Common use of TERMINATION OF AGREEMENT AND APPEALS Clause in Contracts

TERMINATION OF AGREEMENT AND APPEALS. The Provider agrees to notify DHSS immediately if it is no longer eligible to provide services based on applicable Provider eligibility requirements set out in Section I of this Agreement. Notification of non- eligibility will result in automatic termination of this Agreement. Failure to comply with the terms of this Agreement and/or standards outlined in the Agreement and its appendices may result in non- payment and automatic termination of the Agreement by DHSS. A Provider may appeal the decision to terminate a Provider Agreement under 7 AAC 81.200. All appeals will be conducted in accordance with Section 7AAC 81.200-210 of the Alaska Administrative Code. Except as noted above, DHSS may terminate this Agreement with 30 days’ notice. A Provider may also terminate the Agreement with 30 days’ notice, but must provide assistance in making arrangements for safe and orderly transfer of clients and information to other Providers, as directed by DHSS. This Agreement remains in force until the Provider or DHSS terminates the Agreement or a material term of the Agreement is changed. I certify that I am authorized to negotiate, execute and administer this agreement on behalf of the Provider agency named in this agreement, and hereby consent to the terms and conditions of this agreement, and its appendices and attachments. Xxxx Xxxxx, Program Manager DHSS Division of Behavioral Health 0000 X Xxxxxx Xxxxx 000 Anchorage, Alaska 99503-5935 Ph (000) 000-0000/FX (000) 000-0000 PO Box 110650 Juneau, AK 99811-0650

TERMINATION OF AGREEMENT AND APPEALS. The Provider agrees to notify DHSS DFCS immediately if it is no longer eligible to provide services based on applicable Provider eligibility requirements set out in Section I of this Agreement. Notification of non- non-eligibility will result in automatic termination of this Agreement. Failure to comply with the terms of this Agreement and/or standards outlined in the Agreement and its appendices may result in non- non-payment and automatic termination of the Agreement by DHSSDFCS. A Provider may appeal the decision to terminate a Provider Agreement under 7 AAC 81.200. All appeals will be conducted in accordance with Section 7AAC 81.200-210 of the Alaska Administrative Code. Except as noted above, DHSS DFCS may terminate this Agreement with 30 days’ notice. A Provider may also terminate the Agreement with 30 days’ notice, but must provide assistance in making arrangements for safe and orderly transfer of clients and information to other Providers, as directed by DHSSDFCS. This Agreement remains in force until the Provider or DHSS DFCS terminates the Agreement or a material term of the Agreement is changed. I certify that I am authorized to negotiate, execute and administer this agreement on behalf of the Provider agency named in this agreement, and hereby consent to the terms and conditions of this agreement, and its appendices and attachments. Xxxx Xxxxx, Program Manager DHSS Division of Behavioral Health 0000 X Xxxxxx Xxxxx 000 Anchorage, Alaska 99503-5935 Ph (000) 000-0000/FX (000) 000-0000 PO Box 110650 Juneau, AK 99811-0650PROVIDER DEPT.OF FAMILY AND COMMUNITY SERVICES

TERMINATION OF AGREEMENT AND APPEALS. The Provider agrees to notify DHSS immediately if it is no longer eligible to provide services based on applicable Provider eligibility requirements set out in Section I of this Agreement. Notification of non- eligibility will result in automatic termination of this Agreement. Failure to comply with the terms of this Agreement and/or standards outlined in the Agreement and its appendices may result in non- non-payment and automatic termination of the Agreement by DHSS. A Provider may appeal the decision to terminate a Provider Agreement under 7 AAC 81.200. All appeals will be conducted in accordance with Section 7AAC 81.200-210 of the Alaska Administrative Code. Except as noted above, DHSS may terminate this Agreement with 30 days’ notice. A Provider may also terminate the Agreement with 30 days’ notice, but must provide assistance in making arrangements for safe and orderly transfer of clients and information to other Providersproviders, as directed by DHSS. This Agreement remains in force until the Provider or DHSS terminates the Agreement or a material term of the Agreement is changed. I certify that I am authorized to negotiate, execute and administer this agreement Agreement on behalf of the Provider agency named in this agreement, and hereby consent to the terms and conditions of this agreementAgreement, and its appendices and attachments. Xxxx XxxxxXxxxxx, Program Manager DHSS Coordinator Division of Behavioral Health 0000 X Xxxxxx Xxxxxx, Xxxxx 000 Anchorage, Alaska 9950300000-5935 Ph (000) 000-0000/FX 0000 Phone (000) 000-0000 xxxx.xxxxxx@xxxxxx.xxx Xxxxxxxx Xxxxxx, Grants Administrator Grants & Contracts Support Team PO Box 110650 Juneau, AK 99811-0650

