Subcontract Requirements. Subcontracts between the Construction Manager and Subcontractors for construction work for the Project shall be in accordance with the provisions set forth below, unless otherwise authorized in a written directive from the Director. (a) Such subcontracts shall require that all labor performed and all material furnished thereunder shall strictly comply with all requirements of this Agreement. (b) Each such subcontract shall incorporate the material terms of this Agreement, including all addenda and appendices to it, and the DDCM Safety Requirements. Such subcontracts shall contain provisions approved in advance by the Director regarding, at least: (1) time for completion; (2) assessment of liquidated damages, (3) warranties and/or guarantees, (4) the provision required hereunder pertaining to the resolution of disputes related to this Agreement, (5) M/WBE compliance, and (6) compliance with anti-discrimination provisions. (c) Each such subcontract shall require that the Subcontractor who is party to it provide performance and payment bonds, each of which shall be in an amount equal to 100% of the subcontract price, and shall name the Construction Manager as obligee thereunder. Such bonds shall be provided by a surety company licensed and authorized to do business in the State of New York. Such bonds shall be identical in all respects to the form of bonds attached hereto as Exhibit E, with no variations, additions, or deletions to such form of bonds. Premiums for required bonds must be included in the Subcontractor's bid price. The Subcontractor shall be required to submit two (2) originals of such bonds, one of which shall be submitted to CUCF by the Construction Manager immediately after receipt. With respect to performance and payment bonds submitted by Subcontractors hereunder, the Construction Manager agrees, immediately upon receipt of the bonds, to execute an irrevocable assignment in accordance with the form of assignment attached hereto as Exhibit F. The Construction Manager shall submit such executed assignment to CUCF at the time it submits the original bonds. As additional security for the faithful performance of such subcontracts, the Construction Manager shall deduct and retain from all subcontractor progress payments five percent (5%) of the amount certified to be due thereunder. (d) Each such subcontract shall require that the Subcontractor carry the types and amounts, proportionate to its subcontract, of insurance set forth in this Agreement and Appendix I hereof. All required policies shall be in accordance with the terms and conditions set forth in this Agreement. Proof of insurance shall be provided to CUCF in accordance with this Agreement. (e) Each such subcontract shall contain the provisions set forth in the following articles of this Agreement, and shall require the Subcontractor’s compliance with the same. (1) Article 10.4 (concerning substantial completion); (2) Article 10.5 (concerning damages for delay and extensions of time); (3) Article 10.6 (concerning payment) (4) Article 28 (concerning method of payment for Extra Work); (5) Article 29 (concerning the Resolution of Disputes); (6) Article 31 (concerning omitted work); (7) Article 38 (concerning Labor Law Requirements); (8) Article 39 (concerning Payroll Reports); (9) Article 42 (concerning method of payment and retained percentages); (10) Article 41 (concerning Noise Control Code Provisions); (11) Article 45 (concerning termination without cause); (12) Article 46 (concerning termination for cause); (13) Article 49 (concerning Supplies, Labor, Services, Materials, and Tax Exemption) (14) Article 51 (concerning Locally Based Enterprise Program); (15) Article 65 (concerning Ultra Low Sulfur Diesel Fuel) (16) Article 66 (concerning Ultra Low Sulfur Diesel Fuel - Consolidated Construction Act); and (17) Article 68 (concerning Participation by Minority-Owned and Women-Owned Business Enterprises). (f) Each such subcontract shall contain the same terms and conditions with respect to damage for delay, and not less than the following: The [name of the Subcontractor] agrees to make no claim for damages for delay in the performance of this Agreement occasioned by any act or omission by CUCF or by any of its representatives, and agrees that for all delays it shall be compensated fully by an extension of time to complete performance of the work, as provided herein. (g) In removing all ambiguity concerning the resolution of every dispute between the Construction Manager and its Subcontractors related to the Project, each such subcontract shall contain the provision regarding the resolution of disputes set forth at Article 29 hereof, including, without limitation, the provision regarding the appeal from CUCF decisions as set forth at Article 29 hereof; such provisions shall apply to every dispute between the Subcontractor and the Construction Manager related to the Project. Excluding decisions that are the result of this dispute resolution process and are disputed by the Construction Manager or its Subcontractor, which the process requires to be appealed otherwise, either the Construction Manager or a Subcontractor must commence the resolution of a dispute pursuant to the provisions of this Article upon written notice to the other and to CUCF that such dispute will be resolved by CUCF. (h) Such subcontracts shall require that the Subcontractor agree not to make any claim against CUCF, its officers, agents or employees, by reason of such subcontract or any acts or omissions of the Construction Manager; provided however, such restrictions shall not apply to (1) demands filed by Subcontractors pursuant to Article 10.6 hereof, or (2) disputes submitted by Subcontractors pursuant to dispute resolution provisions contained in the subcontract, as described in paragraph 10.2.2(g). (i) Such subcontracts shall stipulate that the Subcontractor, without any further notification or other process, give its unconditional consent for its insurance carrier to release directly to CUCF documentation verifying its actual rate for workers’ compensation insurance.
Appears in 2 contracts
Sources: Construction Management/Build Services Agreement, Construction Management/Build Services Agreement
Subcontract Requirements. Subcontracts between All subcontracts executed by the Construction Manager Contractor pursuant to this section shall, at a minimum, include the requirements listed below. No other terms or conditions agreed to by the Contractor and Subcontractors subcontractor shall negate or supersede the following requirements. All subcontracts must:
5.1.1 Be in writing and signed by the Contractor and subcontractor;
5.1.2 Specify the effective dates of the subcontractor agreement;
5.1.3 Specify that the subcontractor agreement and its appendices contain all the terms and conditions agreed upon by the parties;
5.1.4 Require that no modification or change of any provision of the subcontract shall be made unless such modification is incorporated and attached as a written amendment to the subcontract and signed by the parties;
5.1.5 Assure that the subcontractor shall not enter into any subsequent agreements or subcontracts for construction any of the work for contemplated under the Project shall subcontractor agreement without the Contractor’s approval;
5.1.6 Specify that the services covered by the subcontractor agreement must be in accordance with the provisions set forth below, unless otherwise authorized in a written directive from the Director.
