Material Subcontracts/Subcontractors. a. Prior to contracting with a Material Subcontractor, the Contractor shall evaluate the prospective Material Subcontractor’s ability to perform the activities to be subcontracted. b. All Material Subcontracts must be prior approved by EOHHS. To obtain such approval, the Contractor shall make a request in writing and submit with that request a completed Material Subcontractor checklist using the template provided by EOHHS and attached hereto as Appendix I, as may be modified by EOHHS from time-to-time, at least 60 days prior to the date the Contractor expects to execute the Material Subcontract. Among other things required in the checklist, the Contractor must describe the process for selecting the Material Subcontractor, including the selection criteria used. c. The Contractor shall provide EOHHS with any additional information requested by EOHHS in addition to the information required in the checklist. d. The Material Subcontract shall: 1) Be a written agreement; 2) Specify, and require compliance with, all applicable requirements of this Contract and the activities and reporting responsibilities the Material Subcontractor is obligated to provide; 3) Provide for imposing sanctions, including contract termination, if the Material Subcontractor’s performance is inadequate; 4) Require the Material Subcontractor to comply with all applicable Medicaid laws, regulations, and applicable subregulatory guidance; 5) Comply with the audit and inspection requirements set forth in 42 CFR 438.230(c)(3), such that the Material Subcontract requires the Material Subcontractor to agree as follows. See also Section 6.
Appears in 4 contracts
Samples: Accountable Care Partnership Plan Contract, Contract, Accountable Care Partnership Plan Contract
Material Subcontracts/Subcontractors. a. Prior to contracting with a Material Subcontractor, the Contractor shall evaluate the prospective Material Subcontractor’s ability to perform the activities to be subcontracted.
b. All Material Subcontracts must be prior approved by EOHHS. To obtain such approval, the Contractor shall make a request in writing and submit with that request a completed Material Subcontractor checklist using the template provided by EOHHS and attached hereto as Appendix I, as may be modified by EOHHS from time-to-time, at least 60 days prior to the date the Contractor expects to execute the Material Subcontract. Among other things required in the checklist, the Contractor must describe the process for selecting the Material Subcontractor, including the selection criteria used.
c. The Contractor shall provide EOHHS with any additional information requested by EOHHS in addition to the information required in the checklist.
d. The Material Subcontract shall:
1) Be a written agreement;
2) Specify, and require compliance with, all applicable requirements of this Contract and the activities and reporting responsibilities the Material Subcontractor is obligated to provide;
3) Provide for imposing sanctions, including contract termination, if the Material Subcontractor’s performance is inadequate;
4) Require the Material Subcontractor to comply with all applicable Medicaid laws, regulations, and applicable subregulatory guidance;
5) Comply with the audit and inspection requirements set forth in 42 CFR 438.230(c)(3), such that the Material Subcontract requires the Material Subcontractor to agree as follows. See also Section 65.4.
a) The State, CMS, HHS Inspector General, the Comptroller General, or their designees, have the right to audit, evaluate, and inspect any records or systems that pertain to any activities performed or amounts payable under this Contract. This right exists through 10 years from the final date of the contract or from the date of completion of any audit, whichever is later; provided, however that if any of the entities above determine that there is a reasonable possibility of fraud or similar risk, they may audit, evaluate, and inspect at any time; and
b) The Material Subcontractor will make its premises, facilities, equipment, records, and systems available for the purposes of any audit, evaluation, or inspection described immediately above;
e. The Contractor shall monitor any Material Subcontractor’s performance on an ongoing basis and perform a formal review annually. If any deficiencies or areas for improvement are identified, the Contractor shall require the Material Subcontractor to take corrective action. Upon request, the Contractor shall provide EOHHS with a copy of the annual review and any corrective action plans developed as a result.
f. Upon notifying any Material Subcontractor, or being notified by such Material Subcontractor, of the intention to terminate such subcontract, the Contractor shall notify EOHHS in writing no later than the same day as such notification, and shall otherwise support any necessary member transition or related activities as described in Section 2.2 and elsewhere in this Contract.
