Common use of Provider Contract Requirements Clause in Contracts

Provider Contract Requirements. 1. The Health Plan shall comply with all Agency procedures for provider contract review and approval submission. a. All provider contracts must comply with 42 CFR 438.230, 42 CFR 455.104, 42 CFR 455.105, and 42 CFR 455.106. b. If the Health Plan is capitated, it shall ensure that all providers are eligible for participation in the Medicaid program. If a provider is currently suspended or involuntarily terminated from the Florida Medicaid program whether by contract or WellCare of Florida, Inc., Medicaid HMO Non-Reform Contract sanction, other than for purposes of inactivity, that provider is not considered an eligible Medicaid provider. If the Health Plan is not capitated, its providers shall be enrolled as Florida Medicaid providers. Suspension and termination are described further in Rule 59G-9.070, F.A.C. The Health Plan is responsible for this provision within five (5) calendar days after notification of a provider’s ineligibility to participate in the Medicaid program (by its own or outside source, by communication from the Agency, by listing in an Agency website or other forum designated by the Agency). c. The Health Plan shall not employ or contract with individuals on the state or federal exclusions list. d. No provider contract that the Health Plan enters into with respect to performance under this Contract shall in any way relieve the Health Plan of any responsibility for the provision of services or duties under this Contract. The Health Plan shall assure that all services and tasks related to the provider contract are performed in accordance with the terms of this Contract. The Health Plan shall identify in its provider contract any aspect of service that may be subcontracted by the provider. 2. All provider contracts and amendments executed by the Health Plan shall be in writing, signed, and dated by the Health Plan and the provider, and shall meet the following requirements: a. Prohibit the provider from seeking payment from the enrollee for any covered services provided to the enrollee within the terms of the Contract; b. Require the provider to look solely to the following for compensation for services rendered, with the exception of nominal cost sharing, pursuant to the Medicaid State Plan and the Florida Coverage and Limitations Handbooks: (1) If a capitated Health Plan, then to the capitated Health Plan for compensation; (2) If a FFS Health Plan, then to the Agency or its Agent, unless the service is one for which the Health Plan receives a capitation payment from the Agency. For such capitated services, the Health Plan shall require providers to look solely to the Health Plan; c. 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 provider as an inducement to reduce or limit, medically necessary services to an enrollee, and that incentive plans shall not contain provisions that provide incentives, monetary or otherwise, for withholding medically necessary care; d. Specify that any contracts, agreements, or subcontracts entered into by the provider for purposes of carrying out any aspect of this Contract shall include assurances that the individuals who are signing the contract, agreement or subcontract are so authorized and that it includes all the requirements of this Contract; e. Require the provider to cooperate with the Health Plan's peer review, grievance, QIP and UM activities, and provide for monitoring and oversight, including monitoring of services rendered to enrollees, by the Health Plan (or its subcontractor). If the Health Plan has delegated the credentialing to a subcontractor, the agreement must ensure WellCare of Florida, Inc., Medicaid HMO Non-Reform Contract that all licensed providers are credentialed in accordance with the Health Plan’s and the Agency’s credentialing requirements as found in Attachment II, Section VII, Provider Network, Item H., Credentialing and Recredentialing; f. Include provisions for the immediate transfer to another PCP or health plan if the enrollee's health or safety is in jeopardy; g. Not prohibit a provider from discussing treatment or non-treatment options with enrollees that may not reflect the Health Plan's position or may not be covered by the Health Plan; h. Not prohibit a provider from acting within the lawful scope of practice, from advising or advocating on behalf of an enrollee for the enrollee's health status, medical care, or treatment or non-treatment options, including any alternative treatments that might be self-administered; i. Not prohibit a provider from advocating on behalf of the enrollee in any grievance system or UM process, or individual authorization process to obtain necessary services; j. Require providers to meet appointment waiting time standards pursuant to this Contract; k. Provide for continuity of treatment in the event a provider contract terminates during the course of an enrollee's treatment by that provider; l. Prohibit discrimination with respect to participation, reimbursement, or indemnification of any provider who is acting within the scope of his/her license or certification under applicable state law, solely on the basis of such license or certification. This provision shall not be construed as a willing provider law, as it does not prohibit the Health Plan from limiting provider participation to the extent necessary to meet the needs of the enrollees. This provision