Common use of Management of Subcontracts Clause in Contracts

Management of Subcontracts. The Contractor must monitor the Subcontractor’s performance on an ongoing basis and subject it to formal review according to a periodic schedule established by the HCA, consistent with industry standards or state law and regulation. This review may be combined with a formal review of services performed pursuant to the Contractor’s Medicaid Contract between the Contractor and HCA. The review must be based on the specific delegation agreement with each Subcontractor, and must address compliance with Contract requirements for each delegated function, which may include but is not limited to: Documentation and appropriateness of medical necessity determinations. Enrollee record reviews to ensure services are appropriate based on diagnosis, the treatment plan is based on the Enrollee’s needs and progress notes support the use of each service. Enrollee record reviews to ensure the treatment plans are consistent with WAC 000-000-0000 and 246-341- 0640. Timeliness of service. Network adequacy. Cultural, ethnic, linguistic, disability or age related needs are addressed. Coordination with primary care. Provider adherence to practice guidelines, as relevant. Provider compliance with reporting and managing critical incidents. Information security. Disaster recovery plans. Fiscal management, including documenting the provider’s cost allocations, revenues, expenditures and reserves in order to ensure that funds under this Contract are being spent appropriately. Licensing and certification reviews, including oversight of any issues noted during licensing and/or certification reviews conducted by the Department of Health and communicated to the Contractor. Unless a county is a licensed service provider and the Contractor is contracting with the county for direct services, the Contractor shall not provide GFS funds to a county without a contract or single-case agreement. Health Care Provider Subcontracts The Contractor’s Subcontracts shall also contain the following provisions: A statement that Subcontractors receiving GFS funds shall cooperate with Contractor or HCA-sponsored Quality Improvement (QI) activities. For providers in twenty-four (24) hour settings, a requirement to provide discharge planning services which shall, at a minimum: Coordinate a community-based discharge plan for each Enrollee served under this Contract beginning at intake, including Tribal- community resources and services when applicable. Discharge planning shall apply to all Enrollees regardless of length of stay or whether they complete treatment; Coordinate exchange of assessment, admission, treatment progress, and continuing care information with the referring entity. Contact with the referral agency shall be made within the first week of residential treatment; Establish referral relationships with assessment entities, outpatient providers, vocational or employment services, and courts which specify aftercare expectations and services, including procedure for involvement of entities making referrals in treatment activities; Coordinate, as needed, with HCA/Division of Behavioral Health and Recovery (DBHR) prevention services, vocational services, housing services and supports, and other community resources and services that may be appropriate, such as DCYF services for children and families, including, DCYF-contracted home visiting, Early Support for Infants and Toddlers (ESIT), Early Childhood Intervention and Prevention Services (ECLIPSE), Early Childhood Education and Assistance Program (ECEAP) and Head Start programs using the informational letter template jointly developed by the DCYF and HCA; Coordinate, as needed, with Tribal governments and Indian Health Care Providers for applicable services, including but not limited to assessment and treatment, education support and early childhood services, vocational or employment services, housing services and supports, and Tribal courts; and Coordinate services to financially-eligible Enrollees who are in need of medical services. A requirement that termination of a subcontract shall not be grounds for a fair hearing or a Grievance for the Enrollee if similar services are immediately available in the service area. How Enrollees will be informed of their right to a Grievance in the case of: Denial or termination of service related to medical necessity determinations. Denial or termination of service related to Available Resources. Failure to act upon a request for services with reasonable promptness. A requirement to provide Enrollees access to translated information and interpreter services as described in the Marketing and Information Requirements section of the IMC contract. Adherence to established protocols for determining eligibility for services consistent with the Enrollment section of the IMC contract. A requirement to use HCA/DBHR approved Integrated Co-Occurring Disorder Screening and Assessment Tool(s); this shall include requirements for training staff that will be using the tool(s) to address the screening and assessment process, the tool and quadrant placement as well as requirements for corrective action if the process is not implemented and maintained throughout the Contract’s period of performance. A