(a) Such subcontracts shall SC Title XXI State Plan and require that the subcontractor shall provide these services to members through the last day of the month that the subcontract is in effect. All final benefit determinations are within the sole and exclusive authority of SCDHHS or its designee;
5.1.7 Specify that the subcontractor may not refuse to provide medically necessary or covered preventive services to members covered under this Contract for non-medical reasons;
5.1.8 Require that the subcontractor be currently licensed and/or certified under applicable state and federal statutes and regulations and maintain throughout the term of the subcontract all labor performed necessary licenses, certifications, registrations and permits as are required to provide the health care services and/or other related activities delegated by the Contractor;
5.1.9 Specify the amount, duration and scope of services to be provided by the subcontractor;
5.1.10 Provide that emergency services be rendered without the requirement of prior authorization of any kind;
5.1.11 Require that if the subcontractor performs laboratory services, the subcontractor must meet all applicable state and federal requirements;
5.1.12 Require that an adequate record system be maintained for recording services, service providers, charges, dates and all material furnished thereunder other commonly accepted information elements for services rendered to members pursuant to the agreement (including but not limited to such records as are necessary for the evaluation of the quality, appropriateness, and timeliness of services performed under this Contract). Members and their representatives shall strictly comply with all requirements be given access to and can request copies of this Agreementthe members’ medical records, to the extent and in the manner provided by S.C. Code ▇▇▇. §▇▇-▇▇▇-▇▇ et seq., (Supp. 2000, as amended) subject to reasonable charges;
(b) Each such subcontract shall incorporate 5.1.13 Provide that SCDHHS, the material terms HHS, CMS, the Office of this AgreementInspector General, including all addenda and appendices to itthe State Comptroller, the State Auditor's Office, and the DDCM Safety Requirements. Such subcontracts South Carolina Attorney General's Office shall contain provisions approved in advance have the right to evaluate, through audits, inspection, or other means, whether announced or unannounced, any records pertinent to this Contract including those pertaining to quality, appropriateness and timeliness of services and the timeliness and accuracy of encounter data and practitioner claims submitted by the Director regardingContractor. The subcontractor shall cooperate with these evaluations and inspections;
5.1.14 Whether announced or unannounced, provide for the participation and cooperation in any internal and external quality assessment review, utilization management, and grievance procedures established by the Contractor and/or SCDHHS or its designee;
5.1.15 Specify that the Contractor shall monitor the quality of services delivered under the agreement and initiate a plan of correction where necessary to improve quality of care, in accordance with that level of care which is recognized as acceptable professional practice in the respective community in which the Contractor/subcontractor practices and/or the standards established by SCDHHS or its designee;
5.1.16 Require that the subcontractor comply with any plan of correction initiated by the Contractor and/or required by SCDHHS;
5.1.17 Provide for submission of all reports and clinical information required by the Contractor, including well child care (if applicable);
5.1.18 Require safeguarding of information about members according to applicable state and federal laws and regulations and as described in §13.20 and §13.28 of this Contract;
5.1.19 Provide the name and address of the official payee to whom payment shall be made;
5.1.20 Make full disclosure of the method and amount of compensation or other consideration to be received from the Contractor;
5.1.21 Provide for prompt submission of information needed to make payment;
5.1.22 Provide that the Contractor shall pay 90% of all clean claims from practitioners, either in individual or group practice or who practice in shared health facilities, within thirty (30) days of the date of receipt. The Contractor shall pay 99% of all clean claims from practitioners, either in individual or group practice or who practice in shared health facilities, within ninety (90) days of the date of receipt. The date of receipt is the date the Contractor receives the claim, as indicated by its data stamp on the claim. The date of payment is the date of the check or other form of payment. The MCO and its providers may, by mutual agreement, establish an alternative payment schedule. Any alternative schedule must be stipulated in the Contract;
5.1.23 Provide that subcontractors must submit all claims for payment no later than twelve (12) months from the date of service;
5.1.24 Specify that the subcontractor shall accept payment made by the Contractor as payment-in-full for covered services provided and shall not solicit or accept any surety or guarantee of payment from the member. Member shall include the patient, parent(s), guardian, spouse or any other person legally responsible for the member being served;
5.1.25 Specify that at least: (1) time for completion; (2) assessment all times during the term of liquidated damagesthe agreement, (3) warranties and/or guaranteesthe subcontractor shall indemnify and hold SCDHHS harmless from all claims, (4) the provision required hereunder pertaining losses, or suits relating to activities undertaken pursuant to the resolution Contract between SCDHHS and the Contractor, unless the subcontractor is a governmental entity. For subcontractors that are not governmental entities, the indemnification may be accomplished by incorporating §13.25 of disputes related this Contract in its entirety in the subcontractor’s agreement or by use of other language developed by the Contractor and approved by SCDHHS. For governmental entities, the liability protection may be accomplished by incorporating language developed by SCDHHS;
5.1.26 Require the subcontractor to this Agreement, (5) M/WBE compliance, secure all necessary liability and (6) compliance with anti-discrimination provisions.