does not interfere with measures established by the Health Plan that are designed to maintain quality and control costs; m. Prohibit discrimination against providers serving high-risk populations or those that specialize in conditions requiring costly treatments; n. Require an adequate record system be maintained for recording services, charges, dates and all other commonly accepted information elements for services rendered to the Health Plan; o. Require that records be maintained for a period not less than six (6) years from the close of the Contract, and retained further if the records are under review or audit until the review or audit is complete. Prior approval for the disposition of records must be requested and approved by the Health Plan if the provider contract is continuous; p. Specify that DHHS, the Agency, MPI and MFCU shall have the right to inspect, evaluate, and audit all of the following related to this Contract: WellCare of Florida, Inc., Medicaid HMO Non-Reform Contract (1) Pertinent books, (2) Financial records, (3) Medical records, and (4) Documents, papers, and records of any provider involving financial transactions; q. Specify covered services and populations to be served under the provider contract; r. Require that providers comply with the Health Plan's cultural competency plan; s. Require that any community outreach materials related to this Contract that are displayed by the provider be submitted to the BMHC for written approval before use; t. Provide for submission of all reports and clinical information required by the Health Plan, including Child Health Check-Up reporting (if applicable); u. Require providers of transitioning enrollees to cooperate in all respects with providers of other health plans to assure maximum health outcomes for enrollees; v. Require providers to submit notice of withdrawal from the network at least ninety (90) calendar days before the effective date of such withdrawal; w. Require that all providers agreeing to participate in the network as PCPs fully accept and agree to responsibilities and duties associated with the PCP designation; x. Require all providers to notify the Health Plan in the event of a lapse in general liability or medical malpractice insurance, or if assets fall below the amount necessary for licensure under Florida Statutes; y. Require providers to offer hours of operation that are no less than the hours of operation offered to commercial Health Plan members or comparable non-Reform Medicaid recipients if the provider serves only Medicaid recipients; z. Require safeguarding of information about enrollees according to 42 CFR 438.224; aa. Require compliance with HIPAA privacy and security provisions; bb. Require an exculpatory clause, which survives provider agreement termination, including breach of provider contract due to insolvency, which assures that neither Medicaid recipients nor the Agency shall be held liable for any debts of the provider; cc. Require that the provider secure and maintain during the life of the provider contract worker compensation insurance (complying with the Florida worker compensation law) 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; dd. Make provisions for a waiver of those terms of the provider contract that, as they pertain to Medicaid recipients, are in conflict with the specifications of this Contract; WellCare of Florida, Inc., Medicaid HMO Non-Reform Contract ee. Contain no provision that in any way prohibits or restricts the provider from entering into a commercial contract with any other health plan (see s. 641.315, F.S.); ff. Contain no provision requiring the provider to contract for more than one (1) Health Plan product or otherwise be excluded (see s. 641.315, F.S.); gg. Contain no provision that prohibits the provider from providing inpatient services in a contracted hospital to an enrollee if such services are determined to be medically necessary and covered services under this Contract;

Provider Contract Requirements. 1. The Health Plan shall comply with all Agency procedures for provider contract review and approval submission. a. All provider contracts must comply with 42 CFR 438.230, 42 CFR 455.104, 42 CFR 455.105, and 42 CFR 455.106. b. If the Health Plan is capitated, it shall ensure that all providers are eligible for participation in the Medicaid program. If a provider is currently suspended or was involuntarily terminated from the Florida Medicaid program whether by contract or WellCare of Florida, Inc., Medicaid HMO Non-Reform Contract sanctionprogram, other than for purposes of inactivity, that provider is not considered an eligible Medicaid provider. If the Health Plan is not capitated, its providers shall be enrolled as Florida Medicaid providers. Suspension and termination are described further in Rule 59G-9.070, F.A.C. The Health Plan is responsible for this provision within five (5) calendar days after notification of a provider’s ineligibility to participate in the Medicaid program (by its own or outside source, by communication from the Agency, by listing in an Agency website or other forum designated by the Agency). c. The Health Plan shall not employ or contract with individuals on the state or federal exclusions list. d. No provider contract that the Health Plan enters into with respect to performance under this Contract shall in any way relieve the Health Plan of any responsibility for the provision of services or duties under this Contract. The Health Plan shall assure that all services and tasks related to the provider contract are performed in accordance with the terms of this Contract. The Health Plan shall identify in its provider contract any aspect of service that may be subcontracted by the provider. 