MEDICARE ADVANTAGE REQUIREMENTS. The following provisions shall only apply to services rendered to Subscribers who are Medicare Advantage members enrolled in the Medicare Advantage PPO Program and/or Medicare Advantage DHMO Program ("Medicare Advantage Program"), as applicable (hereinafter, the "MA Members"). In case of conflict between the Agreement and these terms, these terms shall control as to the Medicare Advantage Program only, provided that to the extent Dentist is required by law or by the Agreement to comply with other laws, regulations or requirements by accrediting agencies, the broadest obligation shall control. These provisions may be supplemented by Medicare Advantage Plan’s (the “MA Plan”) policies, procedures and provider manual provisions, as the same may be updated from time to time. To the extent that any greater rights or obligations between the parties are created in these provisions than are in the Agreement, such rights and obligations shall only apply to Covered Services provided under the Medicare Advantage Program. If there is any conflict between the Agreement and Medicare Advantage laws, regulations or guidelines, the Medicare Advantage laws, regulations and guidelines shall control to the extent applicable.
MEDICARE ADVANTAGE REQUIREMENTS. In the event that Provider participates in any Program which is a Medicare Advantage plan, Oscar, Provider, Provider Entities and Employed Professionals will comply with the requirements for Oscar’s Medicare Advantage plans as set forth in Exhibit 7.4. In the event of a conflict between the provisions set forth in Exhibit 7.4 and this Agreement, the requirements in Exhibit 7.4 shall control.
MEDICARE ADVANTAGE REQUIREMENTS. Agent and HNE agree to be bound by the Medicare Advantage Requirements attached and incorporated herein as Exhibit B, as subject to change from time to time.
MEDICARE ADVANTAGE REQUIREMENTS. Agent and SelectHealth agree to be bound by the Medicare Advantage Requirements attached hereto as Exhibit C.
MEDICARE ADVANTAGE REQUIREMENTS. Except as provided herein, all other provisions of the Agreement between IPA and Group not inconsistent herein shall remain in full force and effect. The following provisions shall supersede and replace any inconsistent provisions of the Agreement with regards to Medicare Advantage/I-SNP services to ensure compliance with required CMS provisions, and shall continue concurrently with the term of the Agreement.
MEDICARE ADVANTAGE REQUIREMENTS. In accordance with federal regulations and official guidance applicable to Medicare Advantage (“MA”) plans, (including, but not limited to, 42 CFR 422.504 and the Medicare Managed Care Manual), all “first tier” entities that contract with an MA organization, as well as any “downstream entity” (defined to mean “any party that enters into an acceptable written agreement below the level of arrangement between the MA organization and the first tier entity”) or “related entity” (as defined by 42 CFR 422.500), must agree to certain terms and conditions. Accordingly, to the extent applicable, the following terms and conditions are hereby incorporated by reference into the Agreement:
MEDICARE ADVANTAGE REQUIREMENTS. Provider agrees to comply with the requirements set forth in this addendum for Medicare Members.
MEDICARE ADVANTAGE REQUIREMENTS. Provider agrees to comply with the requirements set forth in this addendum for Medicare Members.
1. Inspection and Audit of Records and Facilities. Provider shall provide access at reasonable times upon demand by Provider and Government Agencies to periodically audit or inspect the facilities, offices, equipment, books, documents and records of Provider relating to the performance of the Addendum and the Medicare Covered Services provided to Medicare Members, including without limitation, all phases of professional and ancillary medical care provided or arranged for Medicare Members by Provider, Medicare Member medical records and financial records pertaining to the cost of operations and income received by Provider for Medicare Covered Services rendered to Medicare Members. Such access shall be limited to that necessary to perform the audit. Provider shall comply with any requirements or directives issued by Provider and Government Agencies as a result of such evaluation, inspection or audit of Provider. Provider shall retain the books and records described in this Section for at least ten (10) years and acknowledge that Government Agencies may have the right to inspect and audit Provider’s books and records for ten (10) years beyond termination of the Addendum or until the conclusion of any governmental audit that may be initiated that pertains to such records, whichever is latest unless: (i) the CMS determines there is a special need to retain a particular record or group of records for a longer period and notifies Contractor or Provider at least thirty (30) days before the normal disposition date; (ii) there has been a termination, dispute, or fraud or similar fault by Provider, in which case the retention may be extended to ten (10) years from the date of any resulting final resolution of the termination, dispute, or fraud or similar fault; or (iii) the CMS determines that there is a reasonable possibility of fraud, in which case it may inspect, evaluate, and audit Provider at any time. Without limiting the foregoing, following the commencement of any audit by a Government Agency, Provider shall retain its relevant books and records until completion of said audit. The provisions of this Section shall survive termination of the Addendum for the period of time required by State and Federal Law. [42 CRF 422.504 (e) (4) and 422.504(i)(2)(i) and (ii)]