(c) Each malpractice insurance coverage as is necessary to adequately protect the plan's members and the Contractor under the agreement. The subcontractor shall provide such subcontract shall require that insurance coverage at all times during the Subcontractor who is party to it provide performance agreement and payment bonds, each of which shall be in an amount equal to 100% upon execution of the subcontract priceagreement, shall furnish the Contractor with written verification of the existence of such coverage;
5.1.27 Specify that the subcontractor agrees to recognize and abide by all state and federal laws, regulations and guidelines applicable to the provision of services under the Program;
5.1.28 Provide that the agreement incorporates by reference all applicable federal and state laws or regulations, and that revisions of such laws or regulations shall name automatically be incorporated into the Construction Manager agreement as obligee thereunderthey become effective. Such bonds In the event that changes in the agreement as a result of revisions and applicable federal or state law materially affect the position of either party, the Contractor and subcontractor agree to negotiate such further amendments as may be necessary to correct any inequities;
5.1.29 Specify procedures and criteria for any alterations, variations, modifications, waivers, extensions of the agreement termination date, or early termination of the agreement and that such change shall only be valid when reduced to writing, duly signed and attached to the original of the agreement;
5.1.30 Specify that the Contractor and subcontractor recognize that in the event of termination of this Contract between the Contractor and SCDHHS for any of the reasons described in this Contract, the Contractor shall immediately make available to SCDHHS, or its designated representative, in a usable form, any and all records, whether medical or financial, related to the Contractor's and subcontractor's activities undertaken pursuant to the Contractor/subcontractor agreement. The provision of such records shall be provided by a surety company licensed at no expense to SCDHHS;
5.1.31 Provide that the Contractor and authorized to do business in the State of New York. Such bonds subcontractor shall be identical in all respects to responsible for resolving any disputes that may arise between the form of bonds attached hereto as Exhibit E, with no variations, additions, or deletions to such form of bonds. Premiums for required bonds must be included in the Subcontractor's bid price. The Subcontractor shall be required to submit two (2) originals parties, and that all subcontracts must specify that no dispute shall disrupt or interfere with the provisions of such bonds, one services to the member including continuity of which care should the subcontract be terminated;
5.1.32 Include a conflict of interest clause as stated in §13.33 of this Contract between the Contractor and SCDHHS;
5.1.33 Specify that the subcontractor must adhere to the Quality Assessment Performance Improvement and Utilization Management requirements as outlined in the Policy and Procedure Guide. The QAPI and UM requirements shall be submitted to CUCF by the Construction Manager immediately after receipt. With respect to performance and payment bonds submitted by Subcontractors hereunder, the Construction Manager agrees, immediately upon receipt included as part of the bondssubcontract between the Contractor and the subcontractor;
5.1.34 Provide that all subcontractors shall give the Contractor immediate notification in writing by certified mail of any administrative legal action or complaint filed and prompt notice of any claim made against the subcontractor by a subcontractor, or a member which may result in litigation related in any way to execute an irrevocable assignment this Contract with SCDHHS. The Contractor shall assure that all responsibilities related to the subcontract are performed in accordance with the form terms of assignment attached hereto as Exhibit F. The Construction Manager shall submit such executed assignment to CUCF at the time it submits the original bonds. As additional security this Contract;
5.1.35 Contain no provision which provides incentives, monetary or otherwise, for the faithful performance withholding of such subcontractsmedically necessary care. See the Policy and Procedure Guide, Incentive Plans;
5.1.36 Specify that the Construction Manager subcontractor shall deduct and retain from all subcontractor progress payments five percent (5%) not assign any of its duties and/or responsibilities under this Contract without the prior written consent of the amount certified to be due thereunder.Contractor;
(d) Each such subcontract shall 5.1.37 For any hospital subcontract, require that the Subcontractor carry hospitals notify the types Contractor and amountsSCDHHS of the births when the mother is a member of the Contractor's plan. The subcontract shall also specify that the hospital is responsible for completing SCDHHS Request for Medicaid ID Number (Form 1716 ME), proportionate including indicating whether the mother is a member of an MCO, and submitting the form to the local SCDHHS/state SCDHHS office;
5.1.38 Specify that the Contractor shall not prohibit or otherwise restrict a network provider/subcontractor from advising a member about the health status of the member or medical care or treatment for the member’s condition or disease, regardless of whether benefits for such care or treatment are provided under the contract, if the network provider/subcontractor is acting within the lawful scope of practice;
5.1.39 Provide that in accordance with Title VI of the Civil Rights Act of 1964 (42 U.S.C. §2000d et seq.) (2001, as amended) and its subcontractimplementing regulation at 45 CFR Part 80 (2001, as amended), the Provider must take adequate steps to ensure that persons with limited English skills receive free of insurance set forth charge the language assistance necessary to afford them meaningful and equal access to the benefits and services provided under this agreement;
5.1.40 Contain no provision which restricts a network provider/ subcontractor from contracting with another Managed Care Organization or other managed care entity;
5.1.41 Where the Contractor has entered into capitated reimbursement arrangements with providers, require submission of all encounter data to the same standards of completeness and accuracy as required for proper adjudication of fee-for-service claims;
5.1.42 Provide that all records originated or prepared in connection with the subcontractor's performance of its obligations under this Agreement Contract, including but not limited to, working papers related to the preparation of fiscal reports, medical records, progress notes, charges, journals, ledgers, and Appendix I hereof. All required policies shall electronic media, will be retained and safeguarded by the subcontractor in accordance with the terms and conditions set forth in this Agreement. Proof of insurance shall be provided to CUCF in accordance with this Agreement.
(e) Each such subcontract shall contain the provisions set forth in the following articles of this AgreementContract. The subcontract must further provide that the subcontractor agrees to retain all financial and programmatic records, supporting documents, statistical records and other records of members relating to the delivery of care or service under this Contract, and shall require the Subcontractor’s compliance with the same.
(1) Article 10.4 (concerning substantial completion);
(2) Article 10.5 (concerning damages as further required by SCDHHS, for delay and extensions a period of time);
(3) Article 10.6 (concerning payment)
(4) Article 28 (concerning method of payment for Extra Work);
five (5) Article 29 years from the expiration date of the Contract, including any Contract extension(s). If any litigation, claim, or other actions involving the records have been initiated prior to the expiration of the five (concerning 5) year period, the Resolution records shall be retained until completion of Disputes);
the action and resolution of all issues which arise from it or until the end of the five (65) Article 31 (concerning omitted work);
(7) Article 38 (concerning Labor Law Requirements);
(8) Article 39 (concerning Payroll Reports);
(9) Article 42 (concerning method year period, whichever is later. If the subcontractor stores records on microfilm or microfiche, the subcontractor must agree to produce, at its expense, legible hard copy records upon the request of payment and retained percentages);
(10) Article 41 (concerning Noise Control Code Provisions);
(11) Article 45 (concerning termination without cause);
(12) Article 46 (concerning termination for cause);
(13) Article 49 (concerning Suppliesstate or federal authorities, Labor, Services, Materials, and Tax Exemption)
(14) Article 51 (concerning Locally Based Enterprise Program);
within fifteen (15) Article 65 (concerning Ultra Low Sulfur Diesel Fuel)
(16) Article 66 (concerning Ultra Low Sulfur Diesel Fuel - Consolidated Construction Act); and
(17) Article 68 (concerning Participation by Minority-Owned and Women-Owned Business Enterprises)calendar days of the request.
5.1.43 Require the subcontractor to report the required immunization data to the State Immunization Information System (fSIIS) Each such subcontract administered by the SCDHEC.
