Common use of Written Agreements, Specific Requirements Clause in Contracts

Written Agreements, Specific Requirements. (A) Each of the Contractor’s Subcontracts shall contain the following: (1) A specific description of the activities, service or responsibility being delegated to the Subcontractor; (2) A provision outlining Contractor’s ability to revoke delegation or impose other sanctions if the Subcontractor’s performance is inadequate; (3) A provision stating that if the Subcontractor becomes insolvent or bankrupt Enrollees shall not be liable for the debt of the Subcontractor; (4) A provision stating that the Subcontractor, acting within the lawful scope of his or her practice, shall not be prohibited from advising or advocating on behalf of an Enrollee who is his or her patient for the following: (i) The Enrollee’s health status, medical care, or treatment options, including any alternative treatment that may be self-administered; (ii) Any information the Enrollee needs in order to decide among all relevant treatment options; (iii) The risks, benefits, and consequences of treatment or non-treatment; and (iv) The Enrollee’s right to participate in decisions regarding his or her health care, including the right to refuse treatment, and to express preferences about future treatment decisions; and (5) Adequate information about the Grievance, Appeal, and State fair hearing procedures and timelines so that the Provider can comply with the Grievance and Appeals Systems requirements including: (i) The Enrollee’s right to a State Fair Hearing, how to obtain a hearing, and representation rules at a hearing; (ii) The Enrollee’s right to file Grievances and Appeals; (iii) The requirements and timeframes for filing a Grievance or Appeal; (iv) The availability of assistance in the filling process; (v) The toll-free numbers that the Enrollee can use to file a Grievance or Appeal by phone; (vi) The fact that, when requested by the Enrollee, disputed services will continue if the Enrollee files an Appeal or request a State fair hearing within the timeframes specified for filing, and the Enrollee may be required to pay the cost of disputed services furnished while the Appeal is pending if the final decision is adverse to the Enrollee; and (vii) Any State-determined Provider Appeal rights to challenge the failure of the Contractor to cover a service. (6) a requirement that the Subcontractor comply with the requirements of 42 CFR Part 438, to the extent they apply.

Written Agreements, Specific Requirements. (A) Each of the Contractor’s Subcontracts shall contain the following: (1) A specific description of the activities, service or responsibility being delegated to the Subcontractor; (2) A provision outlining Contractor’s ability to revoke delegation or impose other sanctions if the Subcontractor’s performance is inadequate; (3) A provision stating that if the Subcontractor becomes insolvent or bankrupt Enrollees shall not be liable for the debt of the Subcontractor; (4) A provision stating that the Subcontractor, acting within the lawful scope of his or her practice, shall not be prohibited from advising or advocating on behalf of an Enrollee who is his or her patient for the following: (i) The Enrollee’s health status, medical care, or treatment options, including any alternative treatment that may be self-administered; (ii) Any information the Enrollee needs in order to decide among all relevant treatment options; (iii) The risks, benefits, and consequences of treatment or non-treatment; and (iv) The Enrollee’s right to participate in decisions regarding his or her health care, including the right to refuse treatment, and to express preferences about future treatment decisions; and (5) Adequate information about the Grievance, Appeal, and State fair hearing procedures and timelines so that the Provider can comply with the Grievance and Appeals Systems requirements including: (i) The Enrollee’s right to a State Fair Hearing, how to obtain a hearing, and representation rules at a hearing; (ii) The Enrollee’s right to file Grievances and Appeals; (iii) The requirements and timeframes for filing a Grievance or Appeal; (iv) The availability of assistance in the filling process; (v) The toll-free numbers that the Enrollee can use to file a Grievance or Appeal by phone; (vi) The fact that, when requested by the Enrollee, disputed services will continue if the Enrollee files an Appeal or request a State fair hearing within the timeframes specified for filing, and the Enrollee may be required to pay the cost of disputed services furnished while the Appeal is pending if the final decision is adverse to the Enrollee; and (vii) Any State-determined Provider Appeal rights to challenge the failure of the Contractor to cover a service. (6) a requirement that the Subcontractor comply with the requirements of 42 CFR Part 438, to the extent they apply.