FQHCs and RHCs Clause Samples

The 'FQHCs and RHCs' clause defines the specific terms and conditions that apply to Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) within a contract or agreement. It typically outlines how services provided by these entities are billed, reimbursed, or subject to special regulatory requirements, such as enhanced payment rates or reporting obligations. For example, the clause may specify that claims from FQHCs and RHCs are processed differently than those from other providers, or that certain compliance standards must be met. The core function of this clause is to ensure that the unique legal and financial considerations for FQHCs and RHCs are clearly addressed, reducing ambiguity and supporting compliance with federal and state regulations.
FQHCs and RHCs. The MCO will submit a quarterly data report of FQHC or RHC copayments for service dates on or after January 1, 2015 in accordance with section 3.7(C) below. In the event that a FQHC/RHC contacts the MCO or the STATE regarding payments made to the FQHC/RHC prior to January 1, 2015, but not included in any submitted report, the MCO shall review, and if appropriate, must submit the missing data. Within eight (8) business days of receipt of this report, the STATE shall provide the MCO a return file that contains incorrect data lines that cannot be read by the system and loaded. The MCO must review the data lines and correct appropriately. Corrected data lines must be resubmitted within thirty (30) days, and shall be reported separately as a corrected file. The MCO shall not resubmit data already submitted and accepted.
FQHCs and RHCs. The MCO shall provide to the STATE a quarterly report for the first quarter of Contract Year 2010, due no later than thirty (30) days following the end of the quarter. The report must identify MCO payments made to FQHCs and RHCs for all programs covered under this Contract. As of April 1st of Contract Year, reports shall be submitted monthly, with the first monthly report due no later than May 31, 2010. (1) The STATE will provide to the MCO no later than the third business day of each month a list of all Providers currently qualified to be designated FQHCs or RHCs. If a new list is not provided, the MCO shall use the prior monthly listing. Any new FQHC/RHC Providers identified after the third of the month will be added to the following monthly MCO report. (2) Pursuant to the State’s specifications in the document entitled “FQHC/RHC Payment Data Report,” MCO reports will be submitted no later than the last day of the following month. (3) Within eight (8) business days of receipt of this report, the STATE shall provide the MCO a return file that contains incorrect data lines that cannot be read by the system and loaded. The MCO must review the data lines and correct appropriately. Corrected data lines must be re-submitted with the next monthly report, and shall be reported separately as a corrected file. The MCO shall not re-submit data already submitted and accepted. (4) In the event that a FQHC/RHC contacts the MCO regarding payments made to the FQHC/RHC during the previous month, but not included in the submitted report, the MCO shall review, and if appropriate, must submit the missing data on the following monthly report.
FQHCs and RHCs. The MCO will submit a quarterly data report of FQHC or RHC copayments for service dates on or after January 1, 2015 in accordance with section 3.8(C) below. In the event that a FQHC/RHC contacts the MCO or the STATE regarding payments made to the FQHC/RHC prior to January 1, 2015, but not included in any submitted report, the MCO shall review, and if appropriate, must submit the missing data. Within eight (8) business days of receipt of this report, the STATE shall provide the MCO a return file that contains incorrect data lines that cannot be read by the system and loaded. The MCO must review the data lines and correct appropriately. Corrected data lines must be resubmitted within thirty (30) days, and shall be reported separately as a corrected file. The MCO shall not resubmit data already submitted and accepted. Payment for ad hoc Reporting. The STATE may require reimbursement at standard rates for ad hoc reports requested of the STATE. For the purposes of this section, “standard rates” means those listed in the STATE policy “DHS Policies and Procedures for Handling Protected Information: 2.60 Data Requests and Copy Costs” available at ▇▇▇▇://▇▇▇.▇▇▇.▇▇▇▇▇.▇▇.▇▇/id_017855. Reporting on MSHO Stakeholder Group. For the MCO’s local or regional stakeholder group (as required in section 7.4.4) the MCO will submit to the STATE twice per Contract Year, on or before June 15th and December 15th, documentation in the form of stakeholder meeting agendas and meeting minutes that demonstrate the MCO response to significant concerns raised by stakeholder group participants. The STATE shall provide the MCO with an electronic listing of all enrolled MHCP Providers and their NPI or UMPI numbers on a monthly basis. The MCO must update the Provider identification numbers by submitting, for Providers who are new to the MCO and do not already have a STATE Provider number (UMPI) or NPI, current complete demographic information about the Provider, on a form approved by the STATE. The MCO shall not require Providers to enroll as an MHCP FFS Provider. If a Provider will only be serving MCO Enrollees, the MCO shall follow the process established by the STATE for MCO-only Providers. Payment Review Information. The MCO shall identify aggregate payment information for specific Provider categories and assess the information as to how it compares to FFS payment information. As part of the assessment the MCO will also be expected to provide an explanation of the basis for how the Prov...
FQHCs and RHCs. In the event that a FQHC/RHC contacts the MCO or the STATE regarding payments made to the FQHC/RHC prior to January 1, 2015, but not included in any submitted report, the MCO shall review, and if appropriate, must submit the missing data. (1) Within eight (8) business days of receipt of this report, the STATE shall provide the MCO a return file that contains incorrect data lines that cannot be read by the system and loaded. The MCO must review the data lines and correct appropriately. Corrected data lines must be resubmitted within thirty (30) days, and shall be reported separately as a corrected file. The MCO shall not resubmit data already submitted and accepted.

