [42 C.F.R. § 422.504(i)(3)(iii)]. 6. Services must be provided in a culturally competent manner to all Members, including those with limited English proficiency or reading skills, and diverse cultural and ethnic backgrounds. [42 C.F.R. § 422.112(a)(8)]. 7. If Payor has delegated the selection of providers, Payor retains the right to approve, suspend, or terminate such arrangement. [42 C.F.R. § 422.504(i)(5)]. 8. Delegated activities and reporting responsibilities delegated hereunder, if any, are set forth in Article II (Group Obligations). [42 C.F.R. § 422.504(i)(4)(i)]. 9. Any delegated activities and reporting requirements may be revoked in instances when CMS or Payor determines that the Parties have not performed satisfactorily. [42 C.F.R. § 422.504(i)(4)(ii)]. 10. The performance of the Parties shall be monitored by Payor on an ongoing basis. [42 C.F.R. §...
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Related to IPA/ACO

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