requirement to conduct criminal background checks and maintain related policies and procedures and personnel files consistent with requirements in Chapter 43.43 RCW and Chapter 388-06 WAC. Requirements for nondiscrimination in employment and Enrollee services. Protocols for screening for debarment and suspension of certification. Requirements to identify funding sources consistent with the Payment and Sanctions Section and Federal Block Grant reporting requirements. A requirement that the Subcontractor shall respond with all available records in a timely manner to law enforcement inquiries regarding an Enrollee’s eligibility to possess a firearm under RCW 9.41.040(2)(C)(iv). The Contractor shall conduct a Subcontractor review which shall include at least one onsite visit every two (2) years to each Subcontractor site providing state funded treatment services during the period of performance of this Contract in order to monitor and document compliance with requirements of the subcontract. The Contractor shall ensure that Subcontractors have complied with data submission requirements established by HCA for all services funded under the Contract. The Contractor shall ensure that the Subcontractor updates Enrollee funding information when the funding source changes. The Contractor shall maintain written or electronic records of all Subcontractor monitoring activities and make them available to HCA upon request. A statement that Subcontractors shall comply with required audits, including authority to conduct a facility inspection and Office of Management and Budget (OMB) Circular and 2 C.F.R. Part 200, Subpart F – Audit Requirements audits, as applicable to the Subcontractor. The Contractor shall submit a copy of the 2 C.F.R. Part 200, Subpart F – Audit Requirements audit performed by the State Auditor to the HCA Contact identified on page one (1) of the Contract within ninety (90) days of receipt by the Contractor of the completed audit. If a Subcontractor is subject to OMB Circular and 2 C.F.R. Part 200, Subpart F – Audit Requirements, the Contractor shall require a copy of the completed Single Audit and ensure corrective action is taken for any audit finding, per 2 C.F.R. Part 200, Subpart F – Audit Requirements. If a Subcontractor is not subject to OMB Circular 2 C.F.R. Part 200, Subpart F – Audit Requirements, the Contractor shall perform subrecipient monitoring in compliance with federal requirements. The Contractor shall respect Tribal sovereignty and shall not conduct on-site reviews of Tribal service providers without advance invitation from the Tribe and without prior notice to, and coordination with, the HCA Office of Tribal Affairs.

Management of Subcontracts. The Contractor must monitor the Subcontractor’s performance on an ongoing basis and subject it to formal review according to a periodic schedule established by the HCA, consistent with industry standards or state law and regulation. This review may be combined with a formal review of services performed pursuant to the Contractor’s Medicaid Contract between the Contractor and HCA. The review must be based on the specific delegation agreement with each Subcontractor, and must address compliance with Contract requirements for each delegated function, which may include but is not limited to: Documentation and appropriateness of medical necessity determinations. Enrollee record reviews to ensure services are appropriate based on diagnosis, the treatment plan is based on the Enrollee’s needs and progress notes support the use of each service. Enrollee record reviews to ensure the treatment plans are consistent with WAC 000-000-0000 and 246-341- 0640. Timeliness of service. Network adequacy. Cultural, ethnic, linguistic, disability or age related needs are addressed. Coordination with primary care. Provider adherence to practice guidelines, as relevant. Provider compliance with reporting and managing critical incidents. Information security. Disaster recovery plans. Fiscal management, including documenting the provider’s cost allocations, revenues, expenditures and reserves in order to ensure that funds under this Contract are being spent appropriately. Licensing and certification reviews, including oversight of any issues noted during licensing and/or certification reviews conducted by the Department of Health and communicated to the Contractor. Unless a county is a licensed service provider and the Contractor is contracting with the county for direct services, the Contractor shall not provide GFS funds to a county without a contract or single-case agreement. Health Care Provider Subcontracts The Contractor’s Subcontracts shall also contain the following provisions: A statement that Subcontractors receiving GFS funds shall cooperate with Contractor or HCA-sponsored Quality Improvement (QI) activities. For providers in twenty-four (24) hour settings, a requirement to provide discharge planning services which shall, at a minimum: Coordinate a community-based discharge plan for each Enrollee served under this Contract beginning at intake, including Tribal- community resources and services when applicable. Discharge planning shall apply to all Enrollees regardless of length of stay or whether they complete treatment; Coordinate exchange of assessment, admission, treatment