2. All provider contracts and amendments executed by the Health Plan shall be in writing, signed, and dated by the Health Plan and the provider, and shall meet the following requirements: a. Prohibit the provider from seeking payment from the enrollee for any covered services provided to the enrollee within the terms of the Contract; b. Require the provider to look solely to the following for compensation for services rendered, with the exception of nominal cost sharing, pursuant to the Medicaid State Plan and the Florida Coverage and Limitations Handbooks:: HealthEase of Florida, Inc. Medicaid HMO Non-Reform Contract (1) If a capitated Health Plan, then to the capitated Health Plan for compensation; (2) If a FFS Health Plan, then to the Agency or its Agent, unless the service is one for which the Health Plan receives a capitation payment from the Agency. For such capitated services, the Health Plan shall require providers to look solely to the Health Plan; c. 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 provider as an inducement to reduce or limit, medically necessary services to an enrollee, and that incentive plans shall not contain provisions that provide incentives, monetary or otherwise, for withholding medically necessary care; d. Specify that any contracts, agreements, or subcontracts entered into by the provider for purposes of carrying out any aspect of this Contract shall include assurances that the individuals who are signing the contract, agreement or subcontract are so authorized and that it includes all the requirements of this Contract; e. Require the provider to cooperate with the Health Plan's peer review, grievance, QIP and UM activities, and provide for monitoring and oversight, including monitoring of services rendered to enrollees, by the Health Plan (or its subcontractor). If the Health Plan has delegated the credentialing to a subcontractor, the agreement must ensure WellCare of Florida, Inc., Medicaid HMO Non-Reform Contract that all licensed providers are credentialed in accordance with the Health Plan’s and the Agency’s credentialing requirements as found in Attachment II, Section VII, Provider Network, Item H., Credentialing and Recredentialing; f. Include provisions for the immediate transfer to another PCP or health plan if the enrollee's health or safety is in jeopardy; g. Not prohibit a provider from discussing treatment or non-treatment options with enrollees that may not reflect the Health Plan's position or may not be covered by the Health Plan; h. Not prohibit a provider from acting within the lawful scope of practice, from advising or advocating on behalf of an enrollee for the enrollee's health status, medical care, or treatment or non-treatment options, including any alternative treatments that might be self-administered; i. Not prohibit a provider from advocating on behalf of the enrollee in any grievance system or UM process, or individual authorization process to obtain necessary services; j. Require providers to meet appointment waiting time standards pursuant to this Contract; k. Provide for continuity of treatment in the event a provider contract terminates during the course of an enrollee's treatment by that provider; l. Prohibit discrimination with respect to participation, reimbursement, or indemnification of any provider who is acting within the scope of his/her license or HealthEase of Florida, Inc. Medicaid HMO Non-Reform Contract certification under applicable state law, solely on the basis of such license or certification. This provision shall not be construed as a willing provider law, as it does not prohibit the Health Plan from limiting provider participation to the extent necessary to meet the needs of the enrollees. This provision does not interfere with measures established by the Health Plan that are designed to maintain quality and control costs; m. Prohibit discrimination against providers serving high-risk populations or those that specialize in conditions requiring costly treatments; n. Require an adequate record system be maintained for recording services, charges, dates and all other commonly accepted information elements for services rendered to the Health Plan; o. Require that records be maintained for a period not less than six five (65) years from the close of the Contract, and retained further if the records are under review or audit until the review or audit is complete. Prior approval for the disposition of records must be requested and approved by the Health Plan if the provider contract is continuous; p. Specify that DHHS, the Agency, MPI and MFCU shall have the right to inspect, evaluate, and audit all of the following related to this Contract: WellCare of Florida, Inc., Medicaid HMO Non-Reform Contract: (1) Pertinent books, (2) Financial records, (3) Medical records, and (4) Documents, papers, and records of any provider involving financial transactions; q. Specify covered services and populations to be served under the provider contract; r. Require that providers comply with the Health Plan's cultural competency plan; s. Require that any community outreach materials related to this Contract that are