Common use of MA Organization Accountability; Delegated Activities Clause in Contracts

MA Organization Accountability; Delegated Activities. Provider acknowledges and agrees that MA Organization oversees and is accountable to CMS for any functions and responsibilities described in the CMS Contract and applicable Medicare Advantage regulations, including those that Company may sub- delegate to Provider. If Company has sub-delegated any of MA Organization’s functions and responsibilities under the CMS Contract to Provider pursuant to the Agreement, the following shall apply in addition to the other provisions of this Appendix: (a) Provider shall perform those delegated activities specified in the Agreement, if any, and shall comply with any reporting responsibilities as set forth in the Agreement. (b) If Company has delegated to Provider any activities related to the credentialing of health care providers, Provider must comply with all applicable CMS requirements for credentialing, including but not limited to the requirement that the credentials of medical professionals must either be reviewed by MA Organization or its designee, or the credentialing process must be reviewed, pre-approved and audited on an ongoing basis by MA Organization or its designee. (c) If Company has delegated to Provider the selection of health care providers to be participating providers in the MA Organization’s Medicare Advantage network, MA Organization retains the right to approve, suspend or terminate the participation status of such health care providers. (d) Provider acknowledges that MA Organization or its designee shall monitor Provider’s performance of any delegated activities on an ongoing basis. If MA Organization or CMS determines that Provider has not performed satisfactorily, MA Organization may revoke any or all delegated activities and reporting requirements. Provider shall cooperate with MA Organization and Company regarding the transition of any delegated activities or reporting requirements that have been revoked by MA Organization.

MA Organization Accountability; Delegated Activities. Provider acknowledges and agrees that MA Organization oversees and is accountable to CMS for any functions and responsibilities described in the CMS Contract and applicable Medicare Advantage regulations, including those that Company may sub- sub-delegate to Provider. If Company has sub-delegated any of MA Organization’s functions and responsibilities under the CMS Contract to Provider pursuant to the Agreement, the following shall apply in addition to the other provisions of this Appendix: (a) Provider shall perform those delegated activities specified in the Agreement, if any, and shall comply with any reporting responsibilities as set forth in the Agreement. (b) If Company has delegated to Provider any activities related to the credentialing of health care providers, Provider must comply with all applicable CMS requirements for credentialing, including but not limited to the requirement that the credentials of medical professionals must either be reviewed by MA Organization or its designee, or the credentialing process must be reviewed, pre-approved and audited on an ongoing basis by MA Organization or its designee. (c) If Company has delegated to Provider the selection of health care providers to be participating providers in the MA Organization’s Medicare Advantage network, MA Organization retains the right to approve, suspend or terminate the participation status of such health care providers. (d) Provider acknowledges that MA Organization or its designee shall monitor Provider’s performance of any delegated activities on an ongoing basis. If MA Organization or CMS determines that Provider has not performed satisfactorily, MA Organization may revoke any or all delegated activities and reporting requirements. Provider shall cooperate with MA Organization and Company regarding the transition of any delegated activities or reporting requirements that have been revoked by MA Organization.

MA Organization Accountability; Delegated Activities. Provider Subcontractor acknowledges and agrees that MA Organization oversees and is accountable to CMS for any functions and responsibilities described in the CMS Contract and applicable Medicare Advantage regulations, including those that Company may sub- delegate MA Organization has delegated to Provider. If Company has sub-delegated any of MA Organization’s functions and responsibilities Subcontractor under the CMS Contract to Provider pursuant to the Agreement, the following shall apply in . In addition to the other provisions of this Appendix, the following shall apply with respect to any functions and responsibilities under the CMS Contract that MA Organization has delegated to Subcontractor pursuant to the Agreement: (a) Provider Subcontractor shall perform or arrange for the provision of those delegated activities specified set forth in the Agreement, if any, and . (b) Subcontractor shall comply with any reporting responsibilities as set forth in the Agreement. (bc) If Company MA Organization has delegated to Provider Subcontractor any activities related to the credentialing of health care providers, Provider Subcontractor must comply with all applicable CMS requirements for credentialing, including but not limited to the requirement that the credentials of medical professionals must either be reviewed by MA Organization or its designeeOrganization, or the credentialing process must be reviewed, pre-approved preapproved, and audited on an ongoing basis by MA Organization or its designeeOrganization. (cd) If Company MA Organization has delegated to Provider Subcontractor the selection of health care providers to be participating providers in the MA Organization’s Medicare Advantage network, or the selection of contractors or subcontractors to perform services under the CMS Contract, MA Organization retains the right to approve, suspend or terminate the participation status of such health care providersproviders and the agreements with such contractors or subcontractors. (de) Provider Subcontractor acknowledges that MA Organization or its designee shall monitor ProviderSubcontractor’s performance of any delegated activities on an ongoing basis. Such monitoring activities may include site visits and periodic audits. If CMS or MA Organization or CMS determines that Provider Subcontractor has not performed satisfactorily, or has failed to meet all reporting and disclosure requirements in a timely manner, MA Organization may revoke any or all of the delegated activities and reporting requirements. Provider Subcontractor shall cooperate with MA Organization and Company regarding the transition of any delegated activities or reporting requirements that have been revoked by MA Organization.

