Common use of Specific Requirements for Contractor’s Management Arrangements or Procedures Clause in Contracts

Specific Requirements for Contractor’s Management Arrangements or Procedures. The Contractor or Subcontractor shall have a written compliance plan to guard against Fraud, Waste, and Abuse that includes: (1) written policies, procedures, and standards of conduct that articulate the Contractor’s commitment to comply with all applicable federal and state requirements; (2) the designation of a compliance officer responsible for developing and implementing policies, procedures, and practices designed to ensure compliance with the requirements of the Contract, and who reports directly to the Chief Executive Officer and the board of directors; (3) the establishment of a regulatory compliance committee that is on the board of directors and at the senior management level charged with overseeing the organization’s compliance program and its compliance with the requirements under the Contract; (4) a system for training and education for the compliance officer, the Contractor’s senior management, and the Contractor’s employees on the federal and state standards and requirements under this Contract (5) effective lines of communication between the compliance officer and the Contractor’s employees; (6) enforcement of standards through well-publicized disciplinary guidelines; (7) establishment and implementation of procedures and a system with dedicated staff for routine internal monitoring and auditing of compliance risks, prompt response to compliance issues as they are raised, investigation of potential compliance problems as they are raised, investigation of potential compliance problems as identified in the course of self-evaluation and audits, correction of such problems promptly and thoroughly (or coordination of suspected criminal acts with law enforcement agencies) to reduce the potential for recurrence, and ongoing compliance with the requirements under the Contract; (8) provisions for prompt reporting to the Department of all Overpayments identified or recovered, specifying the Overpayments due to potential Fraud, Waste, or Abuse; (9) a provision for prompt notification to the Department when it receives information about changes in an Enrollee’s circumstances that may affect eligibility including changes in residence or death of an Enrollee; (10) a provision for notification to the Department when it receives information about a change in a Network Provider’s circumstances that may affect that Network Provider’s eligibility to participate in the PMHP, including the termination of the Network Provider agreement with the Contractor; (11) as detailed in Article 6.1.6, provision for a method to verify, by sampling or other methods, whether services that have been represented to have been delivered by Network Providers were received by Enrollees and the application of such verification processes on a regular basis; (12) as detailed in Article 6.2, provision for written policies for all employees of the Contractor, and of any Subcontractor or agent, that provide detailed information about the False Claims Act and other federal and state laws described in section 1902(a)(68) of the Social Security Act, including information about rights of employees to be protected as whistleblowers; (13) as detailed in Article 6.1.3, provision for the prompt referral of any potential Fraud, Waste, or Abuse that the Contractor identifies to the Department, the Utah OIG, or MFCU; and (14) as detailed in Article 6.1.5, provision for the Contractor’s suspension of payments to a Network Provider for which the Department determines there is a credible allegation of Fraud in accordance with 42 CFR 455.23.

