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. The State is liable only for payment in accordance with the payment provision of this Provider Agreement for relief nursing services rendered before the effective date of termination. This agreement shall be in effect as soon as the agreement is signed by both parties to the agreement. 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. PROVIDER DEPT. OF HEALTH & SOCIAL SERVICES Xxxxxxxx Xxxxxx, Program Manager Alaska Psychiatric Institute 0000 Xxxxx Xxxxxx Anchorage, AK 99508 xxxxxxxx.xxxxxx@xxxxxx.xxx Xxxxxx Xxxxx, Xxxxxx Administrator Grants & Contracts Juneau, AK 99811-0650 Ph. 000-000-0000 Fax 000- 000-0000 Provider’s Federal Tax ID Number xxxxxx.xxxxx@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-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. The State is liable only , but must provide assistance in making arrangements for payment in accordance with the payment provision safe and orderly transfer of this Provider Agreement for relief nursing services rendered before the effective date of termination. This agreement shall be in effect clients and information to other Consultants, as soon as the agreement is signed directed by both parties to the agreementXXXX. 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. PROVIDER CONSULTANT DEPT. OF HEALTH & SOCIAL SERVICES Xxxxxxxx XxxxxxXxxx Xxxxxxx, Health Program Manager Alaska Psychiatric Institute II Division of Behavioral Health 0000 Xxxxx Xxxxxx X Xx Xxx 000 Anchorage, AK 99508 xxxxxxxx.xxxxxx@xxxxxx.xxx Xxxxxx Xxxxx, Xxxxxx Administrator 99503-5935 Ph. 000-000-0000 Fax 000-000-0000 Email: xxxx.xxxxxxx@xxxxxx.xxx Grants & Contracts Support Team Juneau, AK 99811-0650 Ph. 000-000-0000 Fax 000- 000-000-0000 Provider’s Consultant Federal Tax ID Number xxxxxx.xxxxx@xxxxxx.xxxEmail: xxx.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-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. The State is liable only , but must provide assistance in making arrangements for payment in accordance with the payment provision safe and orderly transfer of this Provider Agreement for relief nursing services rendered before the effective date of termination. This agreement shall be in effect clients and information to other Providers, as soon as the agreement is signed directed by both parties to the agreementDHSS. 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. PROVIDER DEPT. OF HEALTH Xxx Xxxxx - Grants & SOCIAL SERVICES Xxxxxxxx XxxxxxProcurement Chief Xxxxxxxxxx Xxxxx, Health Program Manager Alaska Psychiatric Institute II Senior and Disabilities Services, General Relief 0000 Xxxxx Xxxxxx Xx. Anchorage, AK 99508 xxxxxxxx.xxxxxx@xxxxxx.xxx Xxxxxx XxxxxPh. 000-000-0000 / xxxxxxxxxx.xxxxx@xxxxxx.xxx Xxxx Xxxxxxx, Xxxxxx Xxxxx Administrator III Grants & Contracts Support Team, SDS PO Box 110650 Juneau, AK 99811-0650 Ph. 000-000-0000 Fax 000- 000-0000 Provider’s Federal Tax ID Number xxxxxx.xxxxx@xxxxxx.xxx000-000-0000/xxxx.xxxxxxx@xxxxxx.xxx

TERMINATION OF AGREEMENT AND APPEALS. The Provider agrees to notify DHSS DOH 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-payment and automatic termination of the Agreement by DHSSDOH. 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 DOH may terminate this Agreement with 30 days’ notice. A Provider Consultant may also terminate the Agreement with 30 days’ notice. The State is liable only notice but must provide assistance in making arrangements for payment in accordance with the payment provision safe and orderly transfer of this Provider Agreement for relief nursing services rendered before the effective date of termination. This agreement shall be in effect clients and information to other Providers, as soon as the agreement is signed directed by both parties to the agreementDOH. This Agreement remains in force until the Provider or DHSS DOH 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. PROVIDER DEPT. OF HEALTH & SOCIAL SERVICES Xxxxxxxx Xxxxxx_ Signature of Authorized Provider Representative & Date Signature of DOH Representative & Date Xxxx Xxxxxxx, Health Program Manager Alaska Psychiatric Institute II Division of Behavioral Health 0000 Xxxxx Xxxxxx X Xx Xxx 000 Anchorage, AK 99508 xxxxxxxx.xxxxxx@xxxxxx.xxx Xxxxxx Xxxxx, Xxxxxx Administrator Grants & Contracts 99503-5935 Ph. 000-000-0000 Fax 000-000-0000 Email: xxxx.xxxxxxx@xxxxxx.xxx Juneau, AK 99811-0650 Ph. 000-000-0000 Fax 000- 000-000-0000 Provider’s Federal Tax ID Number Email: xxxxxx.xxxxx@xxxxxx.xxx.

