Common use of SDOH Exclusion or Termination of Providers Clause in Contracts

SDOH Exclusion or Termination of Providers. If SDOH excludes or terminates a provider from its Medicaid Program, the Contractor shall, upon learning of such exclusion or termination, immediately terminate the provider agreement with the Participating Provider as it pertains to the Contractor's Medicaid program, and agrees to no longer utilize the services of the subject provider, as applicable. The Contractor shall access information pertaining to excluded Medicaid providers through the SDOH Health Provider Network (HPN). Such information available to the Contractor on the HPN shall be deemed to constitute constructive notice. The HPN should not be the sole basis for identifying current exclusions or termination of previously approved providers. Should the Contractor become aware, through the HPN or any other source, of an SDOH exclusion or termination, the Contractor shall validate this information with the Office of Medicaid Management, Bureau of Enforcement Activities and comply with the provisions of this Section.

Appears in 7 contracts

Samples: Wellcare Health Plans, Inc., Wellcare Health Plans, Inc., Wellcare Health Plans, Inc.

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SDOH Exclusion or Termination of Providers. If SDOH excludes or terminates a provider from its Medicaid Programprogram, the Contractor shall, upon learning of such exclusion or termination, immediately terminate the provider agreement Provider Agreement with the Participating Provider as it pertains with respect to the Contractor's Medicaid programMMC and/or FHPlus product, and agrees to no longer utilize the services of the subject provider, as applicable. The Contractor shall access information pertaining to excluded Medicaid providers through the SDOH Health Provider Network (HPN). Such information available to the Contractor on the HPN shall be deemed to constitute constructive notice. The HPN should not be the sole basis for identifying current exclusions or termination of previously approved providers. Should the Contractor become aware, through the HPN or any other source, of an SDOH exclusion or termination, the Contractor shall validate this information with the Office of Medicaid Management, Bureau of Enforcement Activities and comply with the provisions of this Section.

Appears in 1 contract

Samples: Plan Agreement (Amerigroup Corp)

SDOH Exclusion or Termination of Providers. If SDOH excludes or terminates a provider from its Medicaid Programprogram, the Contractor shall, upon learning of such exclusion or termination, immediately terminate the provider agreement Provider Agreement with the Participating Provider as it pertains with respect to the Contractor's Medicaid programMMC and/or FHPlus product, and agrees to no longer utilize the services of the subject provider, as applicable. The Contractor shall access information pertaining to excluded Medicaid providers through the SDOH Health Provider Network (HPN)Network. Such information available to the Contractor on the HPN shall be deemed to constitute constructive notice. The HPN should not be the sole basis for identifying current exclusions or termination of previously approved providers. Should the Contractor become aware, through the HPN or any other source, of an SDOH exclusion or termination, the Contractor shall validate this information with the Office of Medicaid Management, Bureau of Enforcement Activities and comply with the provisions of this Section.

Appears in 1 contract

Samples: Plan Agreement (Wellcare Health Plans, Inc.)

SDOH Exclusion or Termination of Providers. If SDOH excludes or terminates a provider from its Medicaid Program, the Contractor shall, upon learning of such exclusion or termination, immediately terminate the provider agreement with the Participating Provider as it pertains to the Contractor's Medicaid program, and agrees to no longer utilize the services of the subject provider, as applicable. The Contractor shall access information pertaining to excluded Medicaid providers through the SDOH Health Provider Network (HPN). Such information available to the Contractor on the HPN shall be deemed to constitute constructive notice. The HPN should not be the sole basis for identifying current exclusions or termination of previously approved providers. Should the Contractor become aware, through the HPN or V any other source, of an SDOH exclusion or termination, the Contractor shall validate this information with the Office of Medicaid Management, Bureau of Enforcement Activities and comply with the provisions of this Section.

Appears in 1 contract

Samples: Amerigroup Corp

SDOH Exclusion or Termination of Providers. If SDOH excludes or terminates a provider from its Medicaid Program, the Contractor shall, upon learning of such exclusion or termination, immediately terminate the provider agreement with the Participating Provider as it pertains to the Contractor's Medicaid program, and agrees to no longer utilize the services of the subject provider, as applicable. The Contractor shall access information pertaining will receive a paper listing of currently excluded Medic aid providers mailed monthly to excluded Medicaid providers through their correspondence address, that the Contractor specified to SDOH Health Provider Network (HPN)during the initial provider enrollment process. Such information available to the Contractor on the HPN paper shall be deemed to constitute constructive notice. The HPN This notification should not be the sole basis for identifying current exclusions or termination of previously approved providers. Should the Contractor become aware, through the HPN or any other source, of an SDOH exclusion or termination, the Contractor shall validate this information with the Office of Medicaid Management, Bureau of Enforcement Activities and comply with the provisions of this Section.

Appears in 1 contract

Samples: Agreement Between (Americhoice Corp)

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SDOH Exclusion or Termination of Providers. If SDOH excludes or terminates a provider from its Medicaid Program, the Contractor shall, upon learning of such exclusion or termination, immediately terminate the provider agreement with the Participating Provider as it pertains with respect to the Contractor's Medicaid programAdvantage Product, and agrees to no longer utilize the services of the subject provider, as applicable. The Contractor shall access information pertaining to excluded Medicaid providers through the SDOH Health Provider Network (HPN). Such information available to the Contractor on the HPN shall be deemed to constitute constructive notice. The HPN should not be the sole basis for identifying current exclusions or termination of previously approved providers. Should the Contractor become aware, through the HPN or any other source, of an SDOH exclusion or termination, the Contractor shall validate this information with the Office of Medicaid Management, Bureau of Enforcement Activities and comply with the provisions of this Section.

Appears in 1 contract

Samples: Agreement (Wellcare Health Plans, Inc.)

SDOH Exclusion or Termination of Providers. If SDOH excludes or terminates a provider from its Medicaid Programprogram, the Contractor shall, upon learning of such exclusion or termination, immediately terminate the provider agreement Provider Agreement with the Participating Provider as it pertains to the Contractor's Medicaid programMMC product, and agrees to no longer utilize the services of the subject provider, as applicable. The Contractor shall access information pertaining to excluded Medicaid providers through the SDOH Health Provider Network (HPN). Such information available to the Contractor on the HPN shall be deemed to constitute constructive notice. The HPN should not be the sole basis for identifying current exclusions or termination of previously approved providers. Should the Contractor become aware, through the HPN or any other source, of an SDOH exclusion or termination, the Contractor shall validate this information with the Office of Medicaid Management, Bureau of Enforcement Activities and comply with the provisions of this Section.

Appears in 1 contract

Samples: Model Contract

SDOH Exclusion or Termination of Providers. If SDOH excludes or terminates a provider from its Medicaid Program, the Contractor shall, upon learning of such exclusion or termination, immediately terminate the provider agreement with the Participating Provider as it pertains to the Contractor's Medicaid FHPlus program, and agrees to no longer utilize the services of the subject provider, as applicable. The Contractor shall access information pertaining to will receive a listing of currently excluded Medicaid providers through mailed monthly to the correspondence address, that the Contractor specified to SDOH Health Provider Network (HPN)during the initial provider enrollment process. Such information available to the Contractor on the HPN listing shall be deemed to constitute constructive notice. The HPN This notification should not be the sole basis for identifying current exclusions or termination of previously approved providers. Should the Contractor become aware, through the HPN or any other source, of an SDOH exclusion or termination, the Contractor shall validate this information with the Office of Medicaid Management, Bureau of Enforcement Activities and comply with the provisions of this Section.

Appears in 1 contract

Samples: Plan Agreement (Wellcare Health Plans, Inc.)

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