displayed by the provider be submitted to the BMHC for written approval before use; t. Provide for submission of all reports and clinical information required by the Health Plan, including Child Health Check-Up reporting (if applicable); u. Require providers of transitioning enrollees to cooperate in all respects with providers of other health plans to assure maximum health outcomes for enrollees; v. Require providers to submit notice of withdrawal from the network at least ninety (90) calendar days before the effective date of such withdrawal; w. Require that all providers agreeing to participate in the network as PCPs fully accept and agree to responsibilities and duties associated with the PCP designation;; HealthEase of Florida, Inc. Medicaid HMO Non-Reform Contract x. Require all providers to notify the Health Plan in the event of a lapse in general liability or medical malpractice insurance, or if assets fall below the amount necessary for licensure under Florida Statutesstatutes; y. Require providers to offer hours of operation that are no less than the hours of operation offered to commercial Health Plan members or comparable non-Reform Medicaid recipients if the provider serves only Medicaid recipients; z. Require safeguarding of information about enrollees according to 42 CFR 438.224; aa. Require compliance with HIPAA privacy and security provisions; bb. Require an exculpatory clause, which survives provider agreement termination, including breach of provider contract due to insolvency, which assures that neither Medicaid recipients nor the Agency shall be held liable for any debts of the provider; cc. Require that the provider secure and maintain during the life of the provider contract worker compensation insurance (complying with the Florida worker compensation law) 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; dd. Make provisions for a waiver of those terms of the provider contract that, as they pertain to Medicaid recipients, are in conflict with the specifications of this Contract; WellCare of Florida, Inc., Medicaid HMO Non-Reform Contract; ee. Contain no provision that in any way prohibits or restricts the provider from entering into a commercial contract with any other health plan (see s. 641.315, F.S.); ff. Contain no provision requiring the provider to contract for more than one (1) Health Plan product or otherwise be excluded (see s. 641.315, F.S.); gg. Contain no provision that prohibits the provider from providing inpatient services in a contracted hospital to an enrollee if such services are determined to be medically necessary and covered services under this Contract;

Provider Contract Requirements. 1. The Health Plan shall comply with all Agency procedures for provider contract review and approval submission. a. All provider contracts must comply with 42 CFR 438.230, 42 CFR 455.104, 42 CFR 455.105, and 42 CFR 455.106. b. If the Health Plan is capitated, it shall ensure that all providers are eligible for participation in the Medicaid program. If a provider is currently suspended or was involuntarily terminated from the Florida Medicaid program whether by contract or WellCare of Florida, Inc., Medicaid HMO Non-Reform Contract sanctionprogram, other than for purposes of inactivity, that provider is not considered an eligible Medicaid provider. If the Health Plan is not capitated, its providers shall be enrolled as Florida Medicaid providers. Suspension and termination are described further in Rule 59G-9.070, F.A.C. The Health Plan is responsible for this provision within five (5) calendar days after notification of a provider’s ineligibility to participate in the Medicaid program (by its own or outside source, by communication from the Agency, by listing in an Agency website or other forum designated by the Agency). c. The Health Plan shall not employ or contract with individuals on the state or federal exclusions list. d. No provider contract that the Health Plan enters into with respect to performance under this Contract shall in any way relieve the Health Plan of any responsibility for the provision of services or duties under this Contract. The Health Plan shall assure that all services and tasks related to the provider contract are performed in accordance with the terms of this Contract. The Health Plan shall identify in its provider contract any aspect of service that may be subcontracted by the provider. 2. All provider contracts and amendments executed by the Health Plan shall be in writing, signed, and dated by the Health Plan and the provider, and shall meet the following requirements: a. Prohibit the provider from seeking payment from the enrollee for any covered services provided to the enrollee within the terms of the Contract; b. Require the provider to look solely to the following for compensation for services rendered, with the exception of nominal cost sharing, pursuant to the Medicaid State Plan and the Florida Coverage and Limitations Handbooks:: AMERIGROUP Florida, Inc. d/b/a Medicaid Non-Reform and Reform AMERIGROUP Community Care HMO Contract (1) If a capitated Health Plan, then to the capitated Health Plan for compensation; (2) If a FFS Health Plan, then to the Agency or its Agent, unless the service is one for which the Health Plan receives a capitation payment from the Agency. For such capitated services, the Health Plan shall require providers to look solely to the Health Plan; c. 