Specific Requirements for Contractor’s Management Arrangements or Procedures. (A) The Contractor Contractor’s (and Subcontractor’s to the extent that the Subcontractor is delegated responsibility for coverage of services and payments of claims) shall implement and maintain management arrangements or Subcontractor shall have procedures and a written compliance plan to guard against Fraud, Waste, and Abuse that includeswhich shall include: (1) written policies, procedures, and standards of conduct that articulate the Contractor’s commitment to comply with all applicable federal requirements and state requirementsstandards under the Contract, and all Federal and State standards; (2) the designation of a compliance officer responsible for developing and implementing policies, procedures, and practices designed a regulatory compliance committee that are accountable to ensure compliance with the requirements of the Contract, and who reports directly to the Chief Executive Officer and the board of directorssenior management; (3) the establishment of a regulatory compliance committee that is on accountable to the board of directors and at the senior management level charged with overseeing the organization’s compliance program and its compliance with the requirements under the Contract; (4) a system for effective training and education for the compliance officer, the ContractorXxxxxxxxxx’s senior management, and the Contractor’s employees on for the federal Federal and state State standards and requirements under this Contract; (5) effective lines of communication between the compliance officer and the Contractor’s employees; (6) enforcement of standards through well-publicized disciplinary guidelines; (7) establishment and implementation of procedures and a system with dedicated staff for routine internal monitoring and auditing of compliance risks, prompt response to compliance issues as they are raised, investigation of potential compliance problems as they are raised, investigation of potential compliance problems as identified in the course of self-evaluation and audits, correction of such problems promptly and thoroughly (or coordination of suspected criminal acts with law enforcement agencies) to reduce the potential for recurrence, and ongoing compliance with the requirements under the Contract; (8) provisions for internal monitoring and auditing including: (i) mechanism(s) for verifying with Enrollees that Covered Services provided or reimbursed by the Contractor were actually furnished to Enrollees (such as periodic questionnaires, telephone calls, etc., to a sample of Enrollees); and (ii) documentation of the sampling methodology and the schedule for conducting the verifications; and (9) provisions for prompt reporting to the Department of all Overpayments identified or recovered, specifying the Overpayments due to potential Fraud, Waste, or Abuse; (910) a provision for prompt notification to the Department when it receives information about changes in an Enrollee’s circumstances that may affect eligibility including changes in residence or death of an Enrollee; (1011) a provision for notification to the Department when it receives information about a change in a Network Provider’s circumstances that may affect that Network Provider’s eligibility to participate in the PMHPManaged Care Program, including the termination of the Network Provider agreement with the Contractor; (11) as detailed in Article 6.1.6, provision for a method to verify, by sampling or other methods, whether services that have been represented to have been delivered by Network Providers were received by Enrollees and the application of such verification processes on a regular basis; (12) as detailed in Article 6.2, provision provisions for written policies for all employees of the Contractor, and of any Subcontractor or agent, that provide detailed information about the False Claims Act and other federal Federal and state State laws described in section 1902(a)(68) of the Social Security Act, including information about rights of employees to be protected as whistleblowers; (13) as detailed in Article 6.1.3, provision for the prompt referral of any potential Fraud, Waste, or Abuse that the Contractor identifies to the Department, the Utah OIG, or MFCU; and (14) as detailed in Article 6.1.5, provision for the Contractor’s suspension of payments to a Network Provider for which the Department determines there is a credible allegation of Fraud in accordance with 42 CFR 455.23.

Specific Requirements for Contractor’s Management Arrangements or Procedures. (A) The Contractor (and Subcontractor’s to the extent that the Subcontractor is delegated responsibility for coverage of services and payments of claims) shall implement and maintain management arrangements or Subcontractor shall have procedures and a written compliance plan to guard against Fraud, Waste, and Abuse that includeswhich shall include: (1) written policies, procedures, and standards of conduct that articulate the Contractor’s commitment to comply with all applicable federal requirements and state requirementsstandards under the Contract, and all Federal and State standards; (2) the designation of a compliance officer responsible for developing and implementing policies, procedures, and practices designed a regulatory compliance committee that are accountable to ensure compliance with the requirements of the Contract, and who reports directly to the Chief Executive Officer and the board of directorssenior management; (3) the establishment of a regulatory compliance committee that is on accountable to the board of directors and at the senior management level charged with overseeing the organization’s compliance program and its compliance with the requirements under the Contract; (4) a system for effective training and education for the compliance officer, the ContractorXxxxxxxxxx’s senior management, and the Contractor’s employees on for the federal Federal and state State