Common use of Sterilizations and Hysterectomies Clause in Contracts

Sterilizations and Hysterectomies. (1) Sterilizations and Hysterectomies are a Covered Service only when they meet the federally mandated criteria in 42 CFR §§ 441.250 through 441.259 and the requirements of OHA established in OAR 410-130-0580. (2) Member Representatives do not have the right to give consent for sterilizations. All consents must comply with the criteria set forth in OAR 410-130-0580. (3) CopiesContractor shall submit copies of all signed informed consents for sterilization and hysterectomies must be provided hysterectomy services to OHA, via Administrative Notice, within thirty (30) days of the date of claims Adjudication as specified in accordance with OAR 410-141-3570. (4) In the event OHA OHDUQV WKDW RQH RU PRUH RI &RQWU K\VWHUHFWRP\ RU VWHULOL]DWLRQ VHUYLFH S Notice under Sub.Para (3) of this Para. c to this Sec. 6, Ex. B, Part 2 OHA will, no later than thirty (30) GD\V SDVW WKH HQG RI HDFK FDOHQGD Encounter Data Liaison with Administrative Notice of such services and the names of Members who received such Services. Contractor shall then, within thirty (30) days of VXFK $GPLQLVWUDWLYH 1RWLFH SURYLGH DV informed consent forms for all Members identified therein to OHA. (5) OHA in collaboration with Contractor shall reconcile all hysterectomy or sterilization (or both) services withsuch informed consents with the associated Encounter Data by either: (6) (3) Confirming the validity of the consent as specified in OAR 410-141-3570. 2+$¶poVint of contact for activities involving the informed consents and providing Encounter Data is &RQWUDFWRU¶VL ia(isoQn,FviRa AXdmQiWnisHtraUtiv e N'oDticWe, Dtha t no further action is needed;liaison. (a) $GYLVLQJ &RQWUDFWRU¶V (QFRXQWHU 'DWD OHA requires Contractor to provide corrected informed consent forms to be provided to OHA as set forth in such Administrative Notice; or (b) 3URYLGLQJ &RQWUDFWRU¶V (QFRXQWHU 'DW informed consent form(s) are missing or invalid and Contractor shall return all Payments received for such procedures in accordance with Sub. Para. (6) below of this Para. c, Sec. 6, Ex. B, Part 2 and must change the associated Encounter Data to reflect no payment made for service(s). (7) (4) In the event Contractor fails to comply with the requirements of this Para. c, Sec. 6, Ex. B, Part 2 but nonetheless receives Payment for such procedures, such Payment will be deemed an Overpayment and subject to reporting and return in accordance with Sec. 1112, Para. b, Sub.Paras. (15)-(1716)-(18) of Ex. B, Part 9 and Sec. 1516 of Ex. B, Part 9, or set-off as set forth in Sec. 7, Ex. D of this Contract.

Sterilizations and Hysterectomies. (1) Sterilizations and Hysterectomies are a Covered Service only when they meet the federally mandated criteria in 42 CFR §§ 441.250 through 441.259 and the requirements of OHA established in OAR 410-130-0580. (2) Member Representatives do not have the right to give consent for sterilizations. All consents must comply with the criteria set forth in OAR 410-130-0580. (3) CopiesContractor shall submit Copies copies of all signed informed consents for sterilization and hysterectomies hysterectomy services must be provided hysterectomy services to OHA, via Administrative Notice, in accordance with within thirty (30) days of the date of claims Adjudication as specified in accordance with OAR 410-141-3570. OHA and Contractor shall reconcile all such informed consents with the associated Encounter Data as specified in OAR 410-141-3570. OHA’s point of contact for activities involving the informed consents and Encounter Data is Contractor’s Encounter Data liaison. (4) In the event OHA OHDUQV WKDW RQH RU PRUH RI &RQWU K\VWHUHFWRP\ RU VWHULOL]DWLRQ VHUYLFH S XXX learns that one or more of Contractor’s Members has received a hysterectomy or sterilization service prior to receipt of Contractor’s Administrative Notice under Sub.Para (3) of this Para. c to this Sec. 6, Ex. B, Part 2 OHA will, no later than thirty (30) GD\V SDVW WKH HQG RI HDFK FDOHQGD days past the end of each calendar quarter, provide Contractor’s Encounter Data Liaison with Administrative Notice of such services and the names of Members who received such Services. Contractor shall then, within thirty (30) days of VXFK $GPLQLVWUDWLYH 1RWLFH SURYLGH DV such Administrative Notice, provide, as set forth in OHA’s Administrative Notice, the informed consent forms for all Members identified therein to OHA. (5) OHA in collaboration with Contractor shall reconcile all hysterectomy or sterilization (or both) services withsuch with informed consents with the associated Encounter Data by either: (6) (3a) Confirming the validity of the consent as specified in OAR 410-141-3570. 