TERMINATION OF AGREEMENT AND APPEALS. The Provider agrees to notify DHSS DFCS immediately if it is no longer eligible to provide services based on applicable Provider eligibility requirements set out in Section I of this Agreement. Notification of non- non-eligibility will result in automatic termination of this Agreement. Failure to comply with the terms of this Agreement and/or standards outlined in the Agreement and its appendices may result in non- non-payment and automatic termination of the Agreement by DHSSDFCS. A Provider may appeal the decision to terminate a Provider Agreement under 7 AAC 81.200. All appeals will be conducted in accordance with Section 7AAC 81.200-210 of the Alaska Administrative Code. Except as noted above, DHSS DFCS may terminate this Agreement with 30 days’ notice. A Provider may also terminate the Agreement with 30 days’ notice, notice but must provide assistance in making arrangements for safe and orderly transfer of clients and information to other Providers, as directed by DHSSDFCS. This Agreement remains in force until the Provider or DHSS DFCS terminates the Agreement or a material term of the Agreement is changed. I certify that I am authorized to negotiate, execute execute, and administer this agreement on behalf of the Provider agency named in this agreement, and hereby consent to the terms and conditions of this agreement, and its appendices and attachments. Xxxx Xxxxx, Program Manager DHSS Division of Behavioral Health 0000 X Xxxxxx Xxxxx 000 Anchorage, Alaska 99503-5935 Ph (000) 000-0000/FX (000) 000-0000 PO Box 110650 PROVIDER DEPT. OF FAMILY & COMMUNITY SERVICES Financial Management Servcies Juneau, AK 99811-06502650 Ph. 000-000-0000 Provider’s Federal Tax ID Number xxxx.xxxxxxxx@xxxxxx.xxx

TERMINATION OF AGREEMENT AND APPEALS. The Provider agrees to notify DHSS immediately if it is no longer eligible to provide services based on applicable Provider eligibility requirements set out in Section I II of this Agreement. Notification of non- non-eligibility will result in automatic termination of this Agreement. Failure to comply with the terms of this Agreement and/or standards outlined in the Agreement and its appendices may result in non- non-payment and automatic termination of the Agreement by DHSS. A Provider may appeal the decision to terminate a Provider Agreement under 7 AAC 81.20081.200 Request for Appeal. All appeals will be conducted in accordance with Section 7AAC 81.200-210 of the Alaska Administrative Code. Except as noted above, DHSS may terminate this Agreement with 30 days’ days written notice. A Provider may also terminate the Agreement with 30 days’ days written notice, but must provide assistance in making arrangements for safe and orderly transfer of clients and information to other Providers, as directed by DHSS. This Agreement remains in force until the Provider or DHSS terminates the Agreement or a material term of the Agreement is changed. By my signature below, I certify that I am authorized to negotiate, execute and administer this agreement on behalf of the Provider agency named in this agreement, and hereby consent to the terms and conditions of this agreement, and its appendices and attachments. Xxxx Xxxxx, Program Manager DHSS Division of Behavioral Health 0000 X Xxxxxx Xxxxx 000 Anchorage, Alaska 99503-5935 Ph (000) 000-0000/FX (000) 000-0000 PO Box 110650 Juneau, AK 99811-0650.