MA Organization Accountability; Delegated Activities. Provider Vendor acknowledges and agrees that MA Organization oversees and is accountable to CMS for any functions and responsibilities described in the CMS Contract and applicable Medicare Advantage regulations, including those that Company may sub- delegate MA Organization has delegated to ProviderVendor under the Agreement. If Company has sub-delegated In addition to the other provisions of this Exhibit, the following shall apply with respect to any of MA Organization’s functions and responsibilities under the CMS Contract that MA Organization has delegated to Provider Vendor pursuant to the Agreement, the following shall apply in addition to the other provisions of this Appendix: (a) Provider Vendor shall perform or arrange for the provision of those delegated activities specified set forth in the Agreement, if any, and . (b) Vendor shall comply with any reporting responsibilities as set forth in the Agreement. (bc) If Company MA Organization has delegated to Provider Vendor any activities related to the credentialing of health care providers, Provider Vendor must comply with all applicable CMS requirements for credentialing, including but not limited to the requirement that the credentials of medical professionals must either be reviewed by MA Organization or its designeeOrganization, or the credentialing process must be reviewed, pre-approved preapproved, and audited on an ongoing basis by MA Organization or its designeeOrganization. (cd) If Company MA Organization has delegated to Provider Vendor the selection of health care providers to be participating providers in the MA Organization’s Medicare Advantage network, or the selection of contractors or subcontractors to perform services under the CMS Contract, MA Organization retains the right to approve, suspend or terminate the participation status of such health care providersproviders and the agreements with such contractors or subcontractors. (de) Provider Vendor acknowledges that MA Organization or its designee shall monitor ProviderVendor’s performance of any delegated activities on an ongoing basis. Such monitoring activities may include site visits and periodic audits. If CMS or MA Organization or CMS determines that Provider Vendor has not performed satisfactorily, or has failed to meet all reporting and disclosure requirements in a timely manner, MA Organization may revoke any or all of the delegated activities and reporting requirements. Provider Vendor shall cooperate with MA Organization and Company regarding the transition of any delegated activities or reporting requirements that have been revoked by MA Organization.

MA Organization Accountability; Delegated Activities. Provider acknowledges and agrees that MA Organization oversees and is accountable to CMS for any functions and responsibilities described in the CMS Contract and applicable Medicare Advantage regulations, including those that Company MA Organization may sub- delegate to ProviderProvider or others. If Company MA Organization has sub-delegated any of MA Organization’s its functions and responsibilities under the CMS Contract to Provider pursuant to the Agreement, the following shall apply in addition to the other provisions of this Appendix: (a) Provider shall perform those delegated activities specified in the Agreement, if any, and shall comply with any reporting responsibilities as set forth in the Agreement. (b) If Company MA Organization has delegated to Provider any activities related to the credentialing of health care providers, Provider must comply with all applicable CMS requirements for credentialingcredentialing including, including but not limited to to, the requirement that the credentials of medical professionals must either be reviewed by MA Organization or its designeeOrganization, or the credentialing process must be reviewed, pre-approved approved, and audited on an ongoing basis by MA Organization or its designeeOrganization. (c) If Company MA Organization has delegated to Provider the selection of health care providers to be participating providers in the MA Organization’s Medicare Advantage network, MA Organization retains the right to approve, suspend suspend, or terminate the participation status of such health care providers. (d) Provider acknowledges that MA Organization or its designee shall monitor Provider’s performance of any delegated activities on an ongoing basis. If MA Organization or CMS determines that Provider has not performed satisfactorily, MA Organization may revoke any or all delegated activities and reporting requirements. Provider shall cooperate with MA Organization and Company regarding the transition of any delegated activities or reporting requirements that have been revoked by MA Organization.