g. In accordance with Appendix A, the Contractor shall submit to EOHHS an annual list of all Material Subcontractors. Such annual report shall include notification if any of its Material Subcontractors are a business enterprise (for-profit) or non-profit organization certified by the Commonwealth’s S upplier Diversity Office. The Contractor shall submit ad hoc reports, as frequently as necessary or as directed by EOHHS, with any changes to the above-mentioned list and report.
h. The Contractor shall make best efforts to ensure that all Material Subcontracts stipulate that Massachusetts general law or Massachusetts regulation will prevail if there is a conflict between the state law or state regulation where the Material Subcontractor is based.
i. The Contractor shall, pursuant to the Acts of 2014, c. 165, Section 188, file with MassHealth any contracts or subcontracts for the management and delivery of behavioral health services by specialty behavioral health organizations to MassHealth members and MassHealth shall disclose such contracts upon request.
j. Notwithstanding any relationship the Contractor may have with a subcontractor, including Material subcontractors, the Contractor shall maintain ultimate responsibility for adhering to and otherwise fully complying with all terms and conditions of this Contract; and
k. The Contractor shall remain fully responsible for meeting all of the terms and requirements (including all applicable state and federal regulations) of the Contract regardless of whether the Contractor subcontracts for performance of any Contract responsibility. No subcontract will operate to relieve the Contractor of its legal responsibilities under the Contract.
l. The Contractor shall inform all Material Subcontractors of Enrollee grievance and appeal rights as described in Section 2.8.A.7 and Section 2.12.
Appears in 2 contracts
Samples: Managed Care Organization Contract, Managed Care Organization Contract
Material Subcontracts/Subcontractors. a. Prior to contracting with a Material Subcontractor, the Contractor shall evaluate the prospective Material Subcontractor’s ability to perform the activities to be subcontracted.
b. All Material Subcontracts must be prior approved by EOHHS. To obtain such approval, the Contractor shall make a request in writing and submit with that request a completed Material Subcontractor checklist using the template provided by EOHHS and attached hereto as Appendix I, as may be modified by EOHHS from time-to-time, at least 60 days prior to the date the Contractor expects to execute the Material Subcontract. Among other things required in the checklist, the Contractor must describe the process for selecting the Material Subcontractor, including the selection criteria used.
c. The Contractor shall provide EOHHS with any additional information requested by EOHHS in addition to the information required in the checklist.
d. The Material Subcontract shall:
1) Be a written agreement;
2) Specify, and require compliance with, all applicable requirements of this Contract and the activities and reporting responsibilities the Material Subcontractor is obligated to provide;
3) Provide for imposing sanctions, including contract termination, if the Material Subcontractor’s performance is inadequate;
4) Require the Material Subcontractor to comply with all applicable Medicaid laws, regulations, and applicable subregulatory guidance;
5) Comply with the audit and inspection requirements set forth in 42 CFR 438.230(c)(3), such that the Material Subcontract requires the Material Subcontractor to agree as follows. See also Section 65.4.
a) The State, CMS, HHS Inspector General, the Comptroller General, or their designees, have the right to audit, evaluate, and inspect any records or systems that pertain to any activities performed or amounts payable under this Contract. This right exists through 10 years from the final date of the contract or from the date of completion of any audit, whichever is later; provided, however that if any of the entities above determine that there is a reasonable possibility of fraud or similar risk, they may audit, evaluate, and inspect at any time; and
b) The Material Subcontractor will make its premises, facilities, equipment, records, and systems available for the purposes of any audit, evaluation, or inspection described immediately above;
e. The Contractor shall monitor any Material Subcontractor’s performance on an ongoing basis and perform a formal review annually. If any deficiencies or areas for improvement are identified, the Contractor shall require the Material Subcontractor to take corrective action. Upon request, the Contractor shall provide EOHHS with a copy of the annual review and any corrective action plans developed as a result.