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 provider as an inducement to reduce or limit, medically necessary services to an enrollee, and that incentive plans shall not contain provisions that provide incentives, monetary or otherwise, for withholding medically necessary care; d. Specify that any contracts, agreements, or subcontracts entered into by the provider for purposes of carrying out any aspect of this Contract shall include assurances that the individuals who are signing the contract, agreement or subcontract are so authorized and that it includes all the requirements of this Contract; e. Require the provider to cooperate with the Health Plan's ’s peer review, grievance, QIP and UM activities, and provide for monitoring and oversight, including monitoring of services rendered to enrollees, by the Health Plan (or its subcontractor). If the Health Plan has delegated the credentialing to a subcontractor, the agreement must ensure WellCare of Florida, Inc., Medicaid HMO Non-Reform Contract that all licensed providers are credentialed in accordance with the Health Plan’s and the Agency’s credentialing requirements as found in Attachment II, Section VII, Provider Network, Item H., Credentialing and Recredentialing; f. Include provisions for the immediate transfer to another PCP or health plan if the enrollee's ’s health or safety is in jeopardy; g. Not prohibit a provider from discussing treatment or non-treatment options with enrollees that may not reflect the Health Plan's ’s position or may not be covered by the Health Plan; h. Not prohibit a provider from acting within the lawful scope of practice, from advising or advocating on behalf of an enrollee for the enrollee's ’s health status, medical care, or treatment or non-treatment options, including any alternative treatments that might be self-administered; i. Not prohibit a provider from advocating on behalf of the enrollee in any grievance system or UM process, or individual authorization process to obtain necessary services; j. Require providers to meet appointment waiting time standards pursuant to this Contract; k. Provide for continuity of treatment in the event a provider contract terminates during the course of an enrollee's ’s treatment by that provider; l. Prohibit discrimination with respect to participation, reimbursement, or indemnification of any provider who is acting within the scope of his/her license or certification under applicable state law, solely on the basis of such license or certification. This provision shall not be construed as a willing provider law, as it does not prohibit the Health Plan from limiting provider participation to the extent necessary to meet the needs of the enrollees. This provision does not interfere with measures established by the Health Plan that are designed to maintain quality and control costs; m. Prohibit discrimination against providers serving high-risk populations or those that specialize in conditions requiring costly treatments; n. Require an adequate record system be maintained for recording services, charges, dates and all other commonly accepted information elements for services rendered to the Health Plan; o. Require that records be maintained for a period not less than six (6) years from the close of the Contract, and retained further if the records are under review or audit until the review or audit is complete. Prior approval for the disposition of records must be requested and approved by the Health Plan if the provider contract is continuous; p. Specify that DHHS, the Agency, MPI and MFCU shall have the right to inspect, evaluate, and audit all of the following related to this Contract: WellCare of Florida, Inc., Medicaid HMO Non-Reform Contract (1) Pertinent books, (2) Financial records, (3) Medical records, and (4) Documents, papers, and records of any provider involving financial transactions; q. Specify covered services and populations to be served under the provider contract; r. Require that providers comply with the Health Plan's cultural competency plan; s. Require that any community outreach materials related to this Contract that are displayed by the provider be submitted to the BMHC for written approval before use; t. Provide for submission of all reports and clinical information required by the Health Plan, including Child Health Check-Up reporting (if applicable); u. Require providers of transitioning enrollees to cooperate in all respects with providers of other health plans to assure maximum health outcomes for enrollees; v. Require providers to submit notice of withdrawal from the network at least ninety (90) calendar days before the effective date of such withdrawal; w. Require that all providers agreeing to participate in the network as PCPs fully accept and agree to responsibilities and duties associated with the PCP designation; x. Require all providers to notify the Health Plan in the event of a lapse in general liability or medical malpractice insurance, or if assets fall below the amount necessary for licensure under Florida Statutes; y. Require providers to offer hours of operation that are no less than the hours of operation offered to commercial Health Plan members or comparable non-Reform Medicaid recipients if the provider serves only Medicaid recipients; z. Require safeguarding of information about enrollees according to 42 CFR 438.224; aa. Require compliance with HIPAA privacy and security provisions; bb. Require an exculpatory clause, which