5.1.44 Require the subcontractor to check the Excluded Parties List Service administered by the General Services Administration, when it hires any employee or contracts with another subcontractor, to ensure that it does not employ individuals or use subcontractors who are debarred, suspended, or otherwise excluded from participating in Federal procurement activities and/or have an employment, consulting, or other agreement with debarred individuals for the provision of items and services that are significant to the subcontractor's contractual obligation. The subcontractor shall contain also report to the same terms and conditions with respect to damage Contractor any employees or subcontractors that have been debarred, suspended, and/or excluded from participation in Medicaid, Medicare, or any other federal program. 6 EDUCATION, SELECTION AND ENROLLMENT PROCESS SCDHHS determines eligibility for delaySCHIP. Once an applicant is determined eligible by SCDHHS, and not less than the following: The [name of the Subcontractor] agrees to make no claim for damages for delay pertinent eligibility information is entered in the performance Medicaid Eligibility Determination System (MEDS). The rights afforded to potential members are detailed in the Policy and Procedure Guide, Members’ Bill of this Agreement occasioned by any act or omission by CUCF or by any of its representatives, and agrees that for all delays it shall be compensated fully by an extension of time to complete performance of the work, as provided hereinRights.
(g) In removing all ambiguity concerning the resolution of every dispute between the Construction Manager and its Subcontractors related to the Project, each such subcontract shall contain the provision regarding the resolution of disputes set forth at Article 29 hereof, including, without limitation, the provision regarding the appeal from CUCF decisions as set forth at Article 29 hereof; such provisions shall apply to every dispute between the Subcontractor and the Construction Manager related to the Project. Excluding decisions that are the result of this dispute resolution process and are disputed by the Construction Manager or its Subcontractor, which the process requires to be appealed otherwise, either the Construction Manager or a Subcontractor must commence the resolution of a dispute pursuant to the provisions of this Article upon written notice to the other and to CUCF that such dispute will be resolved by CUCF.
(h) Such subcontracts shall require that the Subcontractor agree not to make any claim against CUCF, its officers, agents or employees, by reason of such subcontract or any acts or omissions of the Construction Manager; provided however, such restrictions shall not apply to (1) demands filed by Subcontractors pursuant to Article 10.6 hereof, or (2) disputes submitted by Subcontractors pursuant to dispute resolution provisions contained 6.1 Enrolling Eligibles in the subcontract, as described in paragraph 10.2.2(g).
(i) Such subcontracts shall stipulate that the Subcontractor, without any further notification or other process, give its unconditional consent for its insurance carrier to release directly to CUCF documentation verifying its actual rate for workers’ compensation insurance.Contractor's Plan
Appears in 1 contract
Sources: Contract for Medical Services
Subcontract Requirements. Subcontracts between the Construction Manager Contractor and Subcontractors for construction work for the Project Work hereunder shall be in accordance with the provisions set forth below, unless otherwise authorized in a written directive from the DirectorCommissioner. The form of subcontracts shall be subject to the prior approval of the Commissioner.
(a) Such subcontracts shall require that all labor performed and all material furnished thereunder shall strictly comply with all requirements of this Agreement.
(b) Each such subcontract Such subcontracts shall incorporate contain the material terms of this Agreement, including all addenda DDC Safety Requirements and appendices to it, and the DDCM Safety RequirementsDDC General Conditions. Such subcontracts shall contain provisions approved in advance by the Director Commissioner regarding, at least: (1) time for completion; (2) performance requirements and assessment of liquidated damages, ; (3) warranties and/or guarantees, (4) the provision required hereunder pertaining to the resolution of disputes related to this Agreement, (5) M/WBE compliance, and (6) compliance with anti-discrimination provisions.
(c) Each such subcontract Such subcontracts shall contain the same terms and conditions with respect to: (1) method of payment, as set forth in Article 42; (2) substantial completion, as set forth in Article 10.4; (3) method of payment for Extra Work, as set forth in Article 28; (4) extension of time, as set forth in Article 10.5; (5) termination without cause, as set forth in Article 45; (6) termination for cause, as set forth in Article 46; (7) omitted work, as set forth in Article 31; (8) tax exemption, as set forth in Article 49.
(d) Such subcontracts shall require that all construction Subcontractors provide bid security in the Subcontractor who is party form attached in Exhibit E, in an amount equivalent to it provide five percent of the bid price, in accordance with 2 CFR 200.325(a) , and performance and payment bonds, each of which shall be in an amount equal to or greater than 100% of the subcontract price, price and shall name the Construction Manager Contractor as obligee thereunder. Such bonds shall be provided by a surety company licensed and authorized to do business in the State of New York. Such bonds shall be identical in all respects to the form of bonds attached hereto as Exhibit E, with no variations, additions, or deletions to such form of bonds. Premiums for required bonds must be included in the Subcontractor's bid price. The Subcontractor shall be required to submit two (2) originals of such bonds, one of which shall be submitted to CUCF the City by the Construction Manager Contractor immediately after receipt. With respect to performance and payment bonds submitted by Subcontractors hereunder, the Construction Manager Contractor agrees, immediately upon receipt of the bonds, to execute an irrevocable assignment in accordance with the form of assignment attached hereto as Exhibit F. The Construction Manager Contractor shall submit such executed assignment to CUCF the City at the time it submits the original bonds. As additional security for the faithful performance of such subcontracts, the Construction Manager shall deduct and retain from all subcontractor progress payments five percent (5%) of the amount certified to be due thereunder.
(de) Each such subcontract Such subcontracts shall require that the Subcontractor carry the types and amounts, proportionate to its subcontract, amounts of insurance set forth in this Agreement and Appendix I hereof. Article 23, All required policies shall be in accordance with the terms and conditions set forth in Article 23 of this AgreementContract. Proof of insurance Insurance shall be provided to CUCF the City in accordance with this AgreementArticle 23.3.
(ef) Each such subcontract Such subcontracts shall contain the provisions set forth in the following articles of this Agreement, and shall require the Subcontractor’s Subcontractor compliance with the same.
(1) Article 10.4 (concerning substantial completion);
38: Labor Law Requirements (2) Article 10.5 (concerning damages for delay and extensions of time);
39: Payroll Reports (3) Article 10.6 (concerning payment)
41: Noise Control Code Provisions (4) Article 28 (concerning method of payment for Extra Work);
(5) Article 29 (concerning the Resolution of Disputes);
(6) Article 31 (concerning omitted work);
(7) Article 38 (concerning Labor Law Requirements);
(8) Article 39 (concerning Payroll Reports);
(9) Article 42 (concerning method of payment and retained percentages);
(10) Article 41 (concerning Noise Control Code Provisions);
(11) Article 45 (concerning termination without cause);
(12) Article 46 (concerning termination for cause);
(13) Article 49 (concerning Supplies, Labor, Services, Materials, and Tax Exemption)
(14) Article 51 (concerning Locally Based Enterprise Program);
(15) Article 65 (concerning Ultra Low Sulfur Diesel Fuel)
(16) Article 66 (concerning Ultra Low Sulfur Diesel Fuel - Consolidated Construction Act); and
(17) Article 68 (concerning Participation by Minority-Owned and Women-Owned Business Enterprises).