standards and requirements under this Contract; (5) effective lines of communication between the compliance officer and the Contractor’s employees; (6) enforcement of standards through well-publicized disciplinary guidelines; (7) establishment and implementation of procedures and a system with dedicated staff for routine internal monitoring and auditing of compliance risks, prompt response to compliance issues as they are raised, investigation of potential compliance problems as they are raised, investigation of potential compliance problems as identified in the course of self-evaluation and audits, correction of such problems promptly and thoroughly (or coordination of suspected criminal acts with law enforcement agencies) to reduce the potential for recurrence, and ongoing compliance with the requirements under the Contract; (8) provisions for internal monitoring and auditing including: (i) mechanism(s) for verifying with Enrollees that Covered Services provided or reimbursed by the Contractor were actually furnished to Enrollees (such as periodic questionnaires, telephone calls, etc., to a sample of Enrollees); and (ii) documentation of the sampling methodology and the schedule for conducting the verifications; and (9) provisions for prompt reporting to the Department of all Overpayments identified or recovered, specifying the Overpayments due to potential Fraud, Waste, or Abuse; (910) a provision for prompt notification to the Department when it receives information about changes in an Enrollee’s circumstances that may affect eligibility including changes in residence or death of an Enrollee; (1011) a provision for notification to the Department when it receives information about a change in a Network Provider’s circumstances that may affect that Network Provider’s eligibility to participate in the PMHPManaged Care Program, including the termination of the Network Provider agreement Agreement with the Contractor; (11) as detailed in Article 6.1.6, provision for a method to verify, by sampling or other methods, whether services that have been represented to have been delivered by Network Providers were received by Enrollees and the application of such verification processes on a regular basis; (12) as detailed in Article 6.2, provision for written policies for all employees of the Contractor, and of any Subcontractor or agent, that provide detailed information about the False Claims Act and other federal Federal and state State laws described in section 1902(a)(68) of the Social Security Act, including information about rights of employees to be protected as whistleblowers; (13) as detailed in Article 6.1.3, provision for the prompt referral of any potential Fraud, Waste, or Abuse that the Contractor identifies to the Department, the Utah OIG, or MFCU; and (14) as detailed in Article 6.1.5, provision for the Contractor’s suspension of payments to a Network Provider for which the Department determines there is a credible allegation of Fraud in accordance with 42 CFR 455.23.

Specific Requirements for Contractor’s Management Arrangements or Procedures. The Contractor (and Subcontractor to the extent the Subcontractor is delegated responsibility for coverage of services and payments of Claims) shall implement and maintain management arrangements or Subcontractor shall have procedures and a written compliance plan to guard against Fraud, Waste, and Abuse that includesshall include: (1) written policies, procedures, and standards of conduct that articulate the Contractor’s commitment to comply with all applicable requirements and standards under the Contract, and all federal and state requirementsState standards; (2) the designation of a compliance officer who is responsible for developing and implementing policies, procedures, and practices designed to ensure compliance with the requirements of the Contract, this Contract and who reports directly to the Chief Executive Officer (CEO) and the board Board of directorsDirectors; (3) the establishment of a regulatory compliance committee that is on accountable to the board Board of directors Directors and at the senior management level charged with overseeing the organization’s compliance program and its compliance with the requirements under the this Contract; (4) a system for training and education for the compliance officer, the Contractor’s senior management, and the Contractor’s employees on the federal and state State standards and requirements under this Contract; (5) effective lines of communication between the compliance officer and the Contractor’s employees; (6) enforcement of standards through well-publicized disciplinary guidelines; (7) establishment and implementation of procedures and a system with dedicated staff for routine internal monitoring and auditing of compliance risks, prompt response to compliance issues as they are raised, investigation of potential compliance problems as they are raised, investigation of potential compliance problems as identified in the course of self-evaluation and audits, correction of such problems promptly and thoroughly (or coordination of suspected criminal acts with law enforcement agencies) to reduce the potential for recurrence, and ongoing compliance with the requirements under the Contract; (8) provisions for internal monitoring and auditing including: (i) mechanism(s) for verifying with Enrollees that Covered Services provided or reimbursed by the Contractor were actually furnished to Enrollees (such as periodic questionnaires, telephone calls, etc., to a sample of Enrollees); and (ii) documentation of the sampling methodology and the schedule for conducting the verifications; (9) provisions for prompt reporting to the Department of all Overpayments identified or recovered, specifying the Overpayments due to potential Fraud, Waste, or Abuse; (910) a provision for prompt notification to the Department when it receives information about changes in an Enrollee’s circumstances that may affect eligibility