Plan Accountability; Delegated Activities Sample Clauses

Plan Accountability; Delegated Activities. Agent acknowledges and agrees that Plan oversees and is accountable to CMS for any functions and responsibilities described in Plan’s contract with CMS and applicable Medicare Advantage regulations, including those that Plan has delegated to Agent. If Plan has delegated any of Plan’s functions and responsibilities under its contract with CMS to Agent pursuant to the Agreement, the following will apply in addition to the other provisions of this Attachment: i. Agent will perform those delegated activities specified in the Agreement, if any, and will comply with any reporting responsibilities as set forth in the Agreement. ii. Plan will have the right to monitor, inspect, evaluate and audit Agent and Agent’s and each Sales Agent’s Records. In connection with any monitoring, inspection, evaluation or audit, Agent will provide Plan with access to all Records, personnel, physical facilities, equipment and other information necessary for Plan, an applicable government agency or its auditors to conduct the audit. Within three (3) business days of Plan’s written request for Records or Records, or such shorter time period required for Plan to comply with requests of government agencies, Agent will compile and prepare all such Records and furnish them to Plan in a format reasonably requested by Plan. iii. Agent will cooperate in reasonably requested on-site inspections of its facilities by Plan, authorized government officials, and accreditation bodies. Such inspections by Plan will be performed in accordance with the Agent’s policies and procedures and will not interfere with the daily operations of the Agent. In preparation for any such on-site inspection, Agent will compile within seven (7) calendar days of a request any and all documents, data, and other information as may be requested by Plan or government officials and Agent will make available sufficient work space for Plan or any authorized government official and accreditation body as well as access to all reasonably necessary personnel during an on-site inspection.

Plan Accountability; Delegated Activities. Provider acknowledges and agrees that Plan oversees and is accountable to CMS for any functions and responsibilities described in Plan’s contract with CMS and applicable Medicare Advantage regulations, including those that Plan has delegated to Provider. If Plan has delegated any of Plan’s functions and responsibilities under its contract with CMS to Provider pursuant to the Agreement, the following will apply in addition to the other provisions of this Attachment: i. Provider will perform those delegated activities specified in the Agreement, if any, and will comply with any reporting responsibilities as set forth in the Agreement. ii. If Plan has delegated to Provider any activities related to the credentialing of health care providers, Plan must comply with all applicable CMS requirements for credentialing, including but not limited to the requirement that the credentials of medical professionals must either be reviewed by Plan or its designee, or the credentialing process must be reviewed, pre-approved and audited on an ongoing basis by Plan or its designee. iii. If Plan has delegated to Provider the selection of health care providers to be participating providers in Plan’s Medicare Advantage network, Plan retains the right to approve, suspend or terminate the participation status of such health care providers. iv. Provider acknowledges that Plan or its designee will monitor Provider’s performance of any delegated activities on an ongoing basis. If Plan or CMS determines that Provider has not performed satisfactorily, Plan may revoke any or all delegated activities and reporting requirements. Provider will cooperate with Plan regarding the transition of any delegated activities or reporting requirements that have been revoked by Plan. [42 C.F.R. §§ 422.504(i)(4) and (5)]