TERMINATION OF AGREEMENT AND APPEALS. The Provider agrees to notify DHSS DOH 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-payment and automatic termination of the Agreement by DHSSDOH. 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 DOH may terminate this Agreement with 30 days’ notice. A Provider may also terminate the Agreement with 30 days’ notice. The State is liable only notice but must provide assistance in making arrangements for payment in accordance with the payment provision safe and orderly transfer of this Provider Agreement for relief nursing services rendered before the effective date of termination. This agreement shall be in effect clients and information to other Providers, as soon as the agreement is signed directed by both parties to the agreementXXX. This Agreement remains in force until the Provider or DHSS DOH 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. PROVIDER DEPT. DEPARTMENT OF HEALTH & SOCIAL SERVICES Xxxxxxxx Division of Behavioral Health 0000 X Xxxxxx, Program Manager Alaska Psychiatric Institute Xxxxx 000 Xxxxxxxxx, XX 00000 Ph. 000-000-0000 Xxxxx Xxxxxx Anchorage, AK 99508 xxxxxxxx.xxxxxx@xxxxxx.xxx Xxxxxx Xxxxx, Xxxxxx Administrator Ema il: xxxx.xxxxx@xxxxxx.xxx Direct Secure Message Email: xxx.xxx.xxxxxxxxxx@xxx.xxx.xxxxx xxx.xxx Grants & Contracts Support Team Juneau, AK 99811-0650 Ph. 000-000 000-0000 Fax 000- 000 000-0000 Provider’s Federal Tax ID IRIS Vendor Number xxxxxx.xxxxx@xxxxxx.xxxEma il: xxxxx.xxxxxxx@xxxxxx.xxx

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-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. The State is liable only , but must provide assistance in making arrangements for payment in accordance with the payment provision safe and orderly transfer of this Provider Agreement for relief nursing services rendered before the effective date of termination. This agreement shall be in effect clients and information to other Providers, as soon as the agreement is signed directed by both parties to the agreementDFCS. 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. PROVIDER DEPT. OF HEALTH FAMILY & SOCIAL COMMUNITY SERVICES Xxxxxxxx Xxxxxx, Program Manager Xxxxx Xxxxxxx Chief Financial Officer Alaska Psychiatric Institute 0000 Xxxxx Xxxxxx Anchorage, AK 99508 xxxxxxxx.xxxxxx@xxxxxx.xxx Xxxxxx Xxxxx, Xxxxxx Administrator Grants & Contracts Juneau, AK 99811-0650 Ph. xxxxx.xxxxxxx@xxxxxx.xxx Phone: (000-) 000-0000 Fax 000- Fax: (000) 000-0000 Provider’s Federal Tax ID Number xxxxxx.xxxxx@xxxxxx.xxxDSM: see subsection VI., above