f. Upon notifying any Material Subcontractor, or being notified by such Material Subcontractor, of the intention to terminate such subcontract, the Contractor shall notify EOHHS in writing no later than the same day as such notification, and shall otherwise support any necessary member transition or related activities as described in Section 2.2 and elsewhere in this Contract.
g. In accordance with Appendix A, the Contractor shall submit to EOHHS an annual list of all Material Subcontractors. Such annual report shall include notification if any of its Material Subcontractors are a business enterprise (for-profit) or non-profit organization certified by the Commonwealth’s Supplier Diversity Office. The Contractor shall submit ad hoc reports, as frequently as necessary or as directed by EOHHS, with any changes to the above-mentioned list and report.
h. The Contractor shall make best efforts to ensure that all Material Subcontracts stipulate that Massachusetts general law or Massachusetts regulation will prevail if there is a conflict between the state law or state regulation where the Material Subcontractor is based.
i. The Contractor shall, pursuant to the Acts of 2014, c. 165, Section 188, file with MassHealth any contracts or subcontracts for the management and delivery of behavioral health services by specialty behavioral health organizations to MassHealth members and MassHealth shall disclose such contracts upon request.
j. Notwithstanding any relationship the Contractor may have with a subcontractor, including Material subcontractors, the Contractor shall maintain ultimate responsibility for adhering to and otherwise fully complying with all terms and conditions of this Contract; and
k. The Contractor shall remain fully responsible for meeting all of the terms and requirements (including all applicable state and federal regulations) of the Contract regardless of whether the Contractor subcontracts for performance of any Contract responsibility. No subcontract will operate to relieve the Contractor of its legal responsibilities under the Contract.
l. The Contractor shall inform all Material Subcontractors of Enrollee grievance and appeal rights as described in Section 2.8.A.7 and Section 2.12.
Appears in 1 contract
Material Subcontracts/Subcontractors. a. Prior to contracting with a Material Subcontractor, the Contractor shall evaluate the prospective Material Subcontractor’s ability to perform the activities to be subcontracted.
b. All Material Subcontracts must be prior approved by EOHHS. To obtain such approval, the Contractor shall make a request in writing and submit with that request a completed Material Subcontractor checklist using the template provided by EOHHS and attached hereto as Appendix I, as may be modified by EOHHS from time-to-time, at least 60 days prior to the date the Contractor expects to execute the Material Subcontract. For Material Subcontractors who are pharmacy benefit managers, the Contractor shall submit the request for Pharmacy Benefit Managers above information 90 days prior to the date the Contractor expects to execute the Material Subcontract. Among other things required in the checklist, the Contractor must describe the process for selecting the Material Subcontractor, including the selection criteria used.
c. The Contractor shall provide EOHHS with any additional information requested by EOHHS in addition to the information required in the checklist. For Material Subcontractors who are pharmacy benefit managers, the Contractor shall provide a network adequacy report at EOHHS’ request.
d. The Material Subcontract shall:
1) Be a written agreement;
2) Specify, and require compliance with, all applicable requirements of this Contract and the activities and reporting responsibilities the Material Subcontractor is obligated to provide;
3) Provide for imposing sanctions, including contract termination, if the Material Subcontractor’s performance is inadequate;
4) Require the Material Subcontractor to comply with all applicable Medicaid laws, regulations, and applicable subregulatory guidance;
5) Comply with the audit and inspection requirements set forth in 42 CFR 438.230(c)(3), such that the Material Subcontract requires the Material Subcontractor to agree as follows. See also Section 65.4.
