Provider Contracts a) Contractor shall include in all of its contracts with Participating Providers the requirement for all Covered Services to be provided by duly licensed, certified or accredited Participating Providers consistent with the scope of their license, certification or accreditation and in accordance with applicable laws, rules, regulations, the standards of medical practice in the community, and the terms set forth in agreements entered into by and between Contractor and Participating Providers (“Provider Agreement”).
b) Contractor shall include in each Provider Agreement a requirement that Participating Providers comply with all other applicable laws, rules and regulations.
c) Contractor shall use commercially reasonable efforts to require the provisions of Subsection
Provider Contracts. (a) Contractor shall include in all of its contracts with Participating Providers the requirement for all Specialized Health Care Services to be provided by duly licensed, certified or accredited Participating Providers consistent with the scope of their license, certification or accreditation and in accordance with applicable laws, rules, regulations, the standards of dental practice in the community, and the terms set forth in agreements entered into by and between Contractor and Participating Providers (“Provider Agreement”).
(b) Contractor shall include in each Provider Agreement a requirement that Participating Providers comply with all other applicable laws, rules and regulations. Contractor shall require the following provisions to be included in each: (i) Provider Agreement entered into by and between Contractor and a Participating Provider, and (ii) any subcontracting arrangement entered into by a Participating Provider. Except as expressly set forth herein, capitalized terms set forth herein shall have the same meaning as set forth in the Agreement between Contractor and Covered California; provided that Contractor may use different terminology as necessary to be consistent with the terms used in the Provider Agreement or subcontracting arrangements entered into by Participating Providers so long as such different terminology does not change the meaning set forth herein and the Agreement.
Provider Contracts a) Contractor shall include in all of its contracts with Participating Providers the requirement for all Covered Services to be provided by duly licensed, certified or accredited Participating Providers consistent with the scope of their license, certification or accreditation and in accordance with applicable laws, rules, regulations, the standards of medical practice in the community, and the terms set forth in agreements entered into by and between Contractor and Participating Providers (“Provider Agreement”).
b) Contractor shall include in each Provider Agreement a requirement that Participating Providers comply with all other applicable laws, rules and regulations.
c) Contractor shall use commercially reasonable efforts to require the provisions of Subsection (d) to be included in each: (i) Provider Agreement entered into by and between Contractor and a Participating Provider, and (ii) any subcontracting arrangement entered into by a Participating Provider.
d) Provision of Covered Services. Contractor shall undertake commercially reasonable efforts to ensure that each Participating Provider Agreement and each subcontracting arrangement entered into by each Participating Provider complies with the applicable terms and conditions set forth in this Agreement, as mutually agreed upon by Covered California and Contractor, and which may include the following:
i. Coordination with Covered California and other programs and stakeholders;
ii. Relationship of the parties as independent contractors (Section 1.3 (a)) and Contractor’s exclusive responsibility for obligations under the Agreement (Section 1.3 (b)); iii. Participating Provider Directory requirements (Section 4.4.4);
Provider Contracts. 7.2.1 All providers must have a written contract, either with an intermediary entity or an HMO, to participate in the Medicaid program (provider contract). HMO must make all contracts available to TDH upon request, at the time and location requested by TDH. All standard formats of provider contracts must be submitted to TDH for approval no later than 60 days after the effective date of this contract, unless previously filed with TDH. HMO must submit 1 paper copy and 1 electronic copy in a form specified by TDH. Any change to the standard format must be submitted to TDH for approval no later than 30 days prior to the implementation of the new standard format. All provider contracts are subject to the terms and conditions of this contract and must contain the provisions of Article V, Statutory and Regulatory Compliance, and the provisions contained in Article 3.2.
7.2.1.1 TDH has 15 working days to review the materials and recommend any suggestions or required changes. If TDH has not responded to HMO by the fifteenth day, HMO may execute the contract. TDH reserves the right to request HMO to modify any contract that has been deemed approved.
7.2.2 Primary Care Provider (PCP) contracts and specialty care contracts must contain provisions relating to the requirements of the provider types found in this contract. For example, PCP contracts must contain the requirements of Article 7.8 relating to Primary Care Providers.
7.2.3 Provider contracts that are requested by any agency with authority to 1999 Renewal Contract Harrxx Xxxvice Area 64 August 9, 1999 investigate and prosecute fraud and abuse must be produced at the time and place required by TDH or the requesting agency. Provider contracts requested in response to a Public Information request must be produced within 48 hours of the request. Requested contracts and all related records must be provided free-of-charge to the requesting agency.
7.2.4 The form and substance of all provider contracts are subject to approval by TDH. TDH retains the authority to reject or require changes to any contract that do not comply with the requirements or duties and responsibilities of this contract. HMO REMAINS RESPONSIBLE FOR PERFORMING AND FOR ANY FAILURE TO PERFORM ALL DUTIES, RESPONSIBILITIES AND SERVICES UNDER THIS CONTRACT REGARDLESS OF WHETHER THE DUTY, RESPONSIBILITY OR SERVICE IS CONTRACTED TO ANOTHER FOR ACTUAL PERFORMANCE.
7.2.5 TDH reserves the right and retains the authority to make reasonable inquiry and conduc...
Provider Contracts. Notice of Nonrenewal or Termination
Provider Contracts. The CMHSP is responsible for the development of the service delivery system and the establishment of sufficient administrative capabilities to carry out the requirements and obligations of this contract. The CMHSP may sub-contract for the provision of any of the services specified in this contract including contracts for administrative, financial management and data processing. The CMHSP shall be held solely and fully responsible to execute all provisions of this contract, whether or not said provisions are directly pursued by the CMHSP or pursued by the CMHSP through a sub-contract vendor. The CMHSP shall ensure that all sub-contract arrangements clearly specify the type of services being purchased. Sub-contracts shall ensure that the MDHHS is not a party to the contract and therefore not a party to any employer/employee relationship with the sub- contractor of the CMHSP. Sub-contracts entered into by the CMHSP shall address the following:
A. Duty to treat and accept referrals B. Prior authorization requirements C. Access standards and treatment time lines
Provider Contracts. Except as otherwise expressly provided in the Service Plan, County may contract with a third person or entity (a “Provider”) for delivery of a particular Service or portion thereof (a “Provider Contract”). County may permit a Provider to subcontract with a third person or entity for delivery of a particular Service or portion thereof and such subcontractors shall also be considered Providers for purposes of this Agreement and the subcontracts shall be considered Provider Contracts for purposes of this Agreement. County shall not permit any person or entity to be a Provider unless the person or entity holds all licenses, certificates, authorizations and other approvals required by applicable law to deliver the Service. The Provider Contract must be in writing and contain all provisions of this Agreement necessary for County to comply with its obligations under this Agreement and applicable to the Provider’s performance under the Provider Contract, including but not limited to, all provisions of this Agreement that expressly require County to require Provider’s compliance with respect thereto. County shall maintain an originally executed copy of each Provider Contract at its office and shall furnish a copy of any Provider Contract to OYA upon request.
Provider Contracts. HHSC reserves the right and retains the authority to make reasonable inquiry and conduct investigations into provider and Member complaints against HMO or any intermediary entity with whom HMO contracts to deliver health care services under this contract. HHSC may impose appropriate sanctions and contract remedies to ensure HMO compliance with the provisions of this contract.
Provider Contracts. Section 7.2.8.2.1 is added and Section 7.2.9.2 is modified, as follows:
Provider Contracts. The Joint Practice Management Board shall approve, disapprove, or amend all managed care, PPO, HMO, Medicare risk and other provider contracts negotiated by INMD.
