Common use of Risk Arrangements Clause in Contracts

Risk Arrangements. The Contractor may maintain provider risk arrangements. The Contractor must disclose these arrangements to CMS and EOHHS as follows and meet the additional requirements specified below. Except as they determine required by law, EOHHS and CMS shall not disclose the Contractor’s provider contracts. Notwithstanding the foregoing nothing herein shall be construed to conflict with the requirements of 42 U.S.C. 1395w-111, Sec. 1860D-11(i). a. The Contractor must provide a description of any changes in its risk arrangements with all members of its Provider Network, including but not limited to primary care, specialists, hospitals, nursing facilities, other long term care providers, Behavioral Health Providers, and ancillary services. The Contractor shall make this description available to its Enrollees, or any prospective Enrollees upon request. b. Any incentive arrangements must not include any specific payment as an inducement to withhold, limit, or reduce services to Enrollees. c. The Contractor must monitor such arrangements, in accordance with the standards of CMS and EOHHS for quality of care, to ensure that medically appropriate Covered Services are not withheld.