TERMINATION OF AGREEMENT AND APPEALS. The Provider agrees to notify DHSS DFCS immediately if it is no longer eligible to provide services based on applicable Provider eligibility requirements set out in Section I of this Agreement. Notification of non- non-eligibility will result in automatic termination of this Agreement. Failure to comply with the terms of this Agreement and/or standards outlined in the Agreement and its appendices may result in non- non-payment and automatic termination of the Agreement by DHSSDFCS. A Provider may appeal the decision to terminate a Provider Agreement under 7 AAC 81.200. All appeals will be conducted in accordance with Section 7AAC 81.200-210 of the Alaska Administrative Code. Except as noted above, DHSS DFCS may terminate this Agreement with 30 days’ notice. A Provider may also terminate the Agreement with 30 days’ notice, but must provide assistance in making arrangements for safe and orderly transfer of clients Clients and information to other Providers, as directed by DHSSDFCS. This Agreement remains in force until the Provider or DHSS DFCS terminates the Agreement or a material term of the Agreement is changed. I certify that I am authorized to negotiate, execute and administer this agreement Agreement on behalf of the Provider agency named in this agreementAgreement, and hereby consent to the terms and conditions of this agreementAgreement, and its appendices and attachments. Xxxx XxxxxPROVIDER DEPT. OF FAMILY & COMMUNITY SERVICES Printed Name Provider Representative & Title Printed Name - DFCS Representative & Title Xxxxx Xxxxxxx, Program Manager DHSS Division of Behavioral Health Chief Financial Officer Alaska Psychiatric Institute 0000 X Xxxxx Xxxxxx Xxxxx 000 Anchorage, Alaska 99503-5935 Ph (000) 000-0000/FX (000) 000AK, 00000-0000 PO Box 110650 Phone 000.000.0000 Fax 000.000.0000 Juneau, AK 99811-06500650 Ph. 000-000-0000 Fax 000-000-0000

TERMINATION OF AGREEMENT AND APPEALS. The Provider agrees to notify DHSS immediately if it is no longer eligible to provide services based on applicable Provider eligibility requirements set out in Section I of this Agreement. Notification of non- eligibility will result in automatic termination of this Agreement. Failure to comply with the terms of this Agreement and/or standards outlined in the Agreement and its appendices may result in non- payment and automatic termination of the Agreement by DHSS. A Provider may appeal the decision to terminate a Provider Agreement under 7 AAC 81.200. All appeals will be conducted in accordance with Section 7AAC 81.200-210 of the Alaska Administrative Code. Except as noted above, DHSS may terminate this Agreement with 30 days’ notice. A Provider may also terminate the Agreement with 30 days’ notice, but must provide assistance in making arrangements for safe and orderly transfer of clients and information to other Providers, as directed by DHSS. This Agreement remains in force until the Provider or DHSS terminates the Agreement or a material term of the Agreement is changed. I certify that I am authorized to negotiate, execute and administer this agreement on behalf of the Provider agency named in this agreement, and hereby consent to the terms and conditions of this agreement, and its appendices and attachments. Xxxx XxxxxXxxxxx, Program Manager DHSS Division of Behavioral Health 0000 X Xxxxxx Xxxxx 000 Anchorage, Alaska 99503-5935 Ph (000) 000-0000/FX (000) 000-0000 PO Box 110650 Juneau, AK 99811-06500650 Providers must identify the business entity type under which they are legally eligible to provide service and intending to enter into this Provider Agreement.

TERMINATION OF AGREEMENT AND APPEALS. The Provider agrees to notify DHSS immediately if it is no longer eligible to provide services based on applicable Provider eligibility requirements set out in Section I of this Agreement. Notification of non- eligibility will result in automatic termination of this Agreement. Failure to comply with the terms of this Agreement and/or standards outlined in the Agreement and its appendices may result in non- payment and automatic termination of the Agreement by DHSS. A Provider may appeal the decision to terminate a Provider Agreement under 7 AAC 81.20081.205. All appeals will be conducted in accordance with Section 7AAC 81.2007 AAC 81.205-210 of the Alaska Administrative Code. Except as noted above, DHSS may terminate this Agreement with 30 days’ notice. A Provider may also terminate the Agreement with 30 days’ notice, but must provide assistance in making arrangements for safe and orderly transfer of clients and information to other Providersproviders, as directed by DHSS. This Agreement remains in force until the Provider or DHSS terminates the Agreement or a material term of the Agreement is changed. I certify that I am authorized to negotiate, execute and administer this agreement Agreement on behalf of the Provider agency named in this agreement, and hereby consent to the terms and conditions of this agreementAgreement, and its appendices and attachments. Xxxx Xxxxxxx-Xxxxx, Program Manager DHSS Division of Behavioral Health P.O. Box 110680 Juneau, AK 00000-0000 X Xxxxxx Xxxxx 000 Anchorage, Alaska 99503-5935 Ph (000) 000-0000/FX Phone: (000) 000-0000 PO Fax: (000) 000-0000 Email: xxxx.xxxxxxx-xxxxx@xxxxxx.xxx Grants & Contracts Support Team P.O. Box 110650 Juneau, AK 99811-06500650 Provider Email Address Phone: (000) 000-0000 Fax: (000) 000-0000 Email: xxxxxxxx.xxxxxx@xxxxxx.xxx

