Common use of Licensure and Accreditation Clause in Contracts

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. 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 (1.51) years year 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. 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 1978XXXX 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) 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 (1.51) years year 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 HSD 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 HSD the current and each reoccurring NCQA accreditation and distinction award letter from NCQA to HCA HSD 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 HSD 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.