Back to Form 8-K
Exhibit 10.1
NON-INSTITUTIONAL
The
Provider agrees to participate in the Florida Medicaid program under the
following terms and conditions:
(1)
Discrimination.
The parties agree that the Agency for Health Care Administration (AHCA)
may make
payments for medical assistance and related services rendered to Medicaid
recipients only to a person or entity who has a provider agreement in effect
with AHCA; who is performing services or supplying goods in accordance
with
federal, state, and local law; and who agrees that no person shall, on
the
grounds of sex, handicap, race, color, national origin, other insurance,
or for
any other reason, be subjected to discrimination under any program or activity
for which the provider receives payment from AHCA.
(2)
Quality of
Service. The provider agrees that services or goods billed to the
Medicaid program must be medically necessary, of a quality comparable to
those
furnished by the provider's peers, and within the parameters permitted
by the
provider's license or certification. The provider further agrees to xxxx
only
for the services performed within the specialty or specialties designated
in the
provider application on file with AHCA. The services or goods must have
been
actually provided to eligible Medicaid recipients by the provider prior
to
submitting the claim.
(3)
Compliance.
The
provider agrees to comply with local, state, and federal laws, as well
as rules,
regulations, and statements of policy applicable to the Medicaid program,
including the Medicaid Provider Handbooks issued by AHCA.
(4)
Term and
signatures. The parties agree that this is a voluntary agreement
between AHCA and the provider, in which the provider agrees to furnish
services
or goods to Medicaid recipients. Provided that all requirements for enrollment
have been met, this agreement shall remain in effect for ten (10) years
from the
effective date of the provider's eligibility unless otherwise terminated.
This
agreement shall be renewable only by mutual consent. The provider understands
and agrees that no AHCA signature is required to make this agreement valid
and
enforceable.
(5)
Provider
Responsibilities. The Medicaid provider shall:
(a)
Possess at the time of the signing of the provider agreement, and maintain
in
good standing throughout the period of the agreement's effectiveness, a
valid
professional, occupational, facility or other license appropriate to the
services or goods being provided, as required by law.
(b)
Keep, maintain, and make available in a systematic and orderly manner all
medical and Medicaid-related records as AHCA requires for a period of at
least
five (5) years.
(c)
Safeguard the use and disclosure of information pertaining to current or
former Medicaid recipients as required by law.
(d)
Send, at the provider's expense, legible copies of all
Medicaid-related information to authorized state and federal employees,
including their agents. The provider shall give state and federal employees,
including their agents, access to all Medicaid patient records and to other
information that can not be separated from Medicaid-related
records.
(e)
Xxxx other insurers and third parties, including the Medicare program,
before billing the Medicaid program, if the recipient is eligible for payment
for health care or related services from another insurer or
person.
(f)
Refund any moneys received from the Medicaid program in error
or in excess of the amount to which the provider is entitled within 90
days of
receipt.
(g)
Be liable for and indemnify, defend, and hold AHCA harmless from all
claims, suits, judgments, or damages, including court costs and attorney's
fees,
arising out of the negligence or omissions of the provider in the course
of
providing services to a recipient or a person believed to be a recipient
to the
extent allowed by in and accordance with section 768.28, F.S. (2001), and
any
successor legislation.
Non-Institutional
MPA (Revised June 2008)
1
of
3
(h)
Accept Medicaid payment as payment in full, and not xxxx or collect from
the
recipient or the recipient's responsible party any additional amount except,
and
only to the extent AHCA permits or requires, co-payments, coinsurance,
or
deductibles to be paid by the recipient for the services or goods provided.
This
includes situations in which the provider's Medicare coinsurance claims
are
denied in accordance with Medicaid's payment.
(i)
Submit claims to AHCA electronically and to abide by the terms of the Electronic
Claims Submission Agreement.
(j)
Receive payment from AHCA by Electronic Funds Transfer (EFT). In the
event that AHCA erroneously deposits funds to the provider's account, then
the
provider agrees that AHCA may withdraw the funds from the
account.
