Common use of Licensure and Accreditation Clause in Contracts

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 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 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