Common use of Non-compliance with General Contract Provisions Clause in Contracts

Non-compliance with General Contract Provisions. The objective of this requirement is to provide the State with an administrative procedure to address issues where the Contractor is not compliant with the Contract. Through routine monitoring, the State may identify Contract non-compliance issues. If this occurs, the State will notify the Contractor in writing of the nature of the non-performance issue. The State will establish a reasonable period of time, but not more than ten (10) business days, during which the Contractor shall provide a written response to the notification. If the Contractor does not correct the non-performance issue within the specified time, the State may enforce any of the remedies listed in this Exhibit. Specifically, the State may enforce any of the remedies listed in this Exhibit if the Contractor does the following:  Fails substantially to provide medically necessary services that the Plan is required to provide, under law or under its Contract with the State, to a member;  Imposes on members premiums or charges that are in excess of the premiums or charges permitted under the Hoosier Healthwise Program;  Acts to discriminate among members on the basis of their health status or need for health care services, such as unlawful termination or refusal to re-enroll a member or engaging in any practice that would reasonably be expected to discourage enrollment by a potential enrollee whose medical condition or history indicates probable need for substantial future medical services;  Misrepresents or falsifies information that it furnishes to CMS or to the State.  Misrepresents or falsifies information that it furnishes to a member, potential enrollee, or health care provider;  Fails to comply with the requirements for physician incentive plans, as set forth in 42 CFR 422.208 and 422.210;  Has violated any of the other applicable requirements of sections 1903(m) or 1932 of the Act and any implementing regulations.

Non-compliance with General Contract Provisions. The objective of this requirement is to provide the State with an administrative procedure to address issues where the Contractor is not compliant with the Contract. Through routine monitoring, the State may identify Contract non-compliance issues. If this occurs, the State will notify the Contractor in writing of the nature of the non-performance issue. The State will establish a reasonable period of time, but not more than ten (10) business days, during which the Contractor shall provide a written response to the notification. If the Contractor does not correct the non-performance issue within the specified time, the State may enforce any of the remedies listed in this Exhibit. Specifically, the State may enforce any of the remedies listed in this Exhibit if the Contractor does the following:   Fails substantially to provide medically necessary services that the Plan is required to provide, under law or under its Contract with the State, to a member;   Imposes on members premiums or charges that are in excess of the premiums or charges permitted under the Hoosier Healthwise Program;   Acts to discriminate among members on the basis of their health status or need for health care services, such as unlawful termination or refusal to re-enroll a member or engaging in any practice that would reasonably be expected to discourage enrollment by a potential enrollee whose medical condition or history indicates probable need for substantial future medical services;   Misrepresents or falsifies information that it furnishes to CMS or to the State.   Misrepresents or falsifies information that it furnishes to a member, potential enrollee, or health care provider;   Fails to comply with the requirements for physician incentive plans, as set forth in 42 CFR 422.208 and 422.210;   Has violated any of the other applicable requirements of sections 1903(m) or 1932 of the Act and any implementing regulations.

Non-compliance with General Contract Provisions. The objective of this requirement is to provide the State with an administrative procedure to address issues where the Contractor is not compliant with the Contract. Through routine monitoring, the State may identify Contract non-compliance issues. If this occurs, the State will notify the Contractor in writing of the nature of the non-performance issue. The State will establish a reasonable period of time, but not more than ten (10) business days, during which the Contractor shall provide a written response to the notification. If the Contractor does not correct the non-performance issue within the specified time, the State may enforce any of the remedies listed in this Exhibit. Specifically, the State may enforce any of the remedies listed in this Exhibit if the Contractor does the following:   Fails substantially to provide medically necessary services that the Plan is required to provide, under law or under its Contract with the State, to a member;   Imposes on members premiums or charges that are in excess of the premiums or charges permitted under the Hoosier Healthwise Healthy Indiana Plan Program;   Acts to discriminate among members on the basis of their health status or need for health care services, such as unlawful termination or refusal to re-enroll a member or engaging in any practice that would reasonably be expected to discourage enrollment by a potential enrollee whose medical condition or history indicates probable need for substantial future medical services;   Misrepresents or falsifies information that it furnishes to CMS or to the State.   Misrepresents or falsifies information that it furnishes to a member, potential enrollee, or health care provider;   Fails to comply with the requirements for physician incentive plans, as set forth in 42 CFR 422.208 and 422.210;   Has violated any of the other applicable requirements of sections 1903(m) or 1932 of the Act and any implementing regulations.