progress, and continuing care information with the referring entity. Contact with the referral agency shall be made within the first week of residential treatment; Establish referral relationships with assessment entities, outpatient providers, vocational or employment services, and courts which specify aftercare expectations and services, including procedure for involvement of entities making referrals in treatment activities; Coordinate, as needed, with HCA/Division of Behavioral Health and Recovery (DBHR) DBHR prevention services, vocational services, housing services and supports, and other community resources and services that may be appropriate, such as DCYF services for children and families, including, DCYF-contracted home visiting, Early Support for Infants and Toddlers (ESIT), Early Childhood Intervention and Prevention Services (ECLIPSE), Early Childhood Education and Assistance Program (ECEAP) and Head Start programs using the informational letter template jointly developed by the DCYF and HCA; Coordinate, as needed, with Tribal governments and Indian Health Care Providers for applicable services, including but not limited to assessment and treatment, education support and early childhood services, vocational or employment services, housing services and supports, and Tribal courts; and Coordinate services to financially-eligible Enrollees who are in need of medical services. A requirement that termination of a subcontract shall not be grounds for a fair hearing or a Grievance for the Enrollee if similar services are immediately available in the service area. How Enrollees will be informed of their right to a Grievance in the case of: Denial or termination of service related to medical necessity determinations. Denial or termination of service related to Available Resources. Failure to act upon a request for services with reasonable promptness. A requirement to provide Enrollees access to translated information and interpreter services as described in the Marketing and Information Requirements section of the IMC contract. Adherence to established protocols for determining eligibility for services consistent with the Enrollment section of the IMC contract. A requirement to use HCA/DBHR approved Integrated Co-Occurring Disorder Screening and Assessment Tool(s); this shall include requirements for training staff that will be using the tool(s) to address the screening and assessment process, the tool and quadrant placement as well as requirements for corrective action if the process is not implemented and maintained throughout the Contract’s period of performance. A requirement to conduct criminal background checks and maintain related policies and procedures and personnel files consistent with requirements in Chapter 43.43 RCW and Chapter 388-06 WAC. Requirements for nondiscrimination in employment and Enrollee services. Protocols for screening for debarment and suspension of certification. Requirements to identify funding sources consistent with the Payment and Sanctions Section and Federal Block Grant reporting requirements. A requirement that the Subcontractor shall respond with all available records in a timely manner to law enforcement inquiries regarding an Enrollee’s eligibility to possess a firearm under RCW 9.41.040(2)(C)(iv). The Contractor shall conduct a Subcontractor review which shall include at least one onsite visit every two (2) years to each Subcontractor site providing state funded treatment services during the period of performance of this Contract in order to monitor and document compliance with requirements of the subcontract. The Contractor shall ensure that Subcontractors have complied with data submission requirements established by HCA for all services funded under the Contract. The Contractor shall ensure that the Subcontractor updates Enrollee funding information when the funding source changes. The Contractor shall maintain written or electronic records of all Subcontractor monitoring activities and make them available to HCA upon request. A statement that Subcontractors shall comply with required audits, including authority to conduct a facility inspection and Office of Management and Budget (OMB) Circular and 2 C.F.R. Part 200, Subpart F – Audit Requirements audits, as applicable to the Subcontractor. The Contractor shall submit a copy of the 2 C.F.R. Part 200, Subpart F – Audit Requirements audit performed by the State Auditor to the HCA Contact identified on page one (1) of the Contract within ninety (90) days of receipt by the Contractor of the completed audit. If a Subcontractor is subject to OMB Circular and 2 C.F.R. Part 200, Subpart F – Audit Requirements, the Contractor shall require a copy of the completed Single Audit and ensure corrective action is taken for any audit finding, per 2 C.F.R. Part 200, Subpart F – Audit Requirements. If a Subcontractor is not subject to OMB Circular 2 C.F.R. Part 200, Subpart F – Audit Requirements, the Contractor shall perform subrecipient monitoring in compliance with federal requirements. The Contractor shall respect Tribal sovereignty and shall not conduct on-site reviews of Tribal service providers without advance invitation from the Tribe and without prior notice to, and coordination with, the HCA Office of Tribal Affairs.

