Provider Relations and Subcontracts. (1) All subcontracts executed by the Contractor must be appropriate to the services or activities delegated under the contract and fulfill all state and federal requirements as specifically provided in 42 CFR 438. The Contractor is responsible for evaluating the prospective subcontractor’s ability to perform these activities. All subcontract templates must be approved in writing, by the Department in advance of implementation and execution. The Contractor shall ensure that all providers are eligible for participation in the Medicaid program; however, the subcontractor is not required to participate in the Medicaid program as a provider. In addition, if a provider was suspended or terminated from the Florida Medicaid program by contract or sanction, a termination other than for purposes of inactivity or withdraw, that provider is not considered an eligible Medicaid provider. Subcontracts are required with all major providers of services and shall not prohibit service providers from contracting with other Long-Term Care Diversion Contractors. (2) The Department may waive the use of the model subcontract and permit the Contractor to enter into a letter of agreement with certain facilities, licensed under Chapter 400 and Chapter 429, F.S. and eligible for participation in the Medicaid program, when it is determined by the Department to be in the best interest of the enrollee(s) to do so. The letter of agreement must contain timeframe provisions for the facility. This exception does not apply for initial network implementation. (3) All subcontractors must comply with the regulations of section 19.2 of the Standard Contract. The Contractor shall ensure that all its subcontractors verify that their staff mandated to report abuse, neglect and exploitation have received appropriate training in reporting abuse, neglect and exploitation. (4) If the Contractor wishes to terminate a subcontract with an assisted living facility or a Nursing Facility in which any of its project enrollees are currently residing, the Contractor shall provide a written notice to the Department at least ten (10) calendar days prior to notifying the subcontractor of its intent to terminate. This requirement is waived if the facility’s license has been revoked or the Department, in consultation with the Agency, waives the notice period. (5) The Contractor shall place procedures in its subcontracts from approval of new providers up to termination of contract. The Contractor shall include imposi...
Provider Relations and Subcontracts. All subcontracts executed by the contractor must be appropriate to the services or activities delegated under the contract and fulfill all state and federal requirements as specifically provided in 42 CFR 438. All subcontract templates must be approved, in writing, by the Department in advance of implementation and execution. All subcontractors must be eligible for participation in the Medicaid program; however, the subcontractor is not required to participate in the Medicaid program as a provider. Subcontracts are required with all major providers of services and shall not prohibit service providers from contracting with other long-term care diversion contractors. The Department may waive the use of the model subcontract and permit the contractor to enter into a letter of agreement with certain facilities, licensed under Chapter 400 and Chapter 429, F.S. and eligible for participation in the Medicaid program, when it is determined by the Department to be in the best interest of the enrollee(s) to do so. The letter of agreement shall contain timeframe provisions for the facility. This exception does not apply for initial network implementation. All subcontractors must comply with the regulations of subparagraph 19.2 of the standard contract. The contractor shall ensure that all subcontractors verify that staff mandated to report abuse, neglect and exploitation have received appropriate training in reporting abuse, neglect and exploitation. If the contractor wishes to terminate a subcontract with an Assisted Living Facility or a Nursing Facility in which any of its project enrollees are currently residing, written notice must be provided to the Department at least ten
Provider Relations and Subcontracts. (1) All subcontracts executed by the Contractor must be appropriate to the services or activities delegated under the contract and fulfill all state and federal requirements as specifically provided in 42 CFR 438. The Contractor is responsible for evaluating the prospective subcontractor’s ability to perform these activities. All subcontract templates must be approved in writing, by the Department in advance of implementation and execution. The Contractor shall ensure that all providers are eligible for participation in the Medicaid program; however, the subcontractor is not required to participate in the Medicaid program as a provider. In addition, if a provider was suspended or terminated from the Florida Medicaid program by contract or sanction, a termination other than for purposes of inactivity or withdraw, that provider is not considered an eligible Medicaid provider. Subcontracts are required with all major providers of services and shall not prohibit service providers from contracting with other Long-Term Care Diversion Contractors.