2+$¶poVint of contact for activities involving the informed consents and providing Contractor’s Encounter Data is &RQWUDFWRU¶VL ia(isoQn,FviRa AXdmQiWnisHtraUtiv e N'oDticWeLiaison, Dtha t via Administrative Notice, that no further action is needed;liaison.needed; (ab) $GYLVLQJ &RQWUDFWRU¶V (QFRXQWHU 'DWD Advising Contractor’s Encounter Data Liaison, via Administrative Notice, that OHA requires Contractor to provide corrected informed consent forms to be provided to OHA as set forth in such Administrative Notice; or (bc) 3URYLGLQJ &RQWUDFWRU¶V (QFRXQWHU 'DW Providing Contractor’s Encounter Data Liaison with Administrative Notice that informed consent form(s) are missing or invalid and Contractor shall return all Payments received for such procedures in accordance with Sub. Para. (6) below of this Para. c, Sec. 6, Ex. B, Part 2 and must change the associated Encounter Data to reflect no payment made for service(s). (76) (4) In the event Contractor fails to comply with the requirements of this Para. c, Sec. 6, Ex. B, Part 2 but nonetheless receives Payment for such procedures, such Payment will be deemed an Overpayment and subject to reporting and return in accordance with Sec. 1112, Para. b, Sub.Paras. (15)-(1716)-(181516)-(1718) of Ex. B, Part 9 and Sec. 1516 15 16 of Ex. B, Part 9, or set-off as set forth in Sec. 7, Ex. D of this Contract.

Sterilizations and Hysterectomies. (1) Sterilizations and Hysterectomies are a Covered Service only when they meet the federally mandated criteria in 42 CFR §§ 441.250 through 441.259 and the requirements of OHA established in OAR 410-130-0580. (2) Member Representatives do not have the right to give consent for sterilizations. All consents must comply with the criteria set forth in OAR 410-130-0580. (3) CopiesContractor shall submit copies Copies of all signed informed consents for sterilization and hysterectomies must be provided hysterectomy services to OHA, via Administrative Notice, within thirty (30) days of after the date of claims Adjudication as specified in accordance with OAR 410-141-3570service. (4) In the event OHA OHDUQV WKDW RQH RU PRUH RI &RQWU K\VWHUHFWRP\ RU VWHULOL]DWLRQ VHUYLFH S XXX learns that one or more of Contractor’s Members has received a hysterectomy or sterilization service prior to receipt of Contractor’s Administrative Notice under Sub.. Para (3) of this Para. c to this Sec. 6, Ex. B, Part 2 OHA will, no later than thirty (30) GD\V SDVW WKH HQG RI HDFK FDOHQGD Encounter Data Liaison with Administrative Notice of such services and the names of Members who received such Services. Contractor shall then, within thirty (30) days of VXFK $GPLQLVWUDWLYH 1RWLFH SURYLGH DV informed consent forms for all Members identified therein to OHA.thirty (5) OHA in collaboration with Contractor shall reconcile all hysterectomy or sterilization (or both) services withsuch with informed consents with the associated Encounter Data by either: (6) (3a) Confirming the validity of the consent as specified in OAR 410-141-3570. 2+$¶poVint of contact for activities involving the informed consents and providing Contractor’s Encounter Data is &RQWUDFWRU¶VL ia(isoQn,FviRa AXdmQiWnisHtraUtiv e N'oDticWeLiaison, Dtha t via Administrative Notice, that no further action is needed;liaison.needed; (ab) $GYLVLQJ &RQWUDFWRU¶V (QFRXQWHU 'DWD Advising Contractor’s Encounter Data Liaison, via Administrative Notice, that OHA requires Contractor to provide corrected informed consent forms to be provided to OHA as set forth in such Administrative Notice; or (bc) 3URYLGLQJ &RQWUDFWRU¶V (QFRXQWHU 'DW Providing Contractor’s Encounter Data Liaison with Administrative Notice that informed consent form(s) are missing or invalid and Contractor shall return all Payments received for such procedures in accordance with Sub. Para. (6) below of this Para. c, Sec. 6, Ex. B, Part 2 and must change the associated Encounter Data to reflect no payment made for service(s). (7) (46) In the event Contractor fails to comply with the requirements of this Para. c, Sec. 6, Ex. B, Part 2 but nonetheless receives Payment for such procedures, such Payment will be deemed an Overpayment and subject to reporting and return in accordance with Sec. 111211, Para. b, Sub.. Paras. (15)-(1716)-(1815)-(17) of Ex. B, Part 9 and Sec. 1516 15 of Ex. B, Part 9, or set-off as set forth in Sec. 7, Ex. D of this Contract.

