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. The Parties will collaborate in good faith to attempt to remedy any issues that might result in the termination 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. PROVIDER DEPT. OF HEALTH & SOCIAL SERVICES Xxxxxx Xxxxxx, Tribal Title IV-E Program Coordinator Office of Children’s Services P.O. Box 110630 Juneau, Alaska 00000-0000 Phone: 000-000-0000 Fax: 000-000-0000 Xxxxxx Xxxxxx-Xxxxxxxx, Grants Administrator P.O. Box 110650 Juneau, AK 00000-0000 Phone: 000-000-0000 Fax: 000-000-0000 Signed provider agreements and documents demonstrating provider eligibility must be emailed to: XXX.XXX.Xxxxxx.Xxxxxxxx.Xxxxxxxxxx@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. The Parties will collaborate in good faith to attempt to remedy any issues that might result in the termination of this Agreement. Notification of non-eligibility ineligibility 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 a decision to terminate a Provider Agreement under 7 AAC 81.200. All appeals Appeals will be conducted in accordance with Section 7AAC 7 AAC 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 and must provide assistance in making arrangements for safe and orderly transfer of clients and information to other Providers, Providers as directed by DHSSDFCS. This Agreement remains in force until the Provider or DHSS DFCS terminates the Agreement 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, its appendices, and its appendices and attachments. PROVIDER DEPT. OF HEALTH Signature of Authorized Provider Representative & SOCIAL SERVICES Xxxxxx Xxxxxx, Tribal Data Signature of DFCS Representative & Date Printed Name & Title IV-E Program Coordinator Office of Children’s Services P.O. Box 110630 Juneau, Alaska 00000-0000 Phone: 000-000-0000 Fax: 000-000-0000 Xxxxxx Xxxxxx-Provider Representative Xxxx Xxxxxxxx, Grants Administrator P.O. Division Operations Manager Provider Contact Xxxx Xxxxxxxx, Social Services Program Officer Provider Mailing Address Division of Juvenile Justice PO Box 110650 120650 Juneau, AK 00000-0000 Phone: (907) 465- Fax: (000-) 000-0000 FaxProvider Phone Number/Fax Number Xxxxxx.Xxxxxxxx0@xxxxxx.xxx Xxxxxxxxxx Xxxxxxx, Grants Administrator Provider Email Address Grants & Contracts Support Team PO Box 112650 Juneau, AK 99811-2650 Provider’s Federal Tax ID Number Phone: (000-) 000-0000 Signed provider agreements xxxxxxxxxx.xxxxxxx@xxxxxx.xxx Providers must identify the business entity type under which they are legally eligible to provide service and documents demonstrating provider eligibility intending to enter into this Provider Agreement. Confirm entity type below. Non-Profit Organization Incorporated in the State of Alaska, or tax exempt under 26 U.S.C. 501(c)(3) Private For-profit Business, licensed to do business in the State of Alaska Political Subdivision of the State (City, Borough or REAA) Alaska Native Entity, as defined in 7 AAC 78.950(1) All applicants under this provision must be emailed to: XXX.XXX.Xxxxxx.Xxxxxxxx.Xxxxxxxxxx@xxxxxx.xxxsubmit with their signed Agreement, a Waiver of Sovereign Immunity, using the form provided as Appendix G to 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. The Parties will collaborate in good faith to attempt to remedy any issues that might result in the termination 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 notice. A Provider may also terminate the Agreement with 30 days’ notice 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 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, Youth ISA Xxxxxxx.Xxxxx@xxxxxx.xxx (000) 000-0000 (000) 000-0000 (Fax) Direct Secure Message: akdhss.dbh xxxxxx@xxxxxx.xxxxxxxxx.xxx Xxx XxXxxxxxxx, Adult ISA Xxxxx.xxxxxxxxxx@xxxxxx.xxx (000) 000-0000 (000) 000-0000 (fax) Direct Secure Message: akdhss.dbh xxxxxxxxxxx@xxxxxx.xxxxxxxxx.xxx Division of Behavioral Health 0000 X Xxxxxx XxxxxxXxx 000 Anchorage, Tribal Title IV-E Program Coordinator Office of Children’s Services P.O. Box 110630 Juneau, Alaska AK 00000-0000 Phone: Grants & Contracts Support Team Juneau, AK 99811-0650 Ph. 000-000-0000 Fax: Fax 000-000-0000 Xxxxxx Xxxxxx-Xxxxxxxx, Grants Administrator P.O. Box 110650 Juneau, AK 00000-0000 Phone: 000-000-0000 Fax: 000-000-0000 Signed provider agreements and documents demonstrating provider eligibility must be emailed to: XXX.XXX.Xxxxxx.Xxxxxxxx.Xxxxxxxxxx@xxxxxx.xxx.Provider’s Federal Tax ID Number xxxxx.xxxxxxx@xxxxxx.xxx