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-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 written notice. A Provider may also terminate the Agreement with 30 days’ days written notice. The State is liable only , but must provide assistance in making arrangements for payment in accordance with the payment provision safe and orderly transfer of this Provider Agreement for relief nursing services rendered before the effective date of termination. This agreement shall be in effect clients and information to other Providers, as soon as the agreement is signed directed by both parties to the agreementDHSS. 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. PROVIDER DEPT. OF HEALTH & SOCIAL SERVICES Xxxxxxxx XxxxxxX. Xxxxx, Program Manager Alaska Psychiatric Institute Division of Public Assistance 0000 X Xxxxxx Xxxxx 000, Xxxxxxxxx XX 00000 Xxxxxxxx.Xxxxx@Xxxxxx.xxx Ph. 000-000-0000 Fax 000-000-0000 Xxxxxx AnchoragePlace, AK 99508 xxxxxxxx.xxxxxx@xxxxxx.xxx Xxxxxx Xxxxx, Xxxxxx Grants Administrator Grants & Contracts Support Team Juneau, AK 99811-0650 Ph. 000-000-0000 Fax 000- 000-0000 Provider’s Federal Tax ID Number xxxxxx.xxxxx@xxxxxx.xxxXxxxxx.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-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. The State is liable only notice but must provide assistance in making arrangements for payment in accordance with the payment provision safe and orderly transfer of this Provider Agreement for relief nursing services rendered before the effective date of termination. This agreement shall be in effect clients and information to other Providers, as soon as the agreement is signed directed by both parties to the agreementDHSS. 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 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. PROVIDER DEPT. OF HEALTH & SOCIAL SERVICES Xxxx Xxxxxxx-Xxxx Division of Behavioral Health 0000 X Xxxxxx Xxxxx 000 Anchorage, AK 99501 000-000-0000 Xxxx.xxxxxxx-xxxx@xxxxxx.xxx Xxxxxxxx Xxxxxx, Program Manager Alaska Psychiatric Institute 0000 Xxxxx Xxxxxx Anchorage, AK 99508 xxxxxxxx.xxxxxx@xxxxxx.xxx Xxxxxx Xxxxx, Xxxxxx Grants Administrator Grants & Contracts Support Team Juneau, AK 99811-0650 Ph. 000-000-0000 Fax 000- 000-0000 Provider’s Federal Tax ID IRIS Vendor Number xxxxxx.xxxxx@xxxxxx.xxxxxxxxxxx.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- 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. The State is liable only notice but must provide assistance in making arrangements for payment in accordance with the payment provision safe and orderly transfer of this Provider Agreement for relief nursing services rendered before the effective date of termination. This agreement shall be in effect clients and information to other Providers, as soon as the agreement is signed directed by both parties to the agreementDHSS. 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 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. PROVIDER DEPT. OF HEALTH & SOCIAL SERVICES Xxxx Xxxxxxxxxxx, FASD Program Manager Office of Substance Misuse & Addiction Prevention 0000 X Xxxxxx, Xxxxx 000 Anchorage, Alaska 99503 xxxx.xxxxxxxxxxx@xxxxxx.xxx Ph. 907.334-2673/ 000-000-0000 Cell Xxxxxxxx Xxxxxx, Program Manager Alaska Psychiatric Institute 0000 Xxxxx Xxxxxx Anchorage, AK 99508 xxxxxxxx.xxxxxx@xxxxxx.xxx Xxxxxx Xxxxx, Xxxxxx Grants Administrator Grants & Contracts Support Team Juneau, AK 99811-0650 Ph. 000-000-0000 / Fax 000- 000-0000 Provider’s Federal Tax ID IRIS Vendor Number xxxxxx.xxxxx@xxxxxx.xxxxxxxxxxx.xxxxxx@xxxxxx.xxx

TERMINATION OF AGREEMENT AND APPEALS. The Provider agrees to notify DHSS DOH 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-payment and automatic termination of the Agreement by DHSSDOH. 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 DOH may terminate this Agreement with 30 days’ notice. A Provider Consultant may also terminate the Agreement with 30 days’ notice. The State is liable only notice but must provide assistance in making arrangements for payment in accordance with the payment provision safe and orderly transfer of this Provider Agreement for relief nursing services rendered before the effective date of termination. This agreement shall be in effect clients and information to other Providers, as soon as the agreement is signed directed by both parties to the agreementDOH. This Agreement remains in force until the Provider or DHSS DOH 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. PROVIDER DEPT. DEPTARTMENT OF HEALTH & SOCIAL SERVICES Xxxxxxxx XxxxxxXxxx Xxxxxxx, Health Program Manager Alaska Psychiatric Institute 0000 Xxxxx Xxxxxx AnchorageII Division of Behavioral Health 3601 X Xx Xxx 000 Xxchorage, AK 99508 xxxxxxxx.xxxxxx@xxxxxx.xxx Xxxxxx Xxxxx, Xxxxxx Administrator 99503-5935 Ph. 000-000-0000 Fax 000-000-0000 Email: xxxx.xxxxxxx@xxxxxx.xxx Grants & Contracts Support Team Juneau, AK 99811-0650 Ph. 000-000-0000 Fax 000- 000-000-0000 Provider’s Federal Tax ID Number Email: xxxxxx.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- 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. The State is liable only , but must provide assistance in making arrangements for payment in accordance with the payment provision safe and orderly transfer of this Provider Agreement for relief nursing services rendered before the effective date of termination. This agreement shall be in effect clients and information to other Providers, as soon as the agreement is signed directed by both parties to the agreementDHSS. 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. PROVIDER DEPT. OF HEALTH & SOCIAL SERVICES Xxxxxxx Xxxxx, ASAP Program Manager Division of Behavioral Health 000 X. Xxxxxx/ASAP Anchorage, AK 99501 Ph. 000-000-0000/Fax907-264-0786 xxxx.xxxxx@xxxxxx.xxx Xxxxxxxx Xxxxxx, Program Manager Alaska Psychiatric Institute 0000 Xxxxx Xxxxxx Anchorage, AK 99508 xxxxxxxx.xxxxxx@xxxxxx.xxx Xxxxxx Xxxxx, Xxxxxx Grants Administrator Grants & Contracts Support Team Juneau, AK 99811-0650 Ph. 000-000-0000 Fax 000- 000-0000 Provider’s Federal Tax ID Number xxxxxx.xxxxx@xxxxxx.xxxxxxxxxxx.xxxxxx@xxxxxx.xxx