Management of Subcontracts. The Contractor must monitor the Subcontractor’s performance on an ongoing basis and subject it to formal review according to a periodic schedule established by the HCA, consistent with industry standards or state law and regulation. This review may be combined with a formal review of services performed pursuant to the Contractor’s Medicaid Contract between the Contractor and HCA. The review must be based on the specific delegation agreement with each Subcontractor, and must address compliance with Contract requirements for each delegated function, which may include but is not limited to: Documentation and appropriateness of medical necessity determinations. Enrollee record reviews to ensure services are appropriate based on diagnosis, the treatment plan is based on the Enrollee’s needs and progress notes support the use of each service. Enrollee record reviews to ensure the treatment plans are consistent with WAC 000-000-0000 and 246-341- 0640. Timeliness of service. Network adequacy. Cultural, ethnic, linguistic, disability or age related needs are addressed. Coordination with primary care. Provider adherence to practice guidelines, as relevant. Provider compliance with reporting and managing critical incidents. Information security. Disaster recovery plans. Fiscal management, including documenting the provider’s cost allocations, revenues, expenditures and reserves in order to ensure that funds under this Contract are being spent appropriately. Licensing and certification reviews, including oversight of any issues noted during licensing and/or certification reviews conducted by the Department of Health and communicated to the Contractor. Unless a county is a licensed service provider and the Contractor is contracting with the county for direct services, the Contractor shall not provide GFS funds to a county without a contract or single-case agreement. Health Care Provider Subcontracts The Contractor’s Subcontracts shall also contain the following provisions: A statement that Subcontractors receiving GFS funds shall cooperate with Contractor or HCA-sponsored Quality Improvement (QI) activities. For providers in twenty-four (24) hour settings, a requirement to provide discharge planning services which shall, at a minimum: Coordinate a community-based discharge plan for each Enrollee served under this Contract beginning at intake, including Tribal- community resources and services when applicable. Discharge planning shall apply to all Enrollees regardless of length of stay or whether they complete treatment; Coordinate exchange of assessment, admission, treatment progress, and continuing care information with the referring entity. Contact with the referral agency shall be made within the first week of residential treatment; Establish referral relationships with assessment entities, outpatient providers, vocational or employment services, and courts which specify aftercare expectations and services, including procedure for involvement of entities making referrals in treatment activities; Coordinate, as needed, with HCA/Division of Behavioral Health and Recovery (DBHR) DBHR prevention services, vocational services, housing services and supports, and other community resources and services that may be appropriate, such as DCYF services for children including the Department of Children, Youth, and families, including, DCYF-contracted home visiting, Early Support for Infants and Toddlers (ESIT), Early Childhood Intervention and Prevention Services (ECLIPSE), Early Childhood Education and Assistance Program (ECEAP) and Head Start programs using the informational letter template jointly developed by the DCYF and HCAFamilies; Coordinate, as needed, with Tribal governments and Indian Health Care Providers for applicable services, including but not limited to assessment and treatment, education support and early childhood services, vocational or employment services, housing services and supports, and Tribal courts; and Coordinate services to financially-eligible Enrollees who are in need of medical services. A requirement that termination of a subcontract shall not be grounds for a fair hearing or a Grievance for the Enrollee if similar services are immediately available in the service area. How Enrollees will be informed of their right to file a Grievance in the case of: Denial or termination of service related to medical necessity determinations. Denial or termination of service related to Available Resources. Failure to act upon a request for services with reasonable promptness. Appeal A requirement to provide Enrollees access to translated information and interpreter services as described in the Marketing and Information Requirements section of the IMC IFC contract. Adherence to established protocols for determining eligibility for services consistent with the Enrollment section of the IMC IFC contract. A requirement to use HCA/DBHR approved Integrated Co-Occurring Disorder Screening and Assessment Tool(s); this shall include requirements for training staff that will be using the tool(s) to address the screening and assessment process, the tool and quadrant placement as well as requirements for corrective action if the process is not implemented and maintained throughout the Contract’s period of performance. A requirement to conduct