Common use of Protective Clauses Clause in Contracts

Protective Clauses. (1) Require safeguarding of information about enrollees according to 42 CFR, Part 438.224. (2) Require compliance with HIPAA privacy and security provisions. (3) Require an exculpatory clause, which survives subcontract termination, including breach of subcontract due to insolvency, which assures that Medicaid recipients or the Agency will not be held liable for any debts of the subcontractor. (4) If there is a Health Plan physician incentive plan, include a statement that the Health Plan shall make no specific payment directly or indirectly under a physician incentive plan to a subcontractor as an inducement to reduce or limit medically necessary services to an enrollee, and affirmatively state that all incentive plans do not provide incentives, monetary or otherwise, for the withholding of medically necessary care; (5) Require full cooperation in any investigation by the Agency, MPI, MFCU or other state or federal entity or any subsequent legal action that may result from such an investigation; WellCare of Florida, Inc. Medicaid HMO Non-Reform Contract (6) Contain a clause indemnifying, defending and holding the Agency and the Health Plan’s enrollees harmless from and against all claims, damages, causes of action, costs or expenses, including court costs and reasonable attorney fees, to the extent proximately caused by any negligent act or other wrongful conduct arising from the subcontract agreement. This clause must survive the termination of the subcontract, including breach due to insolvency. The Agency may waive this requirement for itself, but not Health Plan enrollees, for damages in excess of the statutory cap on damages for public entities, if the subcontractor is a state agency or subdivision as defined by s. 768.28, F.S., or a public health entity with statutory immunity. All such waivers must be approved in writing by the Agency; (7) Require that the subcontractor secure and maintain, during the life of the subcontract, workers’ compensation insurance for all of its employees connected with the work under this Contract unless such employees are covered by the protection afforded by the Health Plan. Such insurance shall comply with Florida's Workers’ Compensation Law; (8) Specify that if the subcontractor delegates or subcontracts any functions of the Health Plan, that the subcontract or delegation includes all the requirements of this Contract; (9) Make provisions for a waiver of those terms of the subcontract, which, as they pertain to Medicaid recipients, are in conflict with the specifications of this Contract; (10) Provide for revoking delegation, or imposing other sanctions, if the subcontractor’s performance is inadequate; (11) Provide that compensation to individuals or entities that conduct utilization management activities is not structured so as to provide incentives for the individual or entity to deny, limit, or discontinue medically necessary services to any enrollee; and (12) Provide details about the following as required by Section 6032 of the federal Deficit Reduction Act of 2005:

Protective Clauses. (1) Require safeguarding of information about enrollees according to 42 CFR, Part 438.224.. HealthEase of Florida, Inc. Medicaid HMO Non-Reform Contract (2) Require compliance with HIPAA privacy and security provisions. (3) Require an exculpatory clause, which survives subcontract termination, including breach of subcontract due to insolvency, which assures that Medicaid recipients or the Agency will not be held liable for any debts of the subcontractor. (4) If there is a Health Plan physician incentive plan, include a statement that the Health Plan shall make no specific payment directly or indirectly under a physician incentive plan to a subcontractor as an inducement to reduce or limit medically necessary services to an enrollee, and affirmatively state that all incentive plans do not provide incentives, monetary or otherwise, for the withholding of medically necessary care; (5) Require full cooperation in any investigation by the Agency, MPI, MFCU or other state or federal entity or any subsequent legal action that may result from such an investigation; WellCare of Florida, Inc. Medicaid HMO Non-Reform Contract; (6) Contain a clause indemnifying, defending and holding the Agency and the Health Plan’s enrollees harmless from and against all claims, damages, causes of action, costs or expenses, including court costs and reasonable attorney fees, to the extent proximately caused by any negligent act or other wrongful conduct arising from the subcontract agreement. This clause must survive the termination of the subcontract, including breach due to insolvency. The Agency may waive this requirement for itself, but not Health Plan enrollees, for damages in excess of the statutory cap on damages for public entities, if the subcontractor is a state agency or subdivision as defined by s. 768.28, F.S., or a public health entity with statutory immunity. All such waivers must be approved in writing by the Agency; (7) Require that the subcontractor secure and maintain, during the life of the subcontract, workers’ compensation insurance for all of its employees connected with the work under this Contract unless such employees are covered by the protection afforded by the Health Plan. Such insurance shall comply with Florida's Workers’ Compensation Law; (8) Specify that if the subcontractor delegates or subcontracts any functions of the Health Plan, that the subcontract or delegation includes all the requirements of this Contract; (9) Make provisions for a waiver of those terms of the subcontract, which, as they pertain to Medicaid recipients, are in conflict with the specifications of this Contract; (10) Provide for revoking delegation, or imposing other sanctions, if the subcontractor’s performance is inadequate; (11) Provide that compensation to individuals or entities that conduct utilization management activities is not structured so as to provide incentives for the HealthEase of Florida, Inc. Medicaid HMO Non-Reform Contract individual or entity to deny, limit, or discontinue medically necessary services to any enrollee; and (12) Provide details about the following as required by Section 6032 of the federal Deficit Reduction Act of 2005: (a) The False Claim Act; (b) The penalties for submitted false claims and statements; (c) Whistleblower protections; and (d) The law’s role in preventing and detecting fraud, waste and abuse, and each person’s responsibility relating to detection and prevention.