a) The State, CMS, HHS Inspector General, the Comptroller General, or their designees, have the right to audit, evaluate, and inspect any records or systems that pertain to any activities performed or amounts payable under this Contract. This right exists through 10 years from the final date of the contract or from the date of completion of any audit, whichever is later; provided, however that if any of the entities above determine that there is a reasonable possibility of fraud or similar risk, they may audit, evaluate, and inspect at any time; and
b) The Material Subcontractor will make its premises, facilities, equipment, records, and systems available for the purposes of any audit, evaluation, or inspection described immediately above;
e. The Contractor shall monitor any Material Subcontractor’s performance on an ongoing basis and perform a formal review annually. If any deficiencies or areas for improvement are identified, the Contractor shall require the Material Subcontractor to take corrective action. Upon request, the Contractor shall provide EOHHS with a copy of the annual review and any corrective action plans developed as a result.
f. Upon notifying any Material Subcontractor, or being notified by such Material Subcontractor, of the intention to terminate such subcontract, the Contractor shall notify EOHHS in writing no later than the same day as such notification, and shall otherwise support any necessary member transition or related activities as described in Section 2.2 and elsewhere in this Contract.
g. In accordance with Appendix A, the Contractor shall submit to EOHHS an annual list of all Material Subcontractors. Such annual report shall include notification if any of its Material Subcontractors are a business enterprise (for-profit) or non-profit organization certified by the Commonwealth’s Supplier Diversity Office. The Contractor shall submit ad hoc reports, as frequently as necessary or as directed by EOHHS, with any changes to the above-mentioned list and report.
h. The Contractor shall make best efforts to ensure that all Material Subcontracts stipulate that Massachusetts general law or Massachusetts regulation will prevail if there is a conflict between the state law or state regulation where the Material Subcontractor is based.
i. The Contractor shall, pursuant to the Acts of 2014, c. 165, Section 188, file with MassHealth any contracts or subcontracts for the management and delivery of behavioral health services by specialty behavioral health organizations to MassHealth members and MassHealth shall disclose such contracts upon request.
j. Notwithstanding any relationship the Contractor may have with a subcontractor, including Material subcontractors, the Contractor shall maintain ultimate responsibility for adhering to and otherwise fully complying with all terms and conditions of this Contract; and
k. The Contractor shall remain fully responsible for meeting all of the terms and requirements (including all applicable state and federal regulations) of the Contract regardless of whether the Contractor subcontracts for performance of any Contract responsibility. No subcontract will operate to relieve the Contractor of its legal responsibilities under the Contract.
l. The Contractor shall inform all Material Subcontractors of Enrollee grievance and appeal rights as described in Section 2.8.A.7 and Section 2.12.
Appears in 1 contract
Material Subcontracts/Subcontractors. a. Prior to contracting with a Material Subcontractor, the Contractor shall evaluate the prospective Material Subcontractor’s ability to perform the activities to be subcontracted.
b. All Material Subcontracts must be prior approved by EOHHS. To obtain such approval, the Contractor shall make a request in writing and submit with that request a completed Material Subcontractor checklist using the template provided by EOHHS and attached hereto as Appendix IB-2, as may be modified by EOHHS from time-to-time, at least 60 days prior to the date the Contractor expects to execute the Material Subcontract. Among other things required in the checklist, the Contractor must describe the process for selecting the Material Subcontractor, including the selection criteria used.
c. The Contractor shall provide EOHHS with any additional information requested by EOHHS in addition to the information required in the checklist.
d. The Material Subcontract shall:
1) Be a written agreement;
2) Specify, and require compliance with, all applicable requirements of this Contract and the activities and reporting responsibilities the Material Subcontractor is obligated to provide;
3) Provide for imposing sanctions, including contract termination, if the Material Subcontractor’s performance is inadequate;
4) Require the Material Subcontractor to comply with all applicable Medicaid laws, regulations, and applicable subregulatory guidance;; and
5) Comply with the audit and inspection requirements set forth in 42 CFR 438.230(c)(3), such that the Material Subcontract requires the Material Subcontractor to agree as follows.