(f) Each such subcontract shall contain the same terms and conditions with respect to damage for delay, and not less than the following43: The [name of the Subcontractor] agrees to make no claim for damages for delay in the performance of this Agreement occasioned by any act or omission by CUCF or by any of its representatives, and agrees that for all delays it shall be compensated fully by an extension of time to complete performance of the work, as provided herein.
(g) In removing all ambiguity concerning the resolution of every dispute between the Construction Manager and its Subcontractors related to the Project, each such subcontract shall contain the provision regarding the resolution of disputes set forth at Article 29 hereof, including, without limitation, the provision regarding the appeal from CUCF decisions as set forth at Article 29 hereof; such provisions shall apply to every dispute between the Subcontractor and the Construction Manager related to the Project. Excluding decisions that are the result of this dispute resolution process and are disputed by the Construction Manager or its Subcontractor, which the process requires to be appealed otherwise, either the Construction Manager or a Subcontractor must commence the resolution of a dispute pursuant to the provisions of this Article upon written notice to the other and to CUCF that such dispute will be resolved by CUCF.
(h) Such subcontracts shall require that the Subcontractor agree not to make any claim against CUCF, its officers, agents or employees, by reason of such subcontract or any acts or omissions of the Construction Manager; provided however, such restrictions shall not apply to (1) demands filed by Subcontractors pursuant to Article 10.6 hereof, or (2) disputes submitted by Subcontractors pursuant to dispute resolution provisions contained in the subcontract, as described in paragraph 10.2.2(g).
(i) Such subcontracts shall stipulate that the Subcontractor, without any further notification or other process, give its unconditional consent for its insurance carrier to release directly to CUCF documentation verifying its actual rate for workers’ compensation insurance.Prompt Payment
Appears in 1 contract
Sources: Contract for Design, Construction and Construction Management Services
Subcontract Requirements. Subcontracts between All subcontracts executed by the Construction Manager Contractor pursuant to this section shall, at a minimum, include the requirements listed below. No other terms or conditions agreed to by the Contractor and Subcontractors subcontractor shall negate or supersede the following requirements. All subcontracts must:
5.1.1 Be in writing and signed by the Contractor and subcontractor;
5.1.2 Specify the effective dates of the subcontractor agreement;
5.1.3 Specify in the subcontractor agreement that the subcontractor agreement and its appendices contain all the terms and conditions agreed upon by the parties;
5.1.4 Require that no modification or change of any provision of the subcontract shall be made unless such modification is incorporated and attached as a written amendment to the subcontract and signed by the parties;
5.1.5 Assure that the subcontractor shall not enter into any subsequent agreements or subcontracts for construction any of the work for contemplated under the Project shall subcontractor agreement without approval of the Contractor;
5.1.6 Specify that the services covered by the subcontractor agreement must be in accordance with the provisions set forth belowTitle XXI SC State Plan and require that the subcontractor shall provide these services to members through the last day that the subcontract is in effect. All final benefit determinations are within the sole and exclusive authority of SCDHHS or its designee;
5.1.7 Specify that the subcontractor may not refuse to provide medically necessary or covered preventive services to members covered under this Contract for non-medical reasons;
5.1.8 Require that the subcontractor be currently licensed and/or certified under applicable state and federal statutes and regulations and shall maintain throughout the term of the subcontract all necessary licenses, unless otherwise authorized certifications, registrations and permits as are required to provide the health care services and/or other related activities delegated by the Contractor;
5.1.9 Specify the amount, duration and scope of services to be provided by the subcontractor;
5.1.10 Provide that emergency services be rendered without the requirement of prior authorization of any kind;
5.1.11 Require that if the subcontractor performs laboratory services, the subcontractor must meet all applicable state and federal requirements;
5.1.12 Require that an adequate record system be maintained for recording services, service providers, charges, dates and all other commonly accepted information elements for services rendered to members pursuant to the agreement (including but not limited to such records as are necessary for the evaluation of the quality, appropriateness, and timeliness of services performed under this Contract). Members and their representatives shall be given access to and can request copies of the members’ medical records, to the extent and in the manner provided by S.C. Code ▇▇▇. §▇▇-▇▇▇-▇▇ et seq., (Supp. 2000, as amended) and subject to reasonable charges;
5.1.13 Require that any and all member records (financial, medical, etc.) be retained for a written directive period of five (5) years after the last payment was made for services provided to a member and retained further if the records are under review or audit until the review or audit is complete. Current State law (SC Code ▇▇▇. §44-115-120) requires physicians to retain their records for at least ten (10) years for adult patients and at least thirteen (13) years for minors. These minimum record keeping periods begin to run from the Director.last date of treatment. After these minimum record keeping periods, state law allows for the destruction of records. Said records shall be made available for fiscal audit, medical audit, medical review, utilization review, and other periodic monitoring upon request of an authorized representative of SCDHHS;
(a) Such subcontracts shall require 5.1.14 Provide that all labor performed and all material furnished thereunder shall strictly comply with all requirements SCDHHS, HHS, CMS, the Office of this Agreement.