(k)
Comply with all of the requirements of Section 6032 (Employee Education
About
False Claims Recovery) of the Deficit Reduction Act of 2005, if the provider
receives or earns five million dollars or greater annually under the State
plan.
(6)
AHCA
Responsibilities. The agency shall:
(a)
Make timely payment at the established rate for services or goods
furnished to a recipient by the provider upon receipt of a properly completed
claim.
(b)
Not seek repayment from the provider in any instance in which the Medicaid
overpayment is attributable solely to error in the state's determination
of
eligibility of a recipient.
(7)
Termination
For
Convenience. This agreement may be terminated without cause upon
thirty (30) days written notice by either party.
(8)
Ownership.
The
provider agrees to give AHCA sixty (60) days written notice before making
any
change in ownership of the entity named in the provider agreement as the
provider. The provider is required to maintain and make available to AHCA
Medicaid-related records that relate to the sale or transfer of the business
interest, practice, or facility in the same manner as though the sale or
transaction had not taken place, unless the provider enters into an agreement
with the purchaser of the business interest, practice, or facility to fulfill
this requirement.
(9)
Complete
Information. All statements and information furnished by the
prospective provider before signing the provider agreement shall b= true
and
complete. The filing of a materially incomplete, misleading or false application
will make the application and agreement voidable at the option of AHCA
and is
sufficient cause for immediate termination of the provider from the Medicaid
program and/or revocation of the provider number.
(10)
Interpretation.
When interpreting this agreement, it shall be neither construed against either
party nor considered which party prepared the agreement.
(11)
Governing
Law. This agreement shall be governed by and construed in
accordance with the laws of the State of Florida.
(12)
Amendment.
This
agreement, application and supporting documents constitute the full and
entire
agreement and understanding between the parties with respect to their
relationship. No amendment is effective unless it is in writing and signed
by
each party.
(13)
Severability.
If one or more of the provisions contained in this agreement or application
shall be invalid, illegal or unenforceable, the validity, legality and
enforceability of the remaining provisions shall not in any way be affected
or
impaired.
(14)
Agreement
Retention. The parties agree that AHCA may only retain the
signature page of this agreement, and that a copy of this standard provider
agreement will be maintained by the Director of Medicaid, or his designee,
and
may be reproduced as a duplicate original for any legal purpose and may
also be
entered into evidence as a business record.
(15)
Funding.
This contract is contingent upon the availability of funds.
(16)
Assignability.
The parties agree that neither may assign their rights under this agreement
without the express written consent of the other.
Non-Institutional
MPA (Revised June 2008)
2
of
3
The
parties concur that this agreement is a legal and binding document and
is fully
enforceable in a court of competent jurisdiction. The signatories hereto
represent and warrant that they have read the agreement, understand it,
and are
authorized to execute it on behalf of their respective principals or co-owners.
This agreement becomes null and void upon transfer of assets; change of
ownership; or upon discovery by AHCA of the submission of a materially
incomplete, misleading or false provider application unless subsequently
ratified or approved by AHCA.
All
shareholders (with five percent or greater ownership interest), principals,
partners and financial custodians are required to sign this agreement or,
a
chief executive officer (CEO) or president of an organization may sign
this
agreement in lieu of the above. Failure to sign the agreement will make
this
application, agreement and provider number voidable by AHCA.
IN
WITNESS WHEREOF, the undersigned have caused this agreement to be duly
executed
under the penalties of perjury, swear or affirm that the foregoing is true
and
correct.
|
Xxxxx
Xxxxxxxxx
|
President
and CEO
|
/s/
Xxxxx Xxxxxxxxx
|
4/1/09 | |||
|
(legibly
print name of signatory)
|
Title
|
Signature
|
Date
|
|||
|
(legibly
print name of signatory)
|
Title
|
Signature
|
Date
|
|||
|
(legibly
print name of signatory)
|
Title
|
Signature
|
Date
|
|||
|
(legibly
print name of signatory)
|
Title
|
Signature
|
Date
|
|||
|
(legibly
print name of signatory)
|
Title
|
Signature
|
Date
|
(USE
ADDITIONAL PAGES IF NECESSARY)
Please
complete the following information:
|
Provider’s
Name:
|
WellCare
of Florida, Inc.