Protective Clauses. (1) Require safeguarding of information about enrollees according to 42 CFR, Part 438.224.. WellCare of Florida, Inc. d/b/a Staywell Health Plan of Florida Medicaid HMO Non-Reform Contract (2) Require compliance with HIPAA privacy and security provisions. (3) Require an exculpatory clause, which survives subcontract termination, including breach of subcontract due to insolvency, which assures that Medicaid recipients or the Agency will not be held liable for any debts of the subcontractor. (4) If there is a Health Plan physician incentive plan, include a statement that the Health Plan shall make no specific payment directly or indirectly under a physician incentive plan to a subcontractor as an inducement to reduce or limit medically necessary services to an enrollee, and affirmatively state that all incentive plans do not provide incentives, monetary or otherwise, for the withholding of medically necessary care; (5) Require full cooperation in any investigation by the Agency, MPI, MFCU or other state or federal entity or any subsequent legal action that may result from such an investigation; WellCare of Florida, Inc. Medicaid HMO Non-Reform Contract; (6) Contain a clause indemnifying, defending and holding the Agency and the Health Plan’s enrollees harmless from and against all claims, damages, causes of action, costs or expenses, including court costs and reasonable attorney fees, to the extent proximately caused by any negligent act or other wrongful conduct arising from the subcontract agreement. This clause must survive the termination of the subcontract, including breach due to insolvency. The Agency may waive this requirement for itself, but not Health Plan enrollees, for damages in excess of the statutory cap on damages for public entities, if the subcontractor is a state agency or subdivision as defined by s. 768.28, F.S., or a public health entity with statutory immunity. All such waivers must be approved in writing by the Agency; (7) Require that the subcontractor secure and maintain, during the life of the subcontract, workers’ compensation insurance for all of its employees connected with the work under this Contract unless such employees are covered by the protection afforded by the Health Plan. Such insurance shall comply with Florida's Workers’ Compensation Law; (8) Specify that if the subcontractor delegates or subcontracts any functions of the Health Plan, that the subcontract or delegation includes all the requirements of this Contract; (9) Make provisions for a waiver of those terms of the subcontract, which, as they pertain to Medicaid recipients, are in conflict with the specifications of this Contract; (10) Provide for revoking delegation, or imposing other sanctions, if the subcontractor’s performance is inadequate; (11) Provide that compensation to individuals or entities that conduct utilization management activities is not structured so as to provide incentives for the WellCare of Florida, Inc. d/b/a Staywell Health Plan of Florida Medicaid HMO Non-Reform Contract individual or entity to deny, limit, or discontinue medically necessary services to any enrollee; and (12) Provide details about the following as required by Section 6032 of the federal Deficit Reduction Act of 2005: (a) The False Claim Act; (b) The penalties for submitted false claims and statements; (c) Whistleblower protections; and (d) The law’s role in preventing and detecting fraud, waste and abuse, and each person’s responsibility relating to detection and prevention.

Protective Clauses. (1) Require safeguarding of information about enrollees according to 42 CFR, Part 438.224.. AMERIGROUP Florida, Inc. d/b/a Medicaid Non-Reform and Reform AMERIGROUP Community Care HMO Contract (2) Require compliance with HIPAA privacy and security provisions. (3) Require an exculpatory clause, which survives subcontract termination, including breach of subcontract due to insolvency, which assures that Medicaid recipients or the Agency will not be held liable for any debts of the subcontractor. (4) If there is a Health Plan physician incentive plan, include a statement that the Health Plan shall make no specific payment directly or indirectly under a physician incentive plan to a subcontractor as an inducement to reduce or limit medically necessary services to an enrollee, and affirmatively state that all incentive plans do not provide incentives, monetary or otherwise, for the withholding of medically necessary care; (5) Require full cooperation in any investigation by the Agency, MPI, MFCU or other state or federal entity or any subsequent legal action that may result from such an investigation; WellCare of Florida, Inc. Medicaid HMO Non-Reform Contract; (6) Contain a clause indemnifying, defending and holding the Agency and the Health Plan’s enrollees harmless from and against all claims, damages, causes of action, costs or expenses, including court costs and reasonable attorney fees, to the extent proximately caused by any negligent act or other wrongful conduct arising from the subcontract agreement. This clause must survive the termination of the subcontract, including breach due to insolvency. The Agency may waive this requirement for itself, but not Health Plan enrollees, for damages in excess of the statutory cap on damages for public entities, if the subcontractor is a state agency or subdivision as defined by s. 768.28, F.S., or a public health entity with statutory immunity. All such waivers must be approved in writing by the Agency; (7) Require that the subcontractor secure and maintain, during the life of the subcontract, workers’ compensation insurance for all of its employees connected with the work under this Contract unless such employees are covered by the protection afforded by the Health Plan. Such insurance shall comply with Florida's ’s Workers’ Compensation Law; (8) Specify that if the subcontractor delegates or subcontracts any functions of the Health Plan, that the subcontract or delegation includes all the requirements of this Contract; (9) Make provisions for a waiver of those terms of the subcontract, which, as they pertain to Medicaid recipients, are in conflict with the specifications of this Contract; (10) Provide for revoking delegation, or imposing other sanctions, if the subcontractor’s performance is inadequate; (11) Provide that compensation to individuals or entities that conduct utilization management activities is not structured so as to provide incentives for the AMERIGROUP Florida, Inc. d/b/a Medicaid Non-Reform and Reform AMERIGROUP Community Care HMO Contract individual or entity to deny, limit, or discontinue medically necessary services to any enrollee; and (12) Provide details about the following as required by Section 6032 of the federal Deficit Reduction Act of 2005: (a) The False Claim Act; (b) The penalties for submitted false claims and statements; (c) Whistleblower protections; and (d) The law’s role in preventing and detecting fraud, waste and abuse, and each person’s responsibility relating to detection and prevention.