(b) Each such subcontract shall incorporate Inspector General Comptroller, the material terms of this Agreement, including all addenda and appendices to itState Auditor's Office, and the DDCM Safety RequirementsSouth Carolina Attorney General's Office shall have the right to evaluate through audits, inspection, or other means, whether announced or unannounced, any records pertinent to this Contract including quality, appropriateness and timeliness of services and the timeliness and accuracy of encounter data and practitioner claims submitted by the Contractor. Such subcontracts evaluation, and when it is performed, shall contain provisions approved be established with the cooperation of the Contractor. Upon request, the Contractor shall assist in advance such reviews;
5.1.15 Whether announced or unannounced, provide for the participation and cooperation in any internal and external quality assessment review, utilization management, and grievance procedures established by the Director regardingContractor and/or SCDHHS or its designee;
5.1.16 Specify that the subcontractor shall monitor the quality of services delivered under the agreement and initiate a plan of correction where necessary to improve quality of care, in accordance with that level of care which is recognized as acceptable professional practice in the respective community in which the Contractor/subcontractor practices and/or the standards established by SCDHHS or its designee;
5.1.17 Require that the subcontractor comply with any plan of correction initiated by the Contractor and/or required by SCDHHS;
5.1.18 Provide for submission of all reports and clinical information required by the Contractor, including well child care (if applicable);
5.1.19 Require safeguarding of information about members according to applicable state and federal laws and regulations and as described in §13.22 and §13.29 of this Contract;
5.1.20 Provide the name and address of the official payee to whom payment shall be made;
5.1.21 Make full disclosure of the method and amount of compensation or other consideration to be received from the Contractor;
5.1.22 Provide for prompt submission of information needed to make payment;
5.1.23 Provide that the Contractor shall pay 90% of all clean claims from practitioners, either in individual or group practice or who practice in shared health facilities, within thirty (30) days of the date of receipt. The Contractor shall pay 99% of all clean claims from practitioners, either in individual or group practice or who practice in shared health facilities, within ninety (90) days of the date of receipt. The date of receipt is the date the Contractor receives the claim, as indicated by its data stamp on the claim. The date of payment is the date of the check or other form of payment. The MCO and its providers may, by mutual agreement, establish an alternative payment schedule. Any alternative schedule must be stipulated in the Contract;
5.1.24 Provide that subcontractors must submit all claims for payment no later than twelve (12) months from the date of service.
5.1.25 Specify that the subcontractor shall accept payment made by the Contractor as payment-in-full for covered services provided and shall not solicit or accept any surety or guarantee of payment from the member. Member shall include the patient, parent(s), guardian, spouse or any other legally responsible person of the member being served;
5.1.26 Specify that at least: (1) time for completion; (2) assessment all times during the term of liquidated damagesthe agreement, (3) warranties and/or guaranteesthe subcontractor shall indemnify and hold SCDHHS harmless from all claims, (4) the provision required hereunder pertaining losses, or suits relating to activities undertaken pursuant to the resolution Contract between SCDHHS and the Contractor, unless the subcontractor is a state agency. For subcontractors that are not state agencies, the indemnification may be accomplished by incorporating §13.26 of disputes related this Contract in its entirety in the subcontractor’s agreement or by use of other language developed by the Contractor and approved by SCDHHS. For state agencies, the liability protection may be accomplished by incorporating language developed by the state agency and approved by SCDHHS;
5.1.27 Require the subcontractor to this Agreement, (5) M/WBE compliance, secure all necessary liability and (6) compliance with anti-discrimination provisions.
(c) Each malpractice insurance coverage as is necessary to adequately protect the plan's members and the Contractor under the agreement. The subcontractor shall provide such subcontract shall require that insurance coverage at all times during the Subcontractor who is party to it provide performance agreement and payment bonds, each of which shall be in an amount equal to 100% upon execution of the subcontract priceagreement, shall furnish the Contractor with written verification of the existence of such coverage;
5.1.28 Specify that the subcontractor agrees to recognize and abide by all state and federal laws, regulations and guidelines applicable to the provision of services under the Program;
5.1.29 Provide that the agreement incorporates by reference all applicable federal and state laws or regulations, and that revisions of such laws or regulations shall name automatically be incorporated into the Construction Manager agreement as obligee thereunderthey become effective. Such bonds In the event that changes in the agreement as a result of revisions and applicable federal or state law materially affect the position of either party, the Contractor and subcontractor agree to negotiate such further amendments as may be necessary to correct any inequities;
5.1.30 Specify procedures and criteria for any alterations, variations, modifications, waivers, extensions of the agreement termination date, or early termination of the agreement and that such change shall only be valid when reduced to writing, duly signed and attached to the original of the agreement;
5.1.31 Specify that the Contractor and subcontractor recognize that in the event of termination of this Contract between the Contractor and SCDHHS for any of the reasons described in this Contract, the Contractor shall immediately make available to SCDHHS, or its designated representative, in a usable form, any and all records, whether medical or financial, related to the Contractor's and subcontractor's activities undertaken pursuant to the Contractor/subcontractor agreement. The provision of such records shall be provided by a surety company licensed at no expense to SCDHHS;
5.1.32 Provide that the Contractor and authorized to do business in the State of New York. Such bonds subcontractor shall be identical in all respects to responsible for resolving any disputes that may arise between the form of bonds attached hereto as Exhibit E, with no variations, additions, or deletions to such form of bonds. Premiums for required bonds must be included in the Subcontractor's bid price. The Subcontractor shall be required to submit two (2) originals parties, and that no dispute shall disrupt or interfere with the provisions of such bonds, one services to the member;
5.1.33 Include a conflict of which interest clause as stated in §13.34 of this Contract between the Contractor and SCDHHS;
5.1.34 Specify that the subcontractor must adhere to the Quality Assessment Performance Improvement and Utilization Management requirements as outlined in the Policy and Procedure Guide. The QAPI and UM requirements shall be submitted to CUCF by the Construction Manager immediately after receipt. With respect to performance and payment bonds submitted by Subcontractors hereunder, the Construction Manager agrees, immediately upon receipt included as part of the bondssubcontract between the Contractor and the subcontractor;
5.1.35 Provide that all subcontractors shall give the Contractor immediate notification in writing by certified mail of any administrative legal action or complaint filed and prompt notice of any claim made against the subcontractor by a subcontractor, or a member which may result in litigation related in any way to execute an irrevocable assignment this Contract with SCDHHS. The Contractor shall assure that all responsibilities related to the subcontract are performed in accordance with the form terms of assignment attached hereto as Exhibit F. The Construction Manager shall submit such executed assignment to CUCF at the time it submits the original bonds. As additional security this Contract;
5.1.36 Contain no provision which provides incentives, monetary or otherwise, for the faithful withholding of medically necessary care. See the Policy and Procedure Guide, Incentive Plans;
5.1.37 Specify that the subcontractor shall not assign any of its duties and/or responsibilities under this Contract without the prior written consent of the Contractor;
5.1.38 Specify that the Contractor shall not prohibit or otherwise restrict a network provider/subcontractor from advising a member about the health status of the member or medical care or treatment for the member’s condition or disease, regardless of whether benefits for such care or treatment are provided under the contract, if the network provider/subcontractor is acting within the lawful scope of practice;
5.1.39 Provide that in accordance with Title VI of the Civil Rights Act of 1964 (42 U.S.C. §2000d et seq.) (2001, as amended) and its implementing regulation at 45 CFR Part 80 (2001, as amended), the Provider must take adequate steps to ensure that persons with limited English skills receive free of charge the language assistance necessary to afford them meaningful and equal access to the benefits and services provided under this agreement;
5.1.40 Contain no provision which restricts a network provider/ subcontractor from contracting with another Managed Care Organization or other managed care entity; and
5.1.41 Where the Contractor has entered into capitated reimbursement arrangements with providers, require submission of all encounter data to the same standards of completeness and accuracy as required for proper adjudication of fee-for-service claims.