including changes in residence or death of an Enrollee; (1011) a provision for notification to the Department when it receives information about a change in a Network Provider’s circumstances that may affect that Network Provider’s eligibility to participate in the PMHPManaged Care Program, including the termination of the Network Provider agreement with the Contractor; (11) as detailed in Article 6.1.6, provision for a method to verify, by sampling or other methods, whether services that have been represented to have been delivered by Network Providers were received by Enrollees and the application of such verification processes on a regular basis; (12) as detailed in Article 6.26.2 of this attachment, provision provisions for written policies for all employees of the Contractor, and of any Subcontractor or agent, that provide detailed information about the False Claims Act and other federal and state laws described in section 1902(a)(68) of the Social Security Act, including information about rights of employees to be protected as whistleblowers; (13) as detailed in Article 6.1.3, provision for the prompt referral of any potential Fraud, Waste, or Abuse that the Contractor identifies to the Department, the Utah OIG, or MFCU; and (14) as detailed in Article 6.1.5, provision for the Contractor’s suspension of payments to a Network Provider for which the Department determines there is a credible allegation of Fraud in accordance with 42 CFR 455.23.other

Specific Requirements for Contractor’s Management Arrangements or Procedures. The Contractor (and Subcontractor to the extent the Subcontractor is delegated responsibility for coverage of services and payments of Claims) shall implement and maintain management arrangements or Subcontractor shall have procedures and a written compliance plan to guard against Fraud, Waste, and Abuse that includesshall include: (1) written policies, procedures, and standards of conduct that articulate the Contractor’s commitment to comply with all applicable requirements and standards under the Contract, and all federal and state requirementsState standards; (2) the designation of a compliance officer who is responsible for developing and implementing policies, procedures, and practices designed to ensure compliance with the requirements of the Contract, this Contract and who reports directly to the Chief Executive Officer (CEO) and the board Board of directorsDirectors; (3) the establishment of a regulatory compliance committee that is on accountable to the board Board of directors Directors and at the senior management level charged with overseeing the organization’s compliance program and its compliance with the requirements under the this Contract; (4) a system for Effective training and education for the compliance officer, the Contractor’s senior management, and the Contractor’s employees on for the federal and state State standards and requirements under this Contract; (5) effective lines of communication between the compliance officer and the Contractor’s employees; (6) enforcement of standards through well-publicized disciplinary guidelines; (7) establishment and implementation of procedures and a system with dedicated staff for routine internal monitoring and auditing of compliance risks, prompt response to compliance issues as they are raised, investigation of potential compliance problems as they are raised, investigation of potential compliance problems as identified in the course of self-evaluation and audits, correction of such problems promptly and thoroughly (or coordination of suspected criminal acts with law enforcement agencies) to reduce the potential for recurrence, and ongoing compliance with the requirements under the Contract; (8) provisions for internal monitoring and auditing including: (i) mechanism(s) for verifying with Enrollees that Covered Services provided or reimbursed by the Contractor were actually furnished to Enrollees (such as periodic questionnaires, telephone calls, etc., to a sample of Enrollees); and (ii) documentation of the sampling methodology and the schedule for conducting the verifications; (9) provisions for prompt reporting to the Department of all Overpayments identified or recovered, specifying the Overpayments due to potential Fraud, Waste, or Abuse; (910) a provision for prompt notification to the Department when it receives information about changes in an Enrollee’s circumstances that may affect eligibility including changes in residence or death of an Enrollee; (1011) a provision for notification to the Department when it receives information about a change in a Network Provider’s circumstances that may affect that Network Provider’s eligibility to participate in the PMHPManaged Care Program, including the termination of the Network Provider agreement with the Contractor; (11) as detailed in Article 6.1.6, provision for a method to verify, by sampling or other methods, whether services that have been represented to have been delivered by Network Providers were received by Enrollees and the application of such verification processes on a regular basis; (12) as detailed in Article 6.26.2 of this attachment, provision provisions for written policies for all employees of the Contractor, and of any Subcontractor or agent, that provide detailed information about the False Claims Act and other federal and state State laws described in section 1902(a)(68) of the Social Security Act, including information about rights of employees to be protected as whistleblowers; (13) as detailed in Article 6.1.36.1.3 of this attachment, provision for the prompt referral of any potential Fraud, Waste, or Abuse that the Contractor identifies to the Department, Department and the Utah OIG, or MFCU; and (14) as detailed in Article 6.1.56.1.5 of this attachment, provision for the Contractor’s suspension of payments to a Network Provider for which the Department determines there is a credible allegation of Fraud in accordance with 42 CFR § 455.23.