TERMINATION OF AGREEMENT AND APPEALS. The Provider agrees to notify DHSS immediately if it is no longer eligible to provide services based on applicable Provider eligibility requirements set out in Section I of this Agreement. Notification of non- eligibility will result in automatic termination of this Agreement. Failure to comply with the terms of this Agreement and/or standards outlined in the Agreement and its appendices may result in non- payment and automatic termination of the Agreement by DHSS. A Provider may appeal the decision to terminate a Provider Agreement under 7 AAC 81.200. All appeals will be conducted in accordance with Section 7AAC 81.200-210 of the Alaska Administrative Code. Except as noted above, DHSS may terminate this Agreement with 30 days’ notice. A Provider may also terminate the Agreement with 30 days’ notice, but must provide assistance in making arrangements for safe and orderly transfer of clients and information to other Providers, as directed by DHSS. This Agreement remains in force until the Provider or DHSS terminates the Agreement or a material term of the Agreement is changed. I certify that I am authorized to negotiate, execute and administer this agreement on behalf of the Provider agency named in this agreement, and hereby consent to the terms and conditions of this agreement, and its appendices and attachments. Xxxx Xxxxx, Program Manager DHSS Division of Behavioral Health 0000 X Xxxxxx Xxxxx 000 Anchorage, Alaska 9950300000-5935 Ph (000) 000-0000/FX 0000 Phone: (000) 000-0000 Fax: (000) 000-0000 Email: xxxx.xxxxx@xxxxxx.xxx Grants & Contracts Support Team PO Box 110650 Juneau, AK 99811Fax: (000) 000-06500000 Federal Tax ID Number Email: xxxxx.xxxxxxx@xxxxxx.xxx

TERMINATION OF AGREEMENT AND APPEALS. The Provider Consultant agrees to notify DHSS immediately if it is no longer eligible to provide services based on applicable Provider Consultant eligibility requirements set out in Section I of this Agreement. Notification of non- non-eligibility will result in automatic termination of this Agreement. Failure to comply with the terms of this Agreement and/or standards outlined in the Agreement and its appendices may result in non- non-payment and automatic termination of the Agreement by DHSS. A Provider Consultant may appeal the decision to terminate a Provider Agreement under 7 AAC 81.200. All appeals will be conducted in accordance with Section 7AAC 81.200-210 of the Alaska Administrative Code. Except as noted above, DHSS may terminate this Agreement with 30 days’ notice. A Provider Consultant may also terminate the Agreement with 30 days’ notice, but must provide assistance in making arrangements for safe and orderly transfer of clients and information to other ProvidersConsultants, as directed by DHSSXXXX. This Agreement remains in force until the Provider Consultant or DHSS terminates the Agreement or a material term of the Agreement is changed. I certify that I am authorized to negotiate, execute and administer this agreement on behalf of the Provider Consultant agency named in this agreement, and hereby consent to the terms and conditions of this agreement, and its appendices and attachments. CONSULTANT DEPT. OF HEALTH & SOCIAL SERVICES Xxxx XxxxxXxxxxxx, Health Program Manager DHSS II Division of Behavioral Health 0000 X Xxxxxx Xxxxx Xx Xxx 000 Anchorage, Alaska AK 99503-5935 Ph (000) Ph. 000-0000/FX (000) 000-0000 PO Box 110650 Juneau, AK 99811Fax 000-0650000-0000 Email: xxxx.xxxxxxx@xxxxxx.xxx

