Licensure and Accreditation. The Contractor certifies that it is licensed in Rhode Island as an HMO under the provisions of Chapter 27-41, “the HMO Act” or that it will become licensed as a Health Maintenance Organization (HMO) or Health Plan (HP) in the State of Rhode Island by the Rhode Island Department of Business Regulation prior to signing an Agreement with EOHHS. If the Contractor is not a licensed HMO in Rhode Island, the Contractor certifies that it is either a nonprofit hospital service corporation that is licensed by the Rhode Island Department of Business Regulation (“DBR”) under Chapter 27-19 of the Rhode Island General Laws, a nonprofit medical service corporation that is licensed by DBR under Chapter 27-20 of the Rhode Island General Laws, or another health insurance entity licensed by DBR, and that it meets the following requirements: Meets the requirements under 27-18.9-8, External Appeal Procedural Requirements only of the Benefit Determination and Utilization Review Act. • Is accredited by the National Committee for Quality Assurance (“NCQA”) as a Medicaid Managed Care organization or otherwise for a newly entering plan: o The Contractor must submit a PDF copy of its current NCQA accreditation certificate for a Medicaid Managed Care organization in another State and; o The Contractor must submit a specific timeline outlining the Contractor’s plan to achieve full accreditation within twelve months of the execution of the contract and; o Failure to obtain accreditation by the date specified will result in the suspension of enrollment. • Is certified by a nationally known health utilization management organization. • Ensuring access to high quality and cost-effective services to all Rhode Islanders is paramount. It is suggested the Contractor obtain NCQA distinction in Multicultural Health Care. Achievement of provisional accreditation status will require a corrective action plan within thirty
Licensure and Accreditation. The CONTRACTOR must have the appropriate licenses in the State to do risk-based contracting through a managed care network of Providers as provided for in the New Mexico Insurance Code, XXXX 0000, Chapter 59A et seq., valid at least six (6) months prior to the Go-Live date.
3.1.1.1 The CONTRACTOR shall be either: (i) National Committee for Quality Assurance (NCQA) accredited in the State of New Mexico or (ii) accredited in another state where the CONTRACTOR currently provides Medicaid services and initiates the NCQA accreditation process for the State of New Mexico upon notice of award and achieves New Mexico NCQA accreditation within one (1) year from Go-Live. The CONTRACTOR shall provide HSD the current and each reoccurring NCQA accreditation award letter, the Accreditation Certificate, Accreditation Summary Report and the HEDIS Score Sheet within thirty (30) Calendar Days of receipt.
3.1.1.2 To the extent the CONTRACTOR is in active pursuit of NCQA accreditation in the State of New Mexico, HSD reserves the right to request additional information regarding the CONTRACTOR’s progress in achieving NCQA accreditation in New Mexico.
3.1.1.3 Failure to meet the accreditation requirements in this Section and/or failure to maintain accreditation throughout the term of this Agreement shall be considered a breach of this Agreement and may be subject to remedies for violation of, breach of, or noncompliance with Contract as described in Section 7.6 of this Agreement.
Licensure and Accreditation. The CONTRACTOR must have the appropriate licenses in the State to do risk-based contracting through a managed care network of Providers as provided for in the New Mexico Insurance Code, NMSA 1978, Chapter 59A et seq., valid at least six (6) months prior to the Go-Live date.
3.1.1.1 The CONTRACTOR shall be either: (i) National Committee for Quality Assurance (NCQA) Health Plan accredited in the State of New Mexico or (ii) accredited in another state where the CONTRACTOR currently provides Medicaid services and initiates the NCQA accreditation process for the State of New Mexico upon notice of award and achieves New Mexico NCQA Health Plan accreditation within one and a half (1.5) years from Go-Live. The Contractor is required to declare intent and timeline to achieve LTSS/HE accreditation no later than December 31, 2026. The CONTRACTOR shall provide HCA the current and each reoccurring NCQA Health Plan accreditation award letter, the Accreditation Certificate, Accreditation Summary Report and the HEDIS Score Sheet within thirty (30) Calendar Days of receipt.
3.1.1.2 The CONTRACTOR shall, within eighteen (18) months of Go-Live, obtain NCQA Distinction in Multicultural Health Care/Health Equity Accreditation and Long-Term Services and Supports (LTSS) Distinction in the State of New Mexico. (The NCQA Distinction in Multicultural Health Care is scheduled to change to transition to NCQA “Health Equity Accreditation” and “Health Equity Accreditation Plus” for surveys after July 2022.) The CONTRACTOR shall provide HCA the current and each reoccurring NCQA accreditation and distinction award letter from NCQA to HCA within thirty (30) Calendar Days of receipt.
3.1.1.3 To the extent the CONTRACTOR is in active pursuit of NCQA accreditation(s) and distinction(s) in the State of New Mexico, HCA reserves the right to request additional information regarding the CONTRACTOR’s progress in achieving NCQA accreditation(s) and distinction(s) in New Mexico.
3.1.1.4 Failure to meet the accreditation and distinction requirements in this section and/or failure to maintain accreditation(s) and distinction(s) throughout the term of this Agreement shall be considered a breach of this Agreement and may be subject to remedies for violation of, breach of, or noncompliance with Contract as described in Section 7.6 of this Agreement.