Specific Requirements for Contractor’s Management Arrangements or Procedures. (A) The Contractor Contractor’s (and Subcontractor’s to the extent that the Subcontractor is delegated responsibility for coverage of services and payment of claims) shall implement and maintain management arrangements or Subcontractor shall have a written procedures and compliance plan to guard against Fraud, Waste, and Abuse that includesXxxxx shall include the following: (1) written Written policies, procedures, and standards of conduct that articulate the Contractor’s commitment to comply with all applicable federal requirements and state requirementsstandards under the Contract, and all Federal and State standards; (2) the The designation of a compliance officer responsible for developing and implementing policies, procedures, and practices designed a regulatory compliance committee that are accountable to ensure compliance with the requirements of the Contract, and who reports directly to the Chief Executive Officer and the board of directorssenior management; (3) the establishment of a regulatory compliance committee that is on the board of directors and at the senior management level charged with overseeing the organization’s compliance program and its compliance with the requirements under the Contract; (4) a system for Effective training and education for the compliance officer, the Contractor’s senior management, and the Contractor’s employees on for the federal Federal and state State standards and requirements under this Contract; (54) effective Effective lines of communication between the compliance officer and the Contractor’s employees; (65) enforcement Enforcement of standards through well-publicized disciplinary guidelines; (76) establishment Establishment and implementation of procedures and a system with dedicated staff for routine internal monitoring and auditing of compliance risks, prompt response to compliance issues as they are raised, investigation of potential compliance problems as they are raised, investigation of potential compliance problems as identified in the course of self-evaluation and audits, correction of such problems promptly and thoroughly (or coordination of suspected criminal acts with law enforcement agencies) to reduce the potential for recurrence, and ongoing compliance with the requirements under the Contract;, (7) As detailed in Article 6.1.6 Mechanism(s) for verifying with Enrollees that Covered Services provided or reimbursed by the Contractor were actually furnished to Enrollees (such as periodic questionnaires, telephone calls, etc., to a sample of Enrollees); and documentation of the sampling methodology and the schedule for conducting the verifications; and (8) provisions Provisions for prompt reporting to the Department of all Overpayments identified or recovered, specifying the Overpayments due to potential Fraud, Waste, or Abuseto the Department; (9) a provision Provision for prompt notification to the Department when it receives information about changes in an Enrollee’s circumstances that may affect eligibility including changes in residence or death of an Enrollee; (10) a provision Provision for notification to the Department when it receives information about a change in a Network Provider’s circumstances that may affect that Network Provider’s eligibility to participate in the PMHPmanaged care program, including the termination of the Network Provider agreement with the Contractor; (11) as detailed in Article 6.1.6, provision for a method to verify, by sampling or other methods, whether services that have been represented to have been delivered by Network Providers were received by Enrollees and the application of such verification processes on a regular basis; (12) as As detailed in Article 6.2, provision for written policies for all employees of the Contractor, and of any Subcontractor or agent, that provide detailed information about the False Claims Act and other federal Federal and state State laws described in section 1902(a)(68) of the Social Security Act, including information about rights of employees to be protected as whistleblowers; (1312) as As detailed in Article 6.1.3, provision for the prompt referral of any potential Fraud, Waste, or Abuse that the Contractor identifies to the Department, the Utah OIG, or MFCU; and (1413) as As detailed in Article 6.1.5, provision Provision for the Contractor’s suspension of payments to a Network Provider for which the Department determines there is a credible allegation of Fraud in accordance with 42 CFR 455.23Fraud.