Related to FQHCs and RHCs

  • Ambulance Escort Where a nurse is assigned to provide patient care for a patient in transit, the following provisions shall apply: i) Where a full-time nurse performs such duties during her or his regular shift, the full-time nurse shall be paid her or his regular rate of pay. Where a full-time nurse performs such duties outside her or his regular shift or on a day off, she or he shall be paid the appropriate overtime rate. ii) Where a part-time nurse performs such duties during an assigned shift, she or he shall be paid her or his regular rate of pay. Where a part-time nurse continues to perform such duties in excess of her or his assigned shift, she or he shall be paid the appropriate overtime rate. (b) Where such duties extend beyond the nurse's regular shift, the Hospital will not require the nurse to return to regular duties at the hospital without at least eight (8) hours of time off. Where such time off extends into the nurse's next regularly scheduled shift she or he will maintain her or his regular earnings for that full shift. (c) Hours spent between the time the nurse is relieved of patient care responsibilities and the time the nurse returns to the hospital or to such other location agreed upon between the Hospital and the nurse will be paid at straight time or at appropriate overtime rates, if applicable under Article 14. 01. It is understood that the nurse shall return to the hospital or to such other location agreed upon between the Hospital and the nurse at the earliest opportunity. Prior to the nurse's departure on escort duty, or at such other time as may be mutually agreed upon between the Hospital and the nurse, the Hospital will establish with the nurse arrangements for return travel. (d) The nurse shall be reimbursed for reasonable out of pocket expenses including room, board and return transportation and consideration will be given to any special circumstances not dealt with under the foregoing provisions. NOTE 1: (Note 1 applies to full-time nurses only) The Hospital agrees to continue to pay any greater monetary benefit for ambulance escort duty if such greater benefit has been paid by the Hospital immediately prior to this Agreement. This note applies at Hospitals where this superior condition exists as of December 14, 1987. NOTE 2: (Note 2 applies to part-time nurses only) The Hospital agrees to continue to pay any greater monetary benefit for ambulance escort duty if such greater benefit was paid by the Hospital under a Collective Agreement immediately prior to this Agreement. This note applies at Hospitals where this superior condition exists as of December 14, 1987.

  • Green Economy/Carbon Footprint a) The Supplier/Service Provider has in its bid provided Transnet with an understanding of the Supplier’s/Service Provider’s position with regard to issues such as waste disposal, recycling and energy conservation.

  • Contractors and Subcontractors Drug-Free Workplace Act of 1988 1) Publish and give a policy statement to all covered employees informing them that the unlawful manufacture, distribution, dispensation, possession or use of a controlled substance is prohibited in the covered workplace and specifying the actions that will be taken against employees who violate the policy. 2) Establish a drug-free awareness program to make employees aware of a) the dangers of drug abuse in the workplace; b) the policy of maintaining a drug-free workplace; c) any available drug counseling, rehabilitation, and employee assistance programs; and d) the penalties that may be imposed upon employees for drug abuse violations. 3) Notify employees that as a condition of employment on a federal contract or grant, the employee must a) abide by the terms of the policy statement; and b) notify the employer, within five (5) calendar days, if he or she is convicted of a criminal drug violation in the workplace. 4) Notify the contracting or granting agency within ten (10) days after receiving notice that a covered employee has been convicted of a criminal drug violation in the workplace. 5) Impose a penalty on or require satisfactory participation in a drug abuse assistance or rehabilitation program by any employee who is convicted of a reportable workplace drug conviction. 6) Make an ongoing, good faith effort to maintain a drug-free workplace by meeting the requirements of the act.

  • SUBCONTRACTORS AND SUPPLIERS The Commissioner reserves the right to reject any proposed Subcontractor or supplier for bona fide business reasons, including, but not limited to: the company failed to solicit New York State certified minority- and women-owned business enterprises as required in prior OGS Contracts; the fact that such Subcontractor or supplier is on the New York State Department of Labor’s list of companies with which New York State cannot do business; the Commissioner’s determination that the company is not qualified or is not responsible; or the fact that the company has previously provided unsatisfactory work or services.

  • Outpatient If you receive infusion therapy services in a hospital's outpatient unit, we cover the use of the treatment room, related supplies, and solutions. For prescription drug coverage, see Section 3.27