Licensure and Accreditation. Pursuant to 25 USC §§ 1621t and 1647a, the managed care organization shall not apply any requirement that any entity operated by the IHS, an Indian tribe, tribal organization or urban Indian organization be licensed or recognized under the State or local law where the entity is located to furnish health care services, if the entity attests that it meets all the applicable standards for such licensure or recognition. In addition, the managed care organization shall not require the licensure of a health professional employed by such an entity under the State or local law where the entity is located, if the professional is licensed in another State.
Licensure and Accreditation. Subject to Regulatory Uncertainty, Manager shall with respect to all applicable state and local licenses, registrations and permits, accreditations, and all certifications required of or beneficial to the operation of the Centers during the Term (collectively “Licenses”): (i) identify in good faith the Party or Parties, as applicable, required to obtain and hold the Licenses; and (ii) obtain and hold the Licenses that must be obtained and held by Manager as provider of the Services. Manager shall maintain documentation of its communications with regulators for at least five years from date of creation and, subject to any reasonable and valid assertions of confidentiality, make such materials available to Walmart upon request. Subject to Regulatory Uncertainty, Walmart shall obtain and hold the Licenses that must be obtained and held by Walmart as owner or seller of the Centers. Manager shall assist Walmart to obtain, complete and submit applicable applications, forms and other materials necessary for Walmart to obtain and hold the Licenses that must be obtained and held by Walmart. The Parties will exercise commercially reasonable efforts to cooperate in their efforts to comply with applicable licensing rules and regulations. Upon request, each Party shall provide the other Party with all information and perform all actions necessary or appropriate to enable each Party to obtain the Licenses necessary for each Party to comply with applicable licensing requirements.
Licensure and Accreditation. CONTRACTOR will provide proof that they are a Mississippi Board Certified Psychiatrist. CONTRACTOR agrees to maintain such Mississippi licensure and accreditation during the term of this Agreement. CONTRACTOR will immediately notify NMSH if it’s licensing status changes.
Licensure and Accreditation. KentuckyOne and University shall cooperate to keep all Programs fully licensed and accredited by hospital licensing and acreditation agencies, obtain and maintain such accreditation such that each of the undergraduate medical, graduate medical, continuing medical, professional, undergraduate, and all other educational programs conducted by the University at the KentuckyOne Facilities or otherwise pertaining to this Agreement remain fully licensed and accredited (e.g., by the ACGME and other similarly recognized accreditation bodies) as needed by such academic, clinical and research Programs.
Licensure and Accreditation. It is the responsibility of each HP to ensure that his/her license and/or accreditation is kept current and that documentation has been provided to his/her supervisor. If an HP’s license/accreditation has expired, he/she will notify the supervisor immediately. Failure to keep licensure/accreditation current will result in removal from his/her job, and may result in termination of employment or other discipline, depending upon the individual circumstances of the situation.
Licensure and Accreditation. Applicant and all personnel and technicians assigned to provide services under the Contract must have all permits, licenses, and certifications required by applicable law. Assigned personnel and technicians, who may include department directors or equivalent positions, providing services that, by law, require a professional license or certification, must hold a current, valid, and applicable Texas license and/or certification in good standing. Contractor is responsible for ensuring all Contractor staff and subcontractors, if any, hold current, valid, and applicable licenses and/or certifications in good standing. A copy of each permit, license, certification, registration or other evidence of authority to practice for both the Applicant and all assigned personnel, as applicable, must be submitted with the Application. Each Contractor is required to maintain all required permits, licenses, and certifications for the business during the term of the Contract. The Contractor and Contractor’s personnel and subcontractors, if any, must also maintain their individual required permits, licenses, and certifications during the term of the Contract. All required permits, licenses, and/or certifications must be included with submitted Applications. Contractor must submit all required permits, licenses, and certifications to the assigned contract manager for additional Contractor’s personnel and subcontractors, if any, added to the VAT after Contract execution. During annual contract reviews, Contractor shall provide updated licenses and/or certifications at DSHS’s request.
Licensure and Accreditation. 3.1.1.1 The CONTRACTOR must have the appropriate licenses in the State to do risk- based contracting through a managed care network of providers as provided for in the New Mexico Insurance Code, XXXX 0000, Chapter 59A et seq., valid at least six (6) months prior to the expected Centennial Care program Go-Live date.
3.1.1.2 The CONTRACTOR shall be either (i) National Committee for Quality Assurance (NCQA) accredited in the State of New Mexico or (ii) accredited in another state where the CONTRACTOR currently provides Medicaid services and achieve New Mexico NCQA accreditation within two (2) years from Go- Live.
3.1.1.3 To the extent the CONTRACTOR is in active pursuit of NCQA accreditation in the State of New Mexico, HSD reserves the right to request additional information regarding the CONTRACTOR’s progress in achieving NCQA accreditation in New Mexico.
3.1.1.4 Failure to meet the accreditation requirements in this Section and/or failure to maintain accreditation throughout the term of this Agreement shall be considered a breach of this Agreement and may be subject to remedies for violation, breach, or noncompliance of Contract requirements as described in Section 7.6 of this Agreement.
