Termination by HCA. HCA may terminate this Contract whenever HCA determines the Contractor has defaulted in performance of the Contract and has failed to cure the default within a reasonable period of as set by HCA, based on the nature of the default and how such default impacts possible Individuals. For purposes of this section, “default” means failure of Contractor to meet one or more material obligations of this Contract; this may minimally include the following: The Contractor did not fully and accurately make any disclosure as required by the HCA. The Contractor failed to timely submit accurate information as required by the HCA. One of the Contractor’s owners failed to timely submit accurate information as required by the HCA. The Contractor’s agent, managing employee, general manager, business manager, administrator, director, or other individual who exercises operational or managerial control over, or who directly or indirectly conducts the day-to- day operation of the Contractor, failed to timely submit accurate information as required by the HCA. One of the Contractor’s owners/administrators did not cooperate with any screening methods as required by the HCA. One of the Contractor’s owners has been convicted of a criminal offense related to that person's involvement with the Medicare, Medicaid, or title XXI program in the last ten (10) years. The Contractor has been terminated under title XVIII of the Social Security Act, or under any states’ Medicaid or CHIP program. One of the Contractor’s owners fails to submit sets of fingerprints in a form and manner to be determined by HCA within thirty (30) days of a HCA request. The Contractor failed to permit access to one of the Contractor’s locations for site visits. The Contractor has falsified any information provided on its application.
Appears in 2 contracts
Samples: Washington Behavioral Health, Washington Behavioral Health
Termination by HCA. HCA may terminate this Contract whenever HCA determines the Contractor has defaulted in performance of the Contract and has failed to cure the default within a reasonable period of as set by HCA, based on the nature of the default and how such default impacts possible Individuals. For purposes of this section, “default” means failure of Contractor to meet one or more material obligations of this Contract; this may minimally include the following: The Contractor did not fully and accurately make any disclosure as required by the HCA. The Contractor failed to timely submit accurate information as required by the HCA. One of the Contractor’s owners failed to timely submit accurate information as required by the HCA. The Contractor’s agent, managing employee, general manager, business manager, administrator, director, or other individual who exercises operational or managerial control over, or who directly or indirectly conducts the day-to- to-day operation of the Contractor, failed to timely submit accurate information as required by the HCA. One of the Contractor’s owners/administrators did not cooperate with any screening methods as required by the HCA. One of the Contractor’s owners has been convicted of a criminal offense related to that person's involvement with the Medicare, Medicaid, or title XXI program in the last ten (10) years. The Contractor has been terminated under title XVIII of the Social Security Act, or under any states’ Medicaid or CHIP program. One of the Contractor’s owners fails to submit sets of fingerprints in a form and manner to be determined by HCA within thirty (30) days of a HCA request. The Contractor failed to permit access to one of the Contractor’s locations for site visits. The Contractor has falsified any information provided on its application. Termination for Convenience Notwithstanding any other provision of this Contract, the HCA may, by giving thirty (30) calendar days written notice, beginning on the second (2nd) day after the mailing, terminate this Contract in whole or in part when it is in the best interest of HCA, as determined by HCA in its sole discretion. If this Contract is so terminated, HCA shall be liable only for payment in accordance with the terms of this Contract for services rendered prior to the effective date of termination. If the Contractor terminates this Contract for convenience, the Contractor is required to provide no less than six (6) months advance notice in writing to HCA. Terminations: Pre-termination Processes Either party to the Contract shall give the other party to the Contract written notice, as described in the Notices section of the General Terms and Conditions of this Contract, of its intent to terminate this Contract and the reason for termination. If either party disagrees with the other party’s decision to terminate this Contract, that party will have the right to a dispute resolution as described in the Disputes section of this Contract. Termination Due to Funding In the event funding from any state, federal, or other source is withdrawn, reduced, or limited in any way after the date this Contract is signed and prior to the termination date, HCA may, in whole or in part, suspend or terminate this Contract upon fifteen (15) calendar days’ prior written notice to Contractor or upon the effective date of withdrawn or reduced funding, whichever occurs earlier. At HCA’s sole discretion the Contract may be renegotiated under the revised funding conditions. If this Contract is so terminated or suspended, HCA shall be liable only for payment in accordance with the terms of this Contract for services rendered prior to the effective date. Termination - Information on Outstanding Claims In the event this Contract is terminated, the Contractor shall provide HCA, within ninety (90) calendar days, all available information reasonably necessary for the reimbursement of any outstanding claims or bills for Contracted Services to Individuals. Information and reimbursement of such claims is subject to the provisions of the Payment and Sanctions section of this Contract. Administrative Simplification The Contractor shall comply with the requirements of RCW 70.14.155 and