Sterilizations and Hysterectomies. (1) Sterilizations and Hysterectomies are a Covered Service only when they meet the federally mandated criteria in 42 CFR §§ 441.250 through to 441.259 and the requirements of OHA established in OAR 410-130-0580. Member Representatives may not give consent for sterilizations. (2) Contractor shall, upon receipt of a Member’s signed informed consent, provide, in accordance with S. 25, P. b. of Ex. D, XXX’s Contract Administrator with Administrative Notice of each Member Representatives do not have who receives a hysterectomy or sterilization service permitted under SP (1) of this P. e to this S.4, Ex. B-Part 2. Such Administrative Notice shall include a copy of the right to give consent for sterilizations. All consents must comply with the criteria set forth in OAR 410-130-0580applicable Member’s signed informed consent. (3) CopiesContractor shall submit copies of all signed informed consents for sterilization and hysterectomies must be provided hysterectomy services to OHA, via Administrative Notice, within thirty (30) days of the date of claims Adjudication as specified in accordance with OAR 410-141-3570. (4) In the event OHA OHDUQV WKDW RQH RU PRUH RI &RQWU K\VWHUHFWRP\ RU VWHULOL]DWLRQ VHUYLFH S XXX learns that one or more of Contractor’s Members have received a hysterectomy or sterilization service prior to receipt of Contractor’s Administrative Notice under Sub.Para SP (31) of this Para. c P. e to this Sec. 6S.4, Ex. B, -Part 2 OHA will, no later than thirty (30) GD\V SDVW WKH HQG RI HDFK FDOHQGD 30 days past the end of each calendar quarter, provide Contractor’s Encounter Data Liaison with Administrative Notice of such services and the names of Members who received such Services. Contractor shall then, within thirty (30) days of VXFK $GPLQLVWUDWLYH 1RWLFH SURYLGH DV such Administrative Notice, provide, as set forth in OHA’s Administrative Notice, the informed consent forms for all Members identified therein to by OHA. (54) OHA in collaboration with Contractor shall reconcile all hysterectomy or sterilization (or both) services withsuch with informed consents with the associated Encounter Data encounter claims by either: (6) (3a) Confirming the validity of the consent as specified in OAR 410-141-3570. 2+$¶poVint of contact for activities involving the informed consents and providing Contractor’s Encounter Data is &RQWUDFWRU¶VL ia(isoQn,FviRa AXdmQiWnisHtraUtiv e N'oDticWe, Dtha t Liaison with Administrative Notice that no further action is needed;liaison.needed; (ab) $GYLVLQJ &RQWUDFWRU¶V (QFRXQWHU 'DWD Advising Contractor’s Encounter Data Liaison with Administrative Notice that OHA requires Contractor to provide corrected informed consent forms to be provided to OHA as set forth in such Administrative Notice; or (bc) 3URYLGLQJ &RQWUDFWRU¶V (QFRXQWHU 'DW Providing Contractor’s Encounter Data Liaison with Administrative Notice that informed consent form(s) are missing or invalid and Contractor shall return all Payments received for such procedures in accordance with Sub. Para. (6) below of this Para. c, Sec. 6, Ex. B, Part 2 Provider must recoup the payment and must change the associated Encounter Data encounter claim to reflect no payment made for service(s). (75) (4) In the event Contractor fails will be subject to Overpayment recovery as described in Ex. D, S. 7 of this Contract for failure to comply with the requirements of this Para. c, Sec. 6, Ex. B, Part 2 but nonetheless receives Payment for such procedures, such Payment will be deemed an Overpayment and subject to reporting and return in accordance with Sec. 1112, Para. b, Subsection.Paras. (15)-(1716)-(18) of Ex. B, Part 9 and Sec. 1516 of Ex. B, Part 9, or set-off as set forth in Sec. 7, Ex. D of this Contract.

