Provider Contract Requirements Sample Clauses

Provider Contract Requirements. The HMO is prohibited from requiring a provider or provider group to enter into an exclusive contracting arrangement with the HMO as a condition for participation in its Provider Network. The HMO’s contract with health care Providers must be in writing, must be in compliance with applicable federal and state laws and regulations, and must include minimum requirements specified in the Uniform Managed Care Contract Terms and Conditions (Attachment A) and HHSC’s Uniform Managed Care Manual. The HMO must submit model Provider contracts to HHSC for review during Readiness Review. HHSC retains the right to reject or require changes to any model Provider contract that does not comply with HMO Program requirements or the HHSC-HMO Contract.
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Provider Contract Requirements. The MCO is prohibited from requiring a provider or provider group to enter into an exclusive contracting arrangement with the MCO as a condition for Network participation. The MCO’s contract with health care Providers must be in writing, must be in compliance with applicable federal and state laws and regulations, and must include minimum requirements specified in Attachment A, "Uniform Managed Care Contract Terms and Conditions," and Uniform Managed Care Manual Chapter 8.1 “Provider Contract Checklist.” As described in Section 7, the MCO must submit model Provider contracts to HHSC for review during Readiness Review. The MCO must resubmit the model Provider contracts any time it makes substantive modifications to such agreements. HHSC retains the right to reject or require changes to any Provider contract that does not comply with MCO Program requirements or the HHSC-MCO Contract.
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Provider Contract Requirements. 1. The Health Plan shall comply with all Agency procedures for provider contract review and approval submission. a. All provider contracts must comply with 42 CFR 438.230, 42 CFR 455.104, 42 CFR 455.105, and 42 CFR 455.106. b. If the Health Plan is capitated, it shall ensure that all providers are eligible for participation in the Medicaid program. If a provider is currently suspended or involuntarily terminated from the Florida Medicaid program whether by contract or WellCare of Florida, Inc., Medicaid HMO Non-Reform Contract sanction, other than for purposes of inactivity, that provider is not considered an eligible Medicaid provider. If the Health Plan is not capitated, its providers shall be enrolled as Florida Medicaid providers. Suspension and termination are described further in Rule 59G-9.070, F.A.C. The Health Plan is responsible for this provision within five (5) calendar days after notification of a provider’s ineligibility to participate in the Medicaid program (by its own or outside source, by communication from the Agency, by listing in an Agency website or other forum designated by the Agency). c. The Health Plan shall not employ or contract with individuals on the state or federal exclusions list. d. No provider contract that the Health Plan enters into with respect to performance under this Contract shall in any way relieve the Health Plan of any responsibility for the provision of services or duties under this Contract. The Health Plan shall assure that all services and tasks related to the provider contract are performed in accordance with the terms of this Contract. The Health Plan shall identify in its provider contract any aspect of service that may be subcontracted by the provider. 2. All provider contracts and amendments executed by the Health Plan shall be in writing, signed, and dated by the Health Plan and the provider, and shall meet the following requirements: a. Prohibit the provider from seeking payment from the enrollee for any covered services provided to the enrollee within the terms of the Contract; b. Require the provider to look solely to the following for compensation for services rendered, with the exception of nominal cost sharing, pursuant to the Medicaid State Plan and the Florida Coverage and Limitations Handbooks: (1) If a capitated Health Plan, then to the capitated Health Plan for compensation; (2) If a FFS Health Plan, then to the Agency or its Agent, unless the service is one for which the Health Plan receive...
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Related to Provider Contract Requirements

  • Subcontract Requirements As required by Section 6.22(e)(5) of the Administrative Code, Contractor shall insert in every subcontract or other arrangement, which it may make for the performance of Covered Services under this Agreement, a provision that said subcontractor shall pay to all persons performing labor in connection with Covered Services under said subcontract or other arrangement not less than the highest general prevailing rate of wages as fixed and determined by the Board of Supervisors for such labor or services.

  • CONTRACT REQUIREMENTS a. NSF will exercise its responsibility for oversight and monitoring of procurements, contracts or other contractual arrangements for the purchase of materials and supplies, equipment or general support services under the award. The procedures set forth below shall be followed to ensure that performance, materials and services are obtained in an effective manner and in compliance with the provisions of applicable Federal statutes and executive orders. The awardee shall obtain prior written approval from the cognizant NSF Grants and Agreements Officer prior to entering into a contract if the amount exceeds $250,000 or other amount specifically identified in the agreement. Contracts clearly identified in the NSF award budget are considered approved at the time of award unless withheld by the Grants and Agreements Officer. Contracts must be clearly identified in the NSF award budget (on Line G6. Other) or by receiving written prior approval from the cognizant NSF Grants and Agreements Officer after an award is issued. The threshold noted above also applies to cumulative increases in the value of the contractual arrangement after initial NSF approval. The awardee shall not artificially segregate its procurements to lesser dollar amounts for the purpose of circumventing this requirement. A request to enter into a contract shall include, at a minimum: 1. Proposed contractual arrangement document; 2. A description of the supplies or services required; 3. Identification of the type of contract to be issued; 4. The proposed price and the recipient's cost or price analysis; 5. Identification of the proposed vendor, an explanation of why and how the proposed vendor was selected, and the degree of competition obtained; and 6. If the contract was awarded without competition, the memorandum shall include a detailed justification.

  • Support Requirements If there is a dispute between the awarded vendor and TIPS Member, TIPS or its representatives may assist, at TIPS sole discretion, in conflict resolution or third party (mandatory mediation), if requested by either party. TIPS, or its representatives, reserves the right to inspect any project and audit the awarded vendors TIPS project files, documentation and correspondence. TIPS Members stand in the place of TIPS as related to this agreement and have the same access to the proposal information and all related documents. TIPS Members have all the same rights under the awarded Agreement as TIPS.

  • Procurement Requirements If the Sponsor has, or is required to have, a procurement process that follows applicable state and/or federal law or procurement rules and principles, it must be followed, documented, and retained. If no such process exists, the Sponsor must follow these minimum procedures: 1) Publish a notice to the public requesting bids/proposals for the project; 2) Specify in the notice the date for submittal of bids/proposals; 3) Specify in the notice the general procedure and criteria for selection; and 4) Sponsor must contract or hire from within its bid pool. If bids are unacceptable the process needs to be repeated until a suitable bid is selected. 5) Comply with the same legal standards regarding unlawful discrimination based upon race, gender, ethnicity, sex, or sex-orientation that are applicable to state agencies in selecting a bidder or proposer. Alternatively, Sponsor may choose a bid from a bidding cooperative if authorized to do so. This procedure creates no rights for the benefit of third parties, including any proposers, and may not be enforced or subject to review of any kind or manner by any entity other than the RCO. Sponsors may be required to certify to the RCO that they have followed any applicable state and/or federal procedures or the above minimum procedure where state or federal procedures do not apply.

  • Match Requirements There is no match required on the part of the Grantee under this Agreement.