5.1.42 Provide that all records originated or prepared in connection with the subcontractor's performance of such subcontractsits obligations under this Contract, including but not limited to, working papers related to the Construction Manager shall deduct preparation of fiscal reports, medical records, progress notes, charges, journals, ledgers, and retain from all electronic media, will be retained and safeguarded by the subcontractor progress payments five percent (5%) of the amount certified to be due thereunder.
(d) Each such subcontract shall require that the Subcontractor carry the types and amounts, proportionate to its subcontract, of insurance set forth in this Agreement and Appendix I hereof. All required policies shall be in accordance with the terms and conditions set forth in this Agreement. Proof of insurance shall be provided to CUCF in accordance with this Agreement.
(e) Each such subcontract shall contain the provisions set forth in the following articles of this AgreementContract. The contract must further provide that the subcontractor agrees to retain all financial and programmatic records, supporting documents, statistical records and other records of members relating to the delivery of care or service under this Contract, and shall require the Subcontractor’s compliance with the same.
(1) Article 10.4 (concerning substantial completion);
(2) Article 10.5 (concerning damages as further required by SCDHHS, for delay and extensions a period of time);
(3) Article 10.6 (concerning payment)
(4) Article 28 (concerning method of payment for Extra Work);
five (5) Article 29 years from the expiration date of the Contract, including any Contract extension(s). If any litigation, claim, or other actions involving the records have been initiated prior to the expiration of the five (concerning 5) year period, the Resolution records shall be retained until completion of Disputes);
the action and resolution of all issues which arise from it or until the end of the five (65) Article 31 (concerning omitted work);
(7) Article 38 (concerning Labor Law Requirements);
(8) Article 39 (concerning Payroll Reports);
(9) Article 42 (concerning method year period, whichever is later. If the subcontractor stores records on microfilm or microfiche, the subcontractor must agree to produce, at its expense, legible hard copy records upon the request of payment and retained percentages);
(10) Article 41 (concerning Noise Control Code Provisions);
(11) Article 45 (concerning termination without cause);
(12) Article 46 (concerning termination for cause);
(13) Article 49 (concerning Suppliesstate or federal authorities, Labor, Services, Materials, and Tax Exemption)
(14) Article 51 (concerning Locally Based Enterprise Program);
within fifteen (15) Article 65 (concerning Ultra Low Sulfur Diesel Fuel)
(16) Article 66 (concerning Ultra Low Sulfur Diesel Fuel - Consolidated Construction Act); and
(17) Article 68 (concerning Participation by Minority-Owned and Women-Owned Business Enterprises).
(f) Each such subcontract shall contain the same terms and conditions with respect to damage for delay, and not less than the following: The [name calendar days of the Subcontractor] agrees to make no claim for damages for delay in the performance of this Agreement occasioned by any act or omission by CUCF or by any of its representatives, and agrees that for all delays it shall be compensated fully by an extension of time to complete performance of the work, as provided hereinrequest.
(g) In removing all ambiguity concerning the resolution of every dispute between the Construction Manager and its Subcontractors related to the Project, each such subcontract shall contain the provision regarding the resolution of disputes set forth at Article 29 hereof, including, without limitation, the provision regarding the appeal from CUCF decisions as set forth at Article 29 hereof; such provisions shall apply to every dispute between the Subcontractor and the Construction Manager related to the Project. Excluding decisions that are the result of this dispute resolution process and are disputed by the Construction Manager or its Subcontractor, which the process requires to be appealed otherwise, either the Construction Manager or a Subcontractor must commence the resolution of a dispute pursuant to the provisions of this Article upon written notice to the other and to CUCF that such dispute will be resolved by CUCF.
(h) Such subcontracts shall require that the Subcontractor agree not to make any claim against CUCF, its officers, agents or employees, by reason of such subcontract or any acts or omissions of the Construction Manager; provided however, such restrictions shall not apply to (1) demands filed by Subcontractors pursuant to Article 10.6 hereof, or (2) disputes submitted by Subcontractors pursuant to dispute resolution provisions contained in the subcontract, as described in paragraph 10.2.2(g).
(i) Such subcontracts shall stipulate that the Subcontractor, without any further notification or other process, give its unconditional consent for its insurance carrier to release directly to CUCF documentation verifying its actual rate for workers’ compensation insurance.
Appears in 1 contract
Sources: Contract for Medical Services
Subcontract Requirements. Subcontracts between All subcontracts executed by the Construction Manager Contractor pursuant to this section shall, at a minimum, include the requirements listed below. No other terms or conditions agreed to by the Contractor and Subcontractors subcontractor shall negate or supersede the following requirements.