Sterilizations and Hysterectomies. (1) Sterilizations and Hysterectomies are a Covered Service only when they meet the federally mandated criteria in 42 CFR §§ 441.250 through 441.259 and the requirements of OHA established in OAR 410-130-0580. (2) Member Representatives do not have the right to give consent for sterilizations. All consents must comply with the criteria set forth in OAR 410-130-0580. (3) CopiesContractor shall submit copies Copies of all signed informed consents for sterilization and hysterectomies must be provided hysterectomy services to OHA, OHA via Administrative Notice, within thirty (30) days Notice prior to the performance of the date of claims Adjudication as specified in accordance with OAR 410-141-3570.procedure.. (4) In the event OHA OHDUQV WKDW RQH RU PRUH RI &RQWU K\VWHUHFWRP\ RU VWHULOL]DWLRQ VHUYLFH S XXX learns that one or more of Contractor’s Members has received a hysterectomy or sterilization service prior to receipt of Contractor’s Administrative Notice under Sub.. Para (3) of this Para. c to this Sec. 6, Ex. B, Part 2 OHA will, no later than thirty (30) GD\V SDVW WKH HQG RI HDFK FDOHQGD days past the end of each calendar quarter, provide Contractor’s Encounter Data Liaison with Administrative Notice of such services and the names of Members who received such Services. Contractor shall then, within thirty (30) days of VXFK $GPLQLVWUDWLYH 1RWLFH SURYLGH DV such Administrative Notice, provide, as set forth in OHA’s Administrative Notice, the informed consent forms for all Members identified therein to by OHA. (5) OHA in collaboration with Contractor shall reconcile all hysterectomy or sterilization (or both) services withsuch with informed consents with the associated Encounter Data by either: (6) (3a) Confirming the validity of the consent as specified in OAR 410-141-3570. 2+$¶poVint of contact for activities involving the informed consents and providing Contractor’s Encounter Data is &RQWUDFWRU¶VL ia(isoQn,FviRa AXdmQiWnisHtraUtiv e N'oDticWe, Dtha t Liaison via Administrative Notice that no further action is needed;liaison.needed; (ab) $GYLVLQJ &RQWUDFWRU¶V (QFRXQWHU 'DWD Advising Contractor’s Encounter Data Liaison via Administrative Notice that OHA requires Contractor to provide corrected informed consent forms to be provided to OHA as set forth in such Administrative Notice; or (bc) 3URYLGLQJ &RQWUDFWRU¶V (QFRXQWHU 'DW Providing Contractor’s Encounter Data Liaison with Administrative Notice that informed consent form(s) are missing or invalid and Contractor shall must return all Payments received for such procedures in accordance with Sub. Para. (6) below of this Para. c, Sec. 6, Ex. B, Part 2 and must change the associated Encounter Data to reflect no payment made for service(s). (7) (46) In the event Contractor fails to comply with the requirements of this Para. c, Sec. 6, Ex. B, Part 2 but is nonetheless receives Payment for such procedures, such Payment will be deemed an Overpayment and subject to reporting and return in accordance with Sec. 111211, Para. b, Sub.Paras. (15)-(1716)-(1815)-(17) and Sec. 15 of Ex. B, Part 9 and Sec. 1516 of Ex. B, Part 9, or set-off as set forth in Sec. 7, Ex. D of this Contract.