TERMINATION OF AGREEMENT AND APPEALS. The Provider agrees to notify DHSS immediately if it is no longer eligible to provide services based on applicable Provider eligibility requirements set out in Section I of this Agreement. Notification of non- non-eligibility will result in automatic termination of this Agreement. Failure to comply with the terms of this Agreement and/or standards outlined in the Agreement and its appendices may result in non- non-payment and automatic termination of the Agreement by DHSS. A Provider may appeal the decision to terminate a Provider Agreement under 7 AAC 81.200. All appeals will be conducted in accordance with Section 7AAC 81.200-210 of the Alaska Administrative Code. Except as noted above, DHSS may terminate this Agreement with 30 days’ days notice. A Provider may also terminate the Agreement with 30 days’ days notice, but must provide assistance in making arrangements for safe and orderly transfer of clients and information to other Providers, as directed by DHSS. This Agreement remains in force until the Provider or DHSS terminates the Agreement or a material term of the Agreement is changed. PROVIDER CERTIFICATION: I certify that I am authorized to negotiate, execute and administer this agreement on behalf of the Provider agency named in this agreement, and hereby consent to the terms and conditions of this agreement, and its appendices and attachments. Xxxx Xxxxx, Program Manager DHSS PROVIDER DEPT. OF HEALTH & SOCIAL SERVICES Division of Behavioral Health 0000 X Xxxxxx Xxxxx Public Assistance 000 AnchorageXxxxxxxxxx, Alaska 99503Suite 301 Juneau, AK 99801 Ph: 000-5935 Ph (000) 000-0000/FX (; Fax: 000) -000-0000 PO Box 110650 Juneau, AK 99811-06500650 Ph. 000-000-0000; Fax 000- 000-0000 Provider’s Federal Tax ID Number Xxxxxxx.Xxxxx@xxxxxx.xxx

TERMINATION OF AGREEMENT AND APPEALS. The Provider agrees to notify DHSS immediately if it is no longer eligible to provide services based on applicable Provider eligibility requirements set out in Section I of this Agreement. Notification of non- non-eligibility will result in automatic termination of this Agreement. Failure to comply with the terms of this Agreement and/or standards outlined in the Agreement and its appendices may result in non- non-payment and automatic termination of the Agreement by DHSS. A Provider may appeal the decision to terminate a Provider Agreement under 7 AAC 81.200. All appeals will be conducted in accordance with Section 7AAC 81.200-210 of the Alaska Administrative Code. Except as noted above, DHSS may terminate this Agreement with 30 days’ notice. A Provider may also terminate the Agreement with 30 days’ notice, but must provide assistance in making arrangements for safe and orderly transfer of clients and information to other Providers, as directed by DHSS. This Agreement remains in force until the Provider or DHSS terminates the Agreement or a material term of the Agreement is changed. I certify that I am authorized to negotiate, execute and administer this agreement on behalf of the Provider agency named in this agreement, and hereby consent to the terms and conditions of this agreement, and its appendices and attachments. Xxxx Xxxxx, Program Manager DHSS Division of Behavioral Health PROVIDER DEPT. OF HEALTH & SOCIAL SERVICES Alaska Psychiatric Institute 0000 X Xxxxx Xxxxxx Xxxxx 000 Anchorage, Alaska 9950399508-5935 Ph (4677 000) -000-0000 / Fax 000-000-0000/FX (000) 000-0000 PO Box 110650 Juneau, AK 99811-0650

TERMINATION OF AGREEMENT AND APPEALS. The Provider agrees to notify DHSS immediately if it is no longer eligible to provide services based on applicable Provider eligibility requirements set out in Section I of this Agreement. Notification of non- non-eligibility will result in automatic termination of this Agreement. Failure to comply with the terms of this Agreement and/or standards outlined in the Agreement and its appendices may result in non- non-payment and automatic termination of the Agreement by DHSS. A Provider may appeal the decision to terminate a Provider Agreement under 7 AAC 81.200. All appeals will be conducted in accordance with Section 7AAC 81.200-210 of the Alaska Administrative Code. Except as noted above, DHSS may terminate this Agreement with 30 days’ notice. A Provider may also terminate the Agreement with 30 days’ notice, but must provide assistance in making arrangements for safe and orderly transfer of clients and information to other Providers, as directed by DHSS. This Agreement remains in force until the Provider or DHSS terminates the Agreement or a material term of the Agreement is changed. I certify that I am authorized to negotiate, execute and administer this agreement Agreement on behalf of the Provider agency named in this agreementAgreement, and hereby consent to the terms and conditions of this agreementAgreement, and its appendices Appendices and attachmentsAttachments. Xxxx Xxxxxx Xxxxx, Health Program Manager DHSS Division of Behavioral Health 0000 X II Senior and Disabilities Services, General Relief 000 Xxxx 0xx Xxxxxx Xxxxx 000 Anchorage, Alaska 99503-5935 Ph (000) AK 99501 Ph. 000-0000/FX (000) 000-0000 PO Box 110650 / Xxxxxx.Xxxxx@xxxxxx.xxx Juneau, AK 99811-0650