Chapter 48.165 RCW. To maximize understanding, communication, and administrative economy among all Contractors, their Subcontractors, governmental entities, and Individuals, Contractor shall use and follow the most recent updated versions of: Current Procedural Terminology (CPT). International Classification of Diseases (ICD). Healthcare Common Procedure Coding System (HCPCS). The Diagnostic and Statistical Manual of Mental Disorders. National Council for Prescription Drug Programs (NCPDP) Telecommunication Standard D.O. Medi-Span® Master Drug Data Base or other nationally recognized drug data base with approval by HCA. The Contractor must follow National Correct Coding Initiative (NCCI) policies to control improper coding that leads to inappropriate payments. The Contractor must incorporate compatible NCCI methodologies in its payment systems for processing claims. The NCCI editing should occur in addition to current procedure code review and editing by the Contractor’s claims payment systems. In lieu of the most recent versions, Contractor may request an exception. HCA’s consent thereto will not be unreasonably withheld. Contractor may set its own conversion factor(s), including special code-specific or group‑specific conversion factors, as it deems appropriate. MATERIALS AND INFORMATION REQUIREMENTS Media Materials and Publications Media materials and publications developed with state funds shall be submitted to the HCA for written approval prior to publication. HCA must be cited as the funding source in news releases, publications, and advertising messages created with or about HCA funding. The funding source shall be cited as: The state of Washington Health Care Authority. The HCA logo may also be used in place of the above citation. Materials described in 3.1.1 but not paid for by funds provided under this Contract must be submitted to HCA for prior approval. The Contractor is encouraged but is not required to submit the following items to HCA for approval: News coverage resulting from interviews with reporters including online news coverage; Pre-scheduled posts on electronic / social media sites; When a statewide media message developed by HCA is localized; and When SAMHSA-sponsored media campaign are localized. Materials for Crisis Services The Contractor shall develop and implement a plan that educates and informs Tribes, and community stakeholders to include: residents of the RSA, Health Care Providers, First Responders, the criminal justice community, educational systems, and faith-based organizations. After the initial Contract period, provide an update by March 31 on a two (2) year cycle as determined by HCA. Publicize the regional crisis system services and facilitate awareness of the existence of the Behavioral Health Crisis Services for all stakeholders and Tribes. Information Requirements for Individuals Upon an Individual’s request, the Contractor shall provide all relevant licensure, certification and accreditation status and information for any contracted provider. Equal Access for Individuals with Communication Barriers The Contractor shall assure equal access for all Individuals when oral or written language creates a barrier to such access. Oral Information: The Contractor shall assure interpreter services are provided free of charge for Individuals with a preferred language other than English. This includes the provision of interpreters for Individuals who are Deaf, DeafBlind, or Hard of Hearing. This includes oral interpretation Sign Language (SL), and the use of Auxiliary Aids and Services as defined in this Contract (42 F.F.R. § 438.10(d)(4)). Interpreter services shall be provided for all interactions between such Individuals and the Contractor or any of its providers including, but not limited to: Customer service; All appointments with any provider for any covered service; and All steps necessary to file Grievances and Appeals.
Appears in 1 contract
Samples: Washington Behavioral Health – Administrative Services Organization Contract
Termination by HCA. HCA may terminate this Contract whenever HCA determines the Contractor has defaulted in performance of the Contract and has failed to cure the default within a reasonable period of as set by HCA, based on the nature of the default and how such default impacts possible Individuals. For purposes of this section, “default” means failure of Contractor to meet one or more material obligations of this Contract; this may minimally include the following: The Contractor did not fully and accurately make any disclosure as required by the HCA. The Contractor failed to timely submit accurate information as required by the HCA. One of the Contractor’s owners failed to timely submit accurate information as required by the HCA. The Contractor’s agent, managing employee, general manager, business manager, administrator, director, or other individual who exercises operational or managerial control over, or who directly or indirectly conducts the day-to- to-day operation of the Contractor, failed to timely submit accurate information as required by the HCA. One of the Contractor’s owners/administrators did not cooperate with any screening methods as required by the HCA. One of the Contractor’s owners has been convicted of a criminal offense related to that person's involvement with the Medicare, Medicaid, or title XXI program in the last ten (10) years. The Contractor has been terminated under title XVIII of the Social Security Act, or under any states’ Medicaid or CHIP program. One of the Contractor’s owners fails to submit sets of fingerprints in a form and manner to be determined by HCA within thirty (30) days of a HCA request. The Contractor failed to permit access to one of the Contractor’s locations for site visits. The Contractor has falsified any information provided on its application. Termination for Convenience Notwithstanding any other provision of this Contract, the HCA may, by giving thirty (30) calendar days written notice, beginning on the second (2nd) day after the mailing, terminate this Contract in whole or in part when it is in the best interest