survives provider agreement termination, including breach of provider contract due to insolvency, which assures that neither Medicaid recipients nor the Agency shall be held liable for any debts of the provider; cc. Require that the provider secure and maintain during the life of the provider contract worker compensation insurance (complying with the Florida worker compensation law) 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; dd. Make provisions for a waiver of those terms of the provider contract that, as they pertain to Medicaid recipients, are in conflict with the specifications of this Contract; WellCare of Florida, Inc., Medicaid HMO Non-Reform Contract ee. Contain no provision that in any way prohibits or restricts the provider from entering into a commercial contract with any other health plan (see s. 641.315, F.S.); ff. Contain no provision requiring the provider to contract for more than one (1) Health Plan product or otherwise be excluded (see s. 641.315, F.S.); gg. Contain no provision that prohibits the provider from providing inpatient services in a contracted hospital to an enrollee if such services are determined to be medically necessary and covered services under this Contract;

Provider Contract Requirements. 1. The Health Plan shall comply with all Agency procedures for provider contract review and approval submission. a. All provider contracts must comply with 42 CFR 438.230, 42 CFR 455.104, 42 CFR 455.105, and 42 CFR 455.106. b. If the Health Plan is capitated, it shall ensure that all providers are eligible for participation in the Medicaid program. If a provider is currently suspended or was involuntarily terminated from the Florida Medicaid program whether by contract or WellCare of Florida, Inc., Medicaid HMO Non-Reform Contract sanctionprogram, other than for purposes of inactivity, that provider is not considered an eligible Medicaid provider. If the Health Plan is not capitated, its providers shall be enrolled as Florida Medicaid providers. Suspension and termination are described further in Rule 59G-9.070, F.A.C. The Health Plan is responsible for this provision within five (5) calendar days after notification of a provider’s ineligibility to participate in the Medicaid program (by its own or outside source, by communication from the Agency, by listing in an Agency website or other forum designated by the Agency). c. The Health Plan shall not employ or contract with individuals on the state or federal exclusions list. d. No provider contract that the Health Plan enters into with respect to performance under this Contract shall in any way relieve the Health Plan of any responsibility for the provision of services or duties under this Contract. The Health Plan shall assure that all services and tasks related to the provider contract are performed in accordance with the terms of this Contract. The Health Plan shall identify in its provider contract any aspect of service that may be subcontracted by the provider. 2. All provider contracts and amendments executed by the Health Plan shall be in writing, signed, and dated by the Health Plan and the provider, and shall meet the following requirements: a. Prohibit the provider from seeking payment from the enrollee for any covered services provided to the enrollee within the terms of the Contract; b. Require the provider to look solely to the following for compensation for services rendered, with the exception of nominal cost sharing, pursuant to the Medicaid State Plan and the Florida Coverage and Limitations Handbooks:: WellCare of Florida, Inc. d/b/a Staywell Health Plan of Florida Medicaid HMO Non-Reform Contract (1) If a capitated Health Plan, then to the capitated Health Plan for compensation; (2) If a FFS Health Plan, then to the Agency or its Agent, unless the service is one for which the Health Plan receives a capitation payment from the Agency. For such capitated services, the Health Plan shall require providers to look solely to the Health Plan; c. 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 provider as an inducement to reduce or limit, medically necessary services to an enrollee, and that incentive plans shall not contain provisions that provide incentives, monetary or otherwise, for withholding medically necessary care; d. Specify that any contracts, agreements, or subcontracts entered into by the provider for purposes of carrying out any aspect of this Contract shall include assurances that the individuals who are signing the contract, agreement or subcontract are so authorized and that it includes all the requirements of this Contract; e. Require the provider to cooperate with the Health Plan's peer review, grievance, QIP and UM activities, and provide for monitoring and oversight, including monitoring of services rendered to enrollees, by the Health Plan (or its subcontractor). If the Health Plan has delegated the credentialing to a subcontractor, the agreement must ensure WellCare of Florida, Inc., Medicaid HMO Non-Reform Contract that all licensed providers are credentialed in accordance with the Health Plan’s and the Agency’s credentialing requirements as found in Attachment II, Section VII, Provider Network, Item H., Credentialing and Recredentialing; f. Include provisions for the immediate transfer to another PCP or health plan if the enrollee's health or safety is in jeopardy; g. Not prohibit a provider from discussing treatment or non-treatment options