criminal background checks and maintain related policies and procedures and personnel files consistent with requirements in Chapter 43.43 RCW RCW, and Chapter 388-06 WAC. Requirements for nondiscrimination in employment and Enrollee services. Protocols for screening for debarment and suspension of certification. Requirements to identify funding sources consistent with the Payment and Sanctions Section and Federal Block Grant reporting requirements. A requirement that the Subcontractor shall respond with all available records in a timely manner to law enforcement inquiries regarding an Enrollee’s eligibility to possess a firearm under RCW 9.41.040(2)(C)(iv). ) The Contractor shall conduct a Subcontractor review which shall include at least one onsite visit every two (2) years to each Subcontractor site providing state funded treatment services during the period of performance of this Contract in order to monitor and document compliance with requirements of the subcontract. The Contractor shall ensure that Subcontractors have complied with data submission requirements established by HCA for all services funded under the Contract. The Contractor shall ensure that the Subcontractor updates Enrollee funding information when the funding source changes. The Contractor shall maintain written or electronic records of all Subcontractor monitoring activities and make them available to HCA upon request. A statement that Subcontractors shall comply with required audits, including authority to conduct a facility inspection and Office of Management and Budget (OMB) Circular and 2 C.F.R. Part 200, Subpart F – Audit Requirements audits, as applicable to the Subcontractor. The Contractor shall submit a copy of the 2 C.F.R. Part 200, Subpart F – Audit Requirements audit performed by the State Auditor to the HCA Contact identified on page one (1) of the Contract within ninety (90) days of receipt by the Contractor of the completed audit. If a Subcontractor is subject to OMB Circular and 2 C.F.R. Part 200, Subpart F – Audit Requirements, the Contractor shall require a copy of the completed Single Audit and ensure corrective action is taken for any audit finding, per 2 C.F.R. Part 200, Subpart F – Audit Requirements. If a Subcontractor is not subject to OMB Circular and 2 C.F.R. Part 200, Subpart F – Audit Requirements, the Contractor shall perform subrecipient monitoring in compliance with federal requirements. The Contractor shall respect Tribal sovereignty and shall not conduct on-site reviews of Tribal service providers without advance invitation from the Tribe and without prior notice to, and coordination with, the HCA Office of Tribal Affairs.

Management of Subcontracts. The Contractor must monitor the Subcontractor’s performance on an ongoing basis and subject it to formal review according to a periodic schedule established by the HCA, consistent with industry standards or state law and regulation. This review may be combined with a formal review of services performed pursuant to the Contractor’s Medicaid Contract between the Contractor and HCA. The review must be based on the specific delegation agreement with each Subcontractor, and must address compliance with Contract requirements for each delegated function, which may include but is not limited to: Documentation and appropriateness of medical necessity determinations. Enrollee record reviews to ensure services are appropriate based on diagnosis, the treatment plan is based on the Enrollee’s needs and progress notes support the use of each service. Enrollee record reviews to ensure the treatment plans are consistent with WAC 000-000-0000 and 246000-341- 0640000-0000. Timeliness of service. Network adequacy. Cultural, ethnic, linguistic, disability or age related needs are addressed. Coordination with primary care. Provider adherence to practice guidelines, as relevant. Provider compliance with reporting and managing critical incidents. Information security. Disaster recovery plans. Fiscal management, including documenting the provider’s cost allocations, revenues, expenditures and reserves in order to ensure that funds under this Contract are being spent appropriately. Licensing and certification reviews, including oversight of any issues noted during licensing and/or certification reviews conducted by the Department of Health and communicated to the Contractor. Unless a county is a licensed service provider and the Contractor is contracting with the county for direct services, the Contractor shall not provide GFS funds to a county without a contract or single-case agreement. Health Care Provider Subcontracts The Contractor’s Subcontracts shall also contain the following provisions: A statement that Subcontractors receiving GFS funds shall cooperate with Contractor or HCA-sponsored Quality Improvement (QI) activities. For providers in twenty-four (24) hour settings, a requirement to provide discharge planning services which shall, at a minimum: Coordinate a community-based discharge plan for each Enrollee served under this Contract beginning at intake, including Tribal- community resources and services when applicable. Discharge planning shall apply to all Enrollees regardless of length of stay or whether they complete treatment; Coordinate exchange of assessment, admission, treatment progress, and continuing care