of HCA, as determined by HCA in its sole discretion. If this Contract is so terminated, HCA shall be liable only for payment in accordance with the terms of this Contract for services rendered prior to the effective date of termination. If the Contractor terminates this Contract for convenience, the Contractor is required to provide no less than six (6) months advance notice in writing to HCA. Terminations: Pre-termination Processes Either party to the Contract shall give the other party to the Contract written notice, as described in the Notices section of the General Terms and Conditions of this Contract, of its intent to terminate this Contract and the reason for termination. If either party disagrees with the other party’s decision to terminate this Contract, that party will have the right to a dispute resolution as described in the Disputes section of this Contract. Termination Due to Funding In the event funding from any state, federal, or other source is withdrawn, reduced, or limited in any way after the date this Contract is signed and prior to the termination date, HCA may, in whole or in part, suspend or terminate this Contract upon fifteen (15) calendar days’ prior written notice to Contractor or upon the effective date of withdrawn or reduced funding, whichever occurs earlier. At HCA’s sole discretion the Contract may be renegotiated under the revised funding conditions. If this Contract is so terminated or suspended, HCA shall be liable only for payment in accordance with the terms of this Contract for services rendered prior to the effective date. Termination - Information on Outstanding Claims In the event this Contract is terminated, the Contractor shall provide HCA, within ninety (90) calendar days, all available information reasonably necessary for the reimbursement of any outstanding claims or bills for Contracted Services to Individuals. Information and reimbursement of such claims is subject to the provisions of the Payment and Sanctions section of this Contract. Administrative Simplification The Contractor shall comply with the requirements of RCW 70.14.155 and Chapter 48.165 RCW. To maximize understanding, communication, and administrative economy among all Contractors, their Subcontractors, governmental entities, and Individuals, Contractor shall use and follow the most recent updated versions of: Current Procedural Terminology (CPT). International Classification of Diseases (ICD). Healthcare Common Procedure Coding System (HCPCS). The Diagnostic and Statistical Manual of Mental Disorders. National Council for Prescription Drug Programs (NCPDP) Telecommunication Standard D.O. Medi-Span® Master Drug Data Base or other nationally recognized drug data base with approval by HCA. The Contractor must follow National Correct Coding Initiative (NCCI) policies to control improper coding that leads to inappropriate payments. The Contractor must incorporate compatible NCCI methodologies in its payment systems for processing claims. The NCCI editing should occur in addition to current procedure code review and editing by the Contractor’s claims payment systems. In lieu of the most recent versions, Contractor may request an exception. HCA’s consent thereto will not be unreasonably withheld. Contractor may set its own conversion factor(s), including special code-specific or group‑specific conversion factors, as it deems appropriate. MATERIALS AND INFORMATION REQUIREMENTS Media Materials and Publications Media materials and publications developed with state funds shall be submitted to the HCA for written approval prior to publication. HCA must be cited as the funding source in news releases, publications, and advertising messages created with or about HCA funding. The funding source shall be cited as: The state of Washington Health Care Authority. The HCA logo may also be used in place of the above citation. Materials described in 3.1.1 but not paid for by funds provided under this Contract must be submitted to HCA for prior approval. The Contractor is encouraged but is not required to submit the following items to HCA for approval: News coverage resulting from interviews with reporters including online news coverage; Pre-scheduled posts on electronic / social media sites; When a statewide media message developed by HCA is localized; and When SAMHSA-sponsored media campaign are localized. Materials for Crisis Services The Contractor shall develop and implement a plan that educates and informs community stakeholders to include: residents of the RSA, Health Care Providers, First Responders, the criminal justice community, educational systems, and faith-based organizations. After the initial Contract period, provide an update by March 31 on a two (2) year cycle as determined by HCA. Publicize the regional crisis system services and facilitate awareness of the existence of the Behavioral Health Crisis Services for all stakeholders. Information Requirements for Individuals Upon an Individual’s request, the Contractor shall provide all relevant licensure, certification and accreditation status and information for any contracted provider. Equal Access for Individuals with Communication Barriers The Contractor shall assure equal access for all Individuals when oral or written language creates a barrier to such access. Oral Information: The Contractor shall assure interpreter services are provided free of charge for Individuals with a preferred language other than English. This includes the provision of interpreters for Individuals who are Deaf, DeafBlind, or Hard of Hearing. This includes oral interpretation Sign Language (SL), and the use of Auxiliary Aids and Services as defined in this Contract (42 F.F.R. § 438.10(d)(4)). Interpreter services shall be provided for all interactions between such Individuals and the Contractor or any of its providers including, but not limited to: Customer service; All appointments with any provider for any covered service; and All steps necessary to file Grievances and Appeals.
Appears in 1 contract
Samples: Washington Behavioral Health – Administrative Services Organization Contract