with enrollees that may not reflect the Health Plan's position or may not be covered by the Health Plan; h. Not prohibit a provider from acting within the lawful scope of practice, from advising or advocating on behalf of an enrollee for the enrollee's health status, medical care, or treatment or non-treatment options, including any alternative treatments that might be self-administered; i. Not prohibit a provider from advocating on behalf of the enrollee in any grievance system or UM process, or individual authorization process to obtain necessary services; j. Require providers to meet appointment waiting time standards pursuant to this Contract; k. Provide for continuity of treatment in the event a provider contract terminates during the course of an enrollee's treatment by that provider; l. Prohibit discrimination with respect to participation, reimbursement, or indemnification of any provider who is acting within the scope of his/her license or WellCare of Florida, Inc. d/b/a Staywell Health Plan of Florida Medicaid HMO Non-Reform Contract certification under applicable state law, solely on the basis of such license or certification. This provision shall not be construed as a willing provider law, as it does not prohibit the Health Plan from limiting provider participation to the extent necessary to meet the needs of the enrollees. This provision does not interfere with measures established by the Health Plan that are designed to maintain quality and control costs; m. Prohibit discrimination against providers serving high-risk populations or those that specialize in conditions requiring costly treatments; n. Require an adequate record system be maintained for recording services, charges, dates and all other commonly accepted information elements for services rendered to the Health Plan; o. Require that records be maintained for a period not less than six five (65) years from the close of the Contract, and retained further if the records are under review or audit until the review or audit is complete. Prior approval for the disposition of records must be requested and approved by the Health Plan if the provider contract is continuous; p. Specify that DHHS, the Agency, MPI and MFCU shall have the right to inspect, evaluate, and audit all of the following related to this Contract: WellCare of Florida, Inc., Medicaid HMO Non-Reform Contract: (1) Pertinent books, (2) Financial records, (3) Medical records, and (4) Documents, papers, and records of any provider involving financial transactions; q. Specify covered services and populations to be served under the provider contract; r. Require that providers comply with the Health Plan's cultural competency plan; s. Require that any community outreach materials related to this Contract that are displayed by the provider be submitted to the BMHC for written approval before use; t. Provide for submission of all reports and clinical information required by the Health Plan, including Child Health Check-Up reporting (if applicable); u. Require providers of transitioning enrollees to cooperate in all respects with providers of other health plans to assure maximum health outcomes for enrollees; v. Require providers to submit notice of withdrawal from the network at least ninety (90) calendar days before the effective date of such withdrawal; w. Require that all providers agreeing to participate in the network as PCPs fully accept and agree to responsibilities and duties associated with the PCP designation;; WellCare of Florida, Inc. d/b/a Staywell Health Plan of Florida Medicaid HMO Non-Reform Contract x. Require all providers to notify the Health Plan in the event of a lapse in general liability or medical malpractice insurance, or if assets fall below the amount necessary for licensure under Florida Statutesstatutes; y. Require providers to offer hours of operation that are no less than the hours of operation offered to commercial Health Plan members or comparable non-Reform Medicaid recipients if the provider serves only Medicaid recipients; z. Require safeguarding of information about enrollees according to 42 CFR 438.224; aa. Require compliance with HIPAA privacy and security provisions; bb. Require an exculpatory clause, which survives provider agreement termination, including breach of provider contract due to insolvency, which assures that neither Medicaid recipients nor the Agency shall be held liable for any debts of the provider; cc. Require that the provider secure and maintain during the life of the provider contract worker compensation insurance (complying with the Florida worker compensation law) 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; dd. Make provisions for a waiver of those terms of the provider contract that, as they pertain to Medicaid recipients, are in conflict with the specifications of this Contract; WellCare of Florida, Inc., Medicaid HMO Non-Reform Contract; ee. Contain no provision that in any way prohibits or restricts the provider from entering into a commercial contract with any other health plan (see s. 641.315, F.S.); ff. Contain no provision requiring the provider to contract for more than one (1) Health Plan product or otherwise be excluded (see s. 641.315, F.S.); gg. Contain no provision that prohibits the provider from providing inpatient services in a contracted hospital to an enrollee if such services are determined to be medically necessary and covered services under this Contract;