information with the referring entity. Contact with the referral agency shall be made within the first week of residential treatment; Establish referral relationships with assessment entities, outpatient providers, vocational or employment services, and courts which specify aftercare expectations and services, including procedure for involvement of entities making referrals in treatment activities; Coordinate, as needed, with HCA/Division of Behavioral Health and Recovery (DBHR) DBHR prevention services, vocational services, housing services and supports, and other community resources and services that may be appropriate, such as DCYF services for children and familiesincluding the Department of Children, including, DCYF-contracted home visiting, Early Support for Infants and Toddlers (ESIT), Early Childhood Intervention and Prevention Services (ECLIPSE), Early Childhood Education and Assistance Program (ECEAP) and Head Start programs using the informational letter template jointly developed by the DCYF and HCA; Coordinate, as needed, with Tribal governments and Indian Health Care Providers for applicable services, including but not limited to assessment and treatment, education support and early childhood services, vocational or employment services, housing services and supportsYouth, and Tribal courtsFamilies; and Coordinate services to financially-eligible Enrollees who are in need of medical services. A requirement that termination of a subcontract shall not be grounds for a fair hearing or a Grievance for the Enrollee if similar services are immediately available in the service area. How Enrollees will be informed of their right to file a Grievance in the case of: Denial or termination of service related to medical necessity determinations. Denial or termination of service related to Available Resources. Failure to act upon a request for services with reasonable promptness. Appeal A requirement to provide Enrollees access to translated information and interpreter services as described in the Marketing and Information Requirements section of the IMC IFC contract. Adherence to established protocols for determining eligibility for services consistent with the Enrollment section of the IMC IFC contract. A requirement to use HCA/DBHR approved Integrated Co-Occurring Disorder Screening and Assessment Tool(s); this shall include requirements for training staff that will be using the tool(s) to address the screening and assessment process, the tool and quadrant placement as well as requirements for corrective action if the process is not implemented and maintained throughout the Contract’s period of performance. A requirement to conduct criminal background checks and maintain related policies and procedures and personnel files consistent with requirements in Chapter 43.43 RCW RCW, and Chapter 388-06 WAC. Requirements for nondiscrimination in employment and Enrollee services. Protocols for screening for debarment and suspension of certification. Requirements to identify funding sources consistent with the Payment and Sanctions Section and Federal Block Grant reporting requirements. A requirement that the Subcontractor shall respond with all available records in a timely manner to law enforcement inquiries regarding an Enrollee’s eligibility to possess a firearm under RCW 9.41.040(2)(C)(iv). The Contractor shall conduct a Subcontractor review which shall include at least one onsite visit every two (2) years to each Subcontractor site providing state funded treatment services during the period of performance of this Contract in order to monitor and document compliance with requirements of the subcontract. The Contractor shall ensure that Subcontractors have complied with data submission requirements established by HCA for all services funded under the Contract. The Contractor shall ensure that the Subcontractor updates Enrollee funding information when the funding source changes. The Contractor shall maintain written or electronic records of all Subcontractor monitoring activities and make them available to HCA upon request. A statement that Subcontractors shall comply with required audits, including authority to conduct a facility inspection and Office of Management and Budget (OMB) Circular and 2 C.F.R. Part 200, Subpart F – Audit Requirements audits, as applicable to the Subcontractor. The Contractor shall submit a copy of the 2 C.F.R. Part 200, Subpart F – Audit Requirements audit performed by the State Auditor to the HCA Contact identified on page one (1) of the Contract within ninety (90) days of receipt by the Contractor of the completed audit. If a Subcontractor is subject to OMB Circular and 2 C.F.R. Part 200, Subpart F – Audit Requirements, the Contractor shall require a copy of the completed Single Audit and ensure corrective action is taken for any audit finding, per 2 C.F.R. Part 200, Subpart F – Audit Requirements. If a Subcontractor is not subject to OMB Circular and 2 C.F.R. Part 200, Subpart F – Audit Requirements, the Contractor shall perform subrecipient monitoring in compliance with federal requirements. The Contractor shall respect Tribal sovereignty and shall not conduct on-site reviews of Tribal service providers without advance invitation from the Tribe and without prior notice to, and coordination with, the HCA Office of Tribal Affairs.