Quality and Oversight. County acknowledges that CalOptima will conduct oversight of County’s provision of ECM Services under this Contract to ensure the quality of ECM Services and compliance with program requirements, which may include audits and/or corrective actions. County shall respond to all reasonable requests from CalOptima for information and documentation related to County’s provision of ECM Services.
Quality and Oversight. Provider acknowledges PARTNERSHIP will conduct oversight of its delivery of ECM to ensure the quality of ECM rendered and ongoing compliance with program requirements, and all legal and contractual obligations both PARTNERSHIP and Provider have, including, but not limited to, required reporting, audits, and corrective actions, among other oversight activities.
Quality and Oversight. 1. CS Provider acknowledges Anthem will conduct oversight of its delivery of CS to ensure the quality of services rendered and ongoing compliance with all legal and contractual obligations both Anthem and the CS Provider have, including but not limited to, required reporting, audits, and corrective actions, among other oversight activities. EXHIBIT F Disclosure of Ownership and Control Interest Statement The federal regulations set forth in 42 CFR 455.104, 455.105 and 455.106 require providers who are entering into or renewing a provider agreement to disclose to the U.S. Department of Health and Human Services, the state Medicaid agency, and to managed care organizations that contract with the state Medicaid agency: 1) the identity of all owners with a control interest of [5%] or greater, 2) certain business transactions as described in 42 CFR 455.105 and 3) the identity of any excluded individual or entity with an ownership or control interest in the provider, the provider group, or disclosing entity or who is an agent or managing employee of the provider group or entity. Please attach a separate sheet if necessary. Answer all questions as of the current date. If additional space is needed, note on the form that the answer is being continued and attach a sheet referencing the relevant item number. Please return the original to us and retain a copy for your files. If a question is not applicable, respond N/A for that question. You should completely answer all applicable questions — No questions should be left blank. You must provide dates of birth and Social Security numbers (SSNs) for validation purposes as outlined in 42 CFR 455.104 (b)(1)(ii). Identifying information Provider entity name: Provider DBA name (if different from provider entity name): Entity NPI: Entity TIN: 94-60000691 Medicaid ID: Provider phone #: Provider address — List all practice locations. Must include at least one street address. Attach a separate sheet if needed. City State ZIP Owner or control information An owner is a person or business entity that owns [5%] or more of the assets, stock, or profits of the provider entity. This [5%] may be direct ownership or indirect ownership. (for example, an individual might own [50%] of a company that owns the actual provider entity. This means that the indirect ownership is [50%.]) In addition to ownership of stock, an owner also has a legal obligation like a mortgage or loan that is secured by the assets of the provider entity.
Quality and Oversight. 1. ECM Provider acknowledges that Anthem will conduct oversight of its participation in ECM to ensure the quality of ECM and ongoing compliance with program requirements, which may include site visits, audits and/or corrective actions.
Quality and Oversight. 7.1 Provider acknowledges Partnership will conduct oversight of its delivery of Community Supports to ensure the quality of Services rendered and ongoing compliance with all legal and contractual obligations both Partnership and the Provider have, including but not limited to, required reporting, audits, and corrective actions, among other oversight activities and Community Supports requirements set forth in the Medi-Cal Contract and applicable DHCS APLs, which are incorporated herein by this reference.
Quality and Oversight. CS Provider acknowledges Health Net will conduct oversight of its delivery of CS services to ensure the quality of services rendered and ongoing compliance with all legal and contractual obligations both the Health Net and the CS Provider have, including but not limited to, required reporting, audits, and corrective actions, among other oversight activities. EXHIBIT B-1 COMMUNITY SUPPORTS PAYMENT RATES The following HCPCS codes must be used for CS services. The HCPCS code and modifier combined define the service as CS services. As an example, a HCPCS code by itself does not define the CS services. The HCPCS code must be reported with a modifier for the services to be defined and categorized as CS services. If CS services are provided through telehealth, the additional modifier GQ must be used. All telehealth services must be provided in accordance with DHCS policy. Subject to the terms of this Agreement Health Net shall pay and CS Provider shall accept as payment in full for Covered Services delivered pursuant to this Exhibit, the lesser of: (i) the rates listed below, or (ii) 100% of Provider’s Allowable Charges. HCPCS Level II Code HCPCS Description Modifier Modifier Description Rate Asthma Remediation S5165 Home modifications; per service U5 Used by Managed Care with HCPCS code S5165 to indicate Community Supports Asthma Remediation 100% of Allowable Charges* Lifetime maximum of $7,500 Community Transition Services/Nursing Facility Transition to a Home T2038 Community transition; per service. Requires billed amount(s) to be reported on the encounter. Modifier used to differentiate from Nursing Facility Transition/Diversion to Assisted Living Facilities U5 Used by Managed Care with HCPCS code T2038 to indicate Community Supports Community Transition Services/Nursing Facility Transition to a Home $432.49 per service Day Habilitation Programs Coding Guidance Forthcoming Day Habilitation Used by Managed Care to indicate Community Supports Day Habilitation Programs $6.46 per hour Not to exceed $51.68 per day Environmental Accessibility Adaptations S5165 Home modifications; per services. Requires billed amount(s) to be reported on the encounter U6, U1 Used by Managed Care with HCPCS code S5165 to indicate Community Services Accessibility Adaptations/Home Modifications 100% of Allowable Charges* Lifetime maximum of $7,500 HCPCS Level II Code HCPCS Description Modifier Modifier Description Rate Housing Deposits H0044 Supported housing, per month. Requires depos...
Quality and Oversight. County acknowledges that CalOptima will conduct oversight of its delivery of Community Supports to ensure the quality of services rendered and ongoing compliance with all legal and contractual obligations both CalOptima and County Associates have, including but not limited to, required reporting, audits, and corrective actions, among other oversight activities.