a) The State, CMS, HHS Inspector General, the Comptroller General, or their designees, have the right to audit, evaluate, and inspect any records or systems that pertain to any activities performed or amounts payable under this Contract. See also This right exists through 10 years from the final date of the Contract or from the date of completion of any audit, whichever is later; provided, however that if any of the entities above determine that there is a reasonable possibility of fraud or similar risk, they may audit, evaluate, and inspect at any time; and
b) The Material Subcontractor will make its premises, facilities, equipment, records, and systems available for the purposes of any audit, evaluation, or inspection described immediately above;
e. The Contractor shall monitor any Material Subcontractor’s performance on an ongoing basis and perform a formal review annually. If any deficiencies or areas for improvement are identified, the Contractor shall require the Material Subcontractor to take corrective action. Upon request, the Contractor shall provide EOHHS with a copy of the annual review and any corrective action plans developed as a result.
f. Upon notifying any Material Subcontractor, or being notified by such Material Subcontractor, of the intention to terminate such subcontract, the Contractor shall notify EOHHS in writing no later than the same day as such notification, and shall otherwise support any necessary member transition or related activities as described in Section 62.2 and elsewhere in this Contract.
g. In accordance with Appendix E-1, the Contractor shall submit to EOHHS an annual list of all Material Subcontractors. Such annual report shall include notification if any of its Material Subcontractors are a business enterprise (for-profit) or nonprofit organization certified by the Commonwealth’s Supplier Diversity Office.
h. The Contractor shall submit ad hoc reports, as frequently as necessary or as directed by XXXXX, with any changes to the above-mentioned list and report.
i. The Contractor shall make best efforts to ensure that all Material Subcontracts stipulate that Massachusetts general law or Massachusetts regulation will prevail if there is a conflict between the state law or state regulation where the Material Subcontractor is based.
j. Notwithstanding any relationship the Contractor may have with a subcontractor, including Material subcontractors, the Contractor shall maintain ultimate responsibility for adhering to and otherwise fully complying with all terms and conditions of this Contract.
k. The Contractor shall remain fully responsible for meeting all of the terms and requirements (including all applicable state and federal regulations) of the Contract regardless of whether the Contractor subcontracts for performance of any Contract responsibility. No subcontract will operate to relieve the Contractor of its legal responsibilities under the Contract.
Appears in 1 contract
Material Subcontracts/Subcontractors. a. Prior to contracting with a Material Subcontractor, the Contractor shall evaluate the prospective Material Subcontractor’s ability to perform the activities to be subcontracted.
b. All Material Subcontracts must be prior approved by EOHHS. To obtain such approval, the Contractor shall make a request in writing and submit with that request a completed Material Subcontractor checklist using the template provided by EOHHS and attached hereto as Appendix I, as may be modified by EOHHS from time-to-time, at least 60 days prior to the date the Contractor expects to execute the Material Subcontract. For Material Subcontractors who are pharmacy benefit managers, the Contractor shall submit the above information 90 days prior to the date the Contractor expects to execute the Material Subcontract. Among other things required in the checklist, the Contractor must describe the process for selecting the Material Subcontractor, including the selection criteria used.
c. The Contractor shall provide EOHHS with any additional information requested by EOHHS in addition to the information required in the checklist. For Material Subcontractors who are pharmacy benefit managers, the Contractor shall provide a network adequacy report at EOHHS’ request.
d. The Material Subcontract shall:
1) Be a written agreement;
2) Specify, and require compliance with, all applicable requirements of this Contract and the activities and reporting responsibilities the Material Subcontractor is obligated to provide;
3) Provide for imposing sanctions, including contract termination, if the Material Subcontractor’s performance is inadequate;
4) Require the Material Subcontractor to comply with all applicable Medicaid laws, regulations, and applicable subregulatory guidance;
5) Comply with the audit and inspection requirements set forth in 42 CFR 438.230(c)(3), such that the Material Subcontract requires the Material Subcontractor to agree as follows. See also Section 6.
Appears in 1 contract