|
|
DBA
Name:
|
N/A
|
|
Tax
ID:
|
00-0000000
|
|
Florida
Medicaid Provider ID:
|
015016900
|
|
(For
new applicants, the Medicaid ID will be entered by the fiscal agent
upon
approval of the application.)
|
|
Non-Institutional
MPA (Revised June 2008)
3
of
3
Non-Institutional
Provider Agreement Addendum
Medicare
Advantage Special Needs Plan (MA SNP)
Crossover
Providers
The
Medicare Advantage Special Needs Plan (MA SNP) Crossover Provider (provider)
agrees to the following terms and conditions:
Provider
Responsibilities
|
1.
|
The
provider shall possess at the time of the signing of the provider
agreement, and maintain in good standing throughout the period
of the
agreement's effectiveness, (1) a valid health maintenance organization
certificate of authority issued by the State of Florida Department
of
Financial Services Office of Insurance Regulation and (2) approval
from
the Centers for Medicare and Medicaid Services of qualifying
as a MA
SNP.
|
|
2.
|
The
provider agrees to facilitate an integrated source of coverage
for
Medicare Advantage Special Needs eligible members by encouraging
enrollment in the Medicare Advantage Special Needs Program offered
by the
member's plan.
|
|
3.
|
The
provider agrees to send to the state on a monthly basis a file
of their MA
SNP members who are enrolled in the MA SNP operated by the entity.
This
file is to be submitted no later than the twentieth of the month
of the
enrollment.
|
|
4.
|
The
provider agrees to accept the Agency's monthly per member payment
for MA
SNP members as payment in full for covered
services.
|
|
5.
|
The
provider agrees to require in its credentialing with network
providers an
agreement that they will not file additional claims for Medicaid
deductibles or co-payment reimbursement and that they will not
balance
xxxx the member covered under this
agreement.
|
|
6.
|
The
provider agrees to assure that network providers serving the
MA SNP
members will be informed and educated to not file claims for
Medicaid
payment for persons covered under this
agreement.
|
Payment
Provisions
|
1.
|
The
Agency will establish for each calendar year, through negotiation
with the
participating MA SNP providers and actuarial consultation, the
monthly per
member payment for MA SNP members. The MA SNP provider will be
notified
each year of the amount payable for the forthcoming calendar
year. For CY
2008, for MA SNP members residing in AHCA Areas Nine, Ten, or
Eleven, the
monthly per member payment will be $15.00. For CY 2008, for MA
SNP members
residing in AHCA Areas One, Two, Three, Four, Five, Six, Seven,
or Eight,
the monthly per member payment will be
$50.00.
|
|
2.
|
Any
claims for copayments and deductibles processed by Medicaid for
MA SNP
members shall be deducted from future per member
payments.
|
THE
SIGNATORY BELOW REPRESENTS THAT HE OR SHE HAS READ THE AGREEMENT, UNDERSTANDS
IT, AND IS AUTHORIZED TO EXECUTE IT ON BEHALF OF HIS OR HER RESPECTIVE
PRINCIPALS
IN
WITNESS WHEREOF, the undersigned representative of the above executed this
agreement under the penalty of perjury and now affirms that the foregoing
is
true and correct.
|
Xxxxx
Xxxxxxxxx
|
President
and CEO
|
/s/
Xxxxx Xxxxxxxxx
|
4/1/09 | |||
|
(legibly
print name of signatory)
|
Title
|
Signature
|
Date
|
Please
Complete The Following Information:
|
Provider’s
Name:
|
WellCare
of Florida, Inc.
|
|
DBA
Name:
|
N/A
|
|
Tax
ID:
|
00-0000000
|
|
Florida
Medicaid Provider ID:
|
015016900
|
|
(For
new applicants, the Medicaid ID will be entered by the fiscal agent
upon
approval of the application.)
|
|
MA
SNP MPA
Addendum 2008