5.1.1 Be in writing and signed by the Contractor and subcontractor;
5.1.2 Specify the effective dates of the subcontractor agreement;
5.1.3 Specify in the subcontractor agreement that the subcontractor agreement and its appendices contain all the terms and conditions agreed upon by the parties. Require that no modification or change of any provision of the subcontract shall be made unless such modification is incorporated and attached as a written amendment to the subcontract and signed by the parties;
5.1.4 Assure that the subcontractor shall not enter into any subsequent agreements or subcontracts for construction any of the work for contemplated under the Project shall subcontractor agreement without approval of the Contractor;
5.1.5 Specify that the services covered by the subcontractor agreement must be in accordance with the provisions set forth belowTitle XIX SC State Medicaid Plan and require that the subcontractor shall provide these services to members through the last day that the subcontract is in effect, unless otherwise authorized all final Medicaid benefit determinations are within the sole and exclusive authority of SCDHHS or its designee;
5.1.6 Specify that the subcontractor may not refuse to provide medically necessary or covered preventive services to Medicaid MHN program members covered under this Contract for non-medical reasons;
5.1.7 Require that the subcontractor be currently licensed and/or certified under applicable state and federal statutes and regulations and shall maintain throughout the term of the subcontract all necessary licenses, certifications, registrations and permits as are required to provide the health care services and/or other related activities delegated by the Contractor;
5.1.8 Specify the amount, duration and scope of services to be provided by the subcontractor;
5.1.9 Provide that emergency services be rendered without the requirement of prior authorization of any kind;
5.1.10 If the subcontractor performs laboratory services, the subcontractor must meet all applicable state and federal requirements;
5.1.11 Require that an adequate record system be maintained for recording services, service providers, charges, dates and all other commonly accepted information elements for services rendered to members pursuant to the agreement (including but not limited to such records as are necessary for the evaluation of the quality, appropriateness, and timeliness of services performed under this Contract). Medicaid MHN program members and their representatives shall be given access to and requested copies of the members medical records, to the extent and in the manner provided by S.C. Code ▇▇▇. §▇▇-▇▇▇-▇▇ et. seq., (Supp. 2000) as amended and subject to reasonable charges;
5.1.12 Require that any and all member records—financial, medical, etc.—be retained for a written directive period of three (3) years after the last payment was made for services provided to a member and retained further if the records are under review or audit until the review or audit is complete. This requirement pertains to the retention of records for Medicaid purposes only; other state or federal rules may require longer retention periods. Current State law (SC ST SEC 44-115-120) requires physicians to retain their records for at least ten (10) years for adult patients and at least thirteen (13) years for minors. These minimum record keeping periods begin to run from the Directorlast date of treatment. After these minimum record-keeping periods, state law allows for the destruction of records. Said records shall be made available for fiscal audit, medical audit, medical review, utilization review, and other periodic monitoring upon request of authorized representative of SCDHHS.
5.1.13 Provide that SCDHHS, U.S. Department of Health and Human Services (a) Such subcontracts shall require that all labor performed and all material furnished thereunder shall strictly comply with all requirements HHS), CMS, Office of this Agreement.
(b) Each such subcontract shall incorporate the material terms of this AgreementInspector General Comptroller, including all addenda and appendices to itState Auditor's Office, and the DDCM Safety RequirementsSouth Carolina Attorney General's Office shall have the right to evaluate through inspection, or other means, whether announced or unannounced, any records pertinent to this Contract including quality, appropriateness and timeliness of services and such evaluation, and when performed, shall be performed with the cooperation of the Contractor. Such subcontracts Upon request, the Contractor shall contain provisions approved assist in advance such reviews;
5.1.14 Whether announced or unannounced, provide for the participation and cooperation in any internal and external quality assessment review, case management and grievance procedures established by the Director regardingContractor and/or SCDHHS or its designee;
5.1.15 Specify that the subcontractor shall monitor the quality of services delivered under the agreement and initiate plan of correction where necessary to improve quality of care, in accordance with that level of care which is recognized as acceptable professional practice in the respective community in which the Contractor/subcontractor practices and/or the standards established by SCDHHS or its designee;
5.1.16 Require that the subcontractor comply with plan of correction initiated by the Contractor and/or required by SCDHHS;
5.1.17 Provide for submission of all reports and clinical information required by the Contractor, including EPSDT (if applicable);
5.1.18 Require safeguarding of information about Medicaid MHN program members according to applicable state and federal laws and regulations and as described in §13.22 and §13.29 and of this Contract;
5.1.19 Provide the name and address of the official payee to whom payment shall be made;
5.1.20 Make full disclosure of the method and amount of compensation or other consideration to be received from the Contractor;
5.1.21 Provide for prompt submission of information needed to make payment;
5.1.22 Specify that the subcontractor shall accept payment made by the Contractor as payment-in-full for covered services provided and shall not solicit or accept any surety or guarantee of payment from the member. Member shall include the patient, parent(s), guardian, spouse or any other legally responsible person of the member being served;
5.1.23 Specify that at least: (1) time for completion; (2) assessment all times during the term of liquidated damagesthe agreement, (3) warranties and/or guaranteesthe subcontractor shall indemnify and hold SCDHHS harmless from all claims, (4) the provision required hereunder pertaining losses, or suits relating to activities undertaken pursuant to the resolution Contract between SCDHHS and the Contractor, unless the subcontractor is a state agency. For subcontractors that are not state agencies, the indemnification may be accomplished by incorporating §13.26 of disputes related to this AgreementContract in its entirety in the subcontractor’s agreement or by use of other language developed by the Contractor and approved by SCDHHS. For state agencies, (5) M/WBE compliance, the liability protection may be accomplished by incorporating language developed by the state agency and (6) compliance with anti-discrimination provisionsapproved by SCDHHS.
(c) Each 5.1.24 Require the subcontractor to secure all necessary liability and malpractice insurance coverage as is necessary to adequately protect the plan's members and the Contractor under the agreement. The subcontractor shall provide such subcontract shall require that insurance coverage at all times during the Subcontractor who is party to it provide performance agreement and payment bonds, each of which shall be in an amount equal to 100% upon execution of the subcontract priceagreement furnish the Contractor with written verification of the existence of such coverage;
5.1.25 Specify that the subcontractor agrees to recognize and abide by all state and federal laws, regulations and guidelines applicable to the provision of services under the Medicaid MHN Program;
5.1.26 Provide that the agreement incorporates by reference all applicable federal and state laws or regulations, and revisions of such laws or regulations shall name automatically be incorporated into the Construction Manager agreement as obligee thereunderthey become effective. Such bonds In the event that changes in the agreement as a result of revisions and applicable federal or state law materially affect the position of either party, the Contractor and subcontractor agree to negotiate such further amendments as may be necessary to correct any inequities;
5.1.27 Specify procedures and criteria for any alterations, variations, modifications, waivers, extension of the agreement termination date, or early termination of the agreement and that such change shall only be valid when reduced to writing, duly signed and attached to the original of the agreement;
5.1.28 Specify that the Contractor and subcontractor recognize that in the event of termination of this Contract between the Contractor and SCDHHS for any of the reasons described in this Contract, the Contractor shall immediately make available, to SCDHHS, or its designated representative, in a usable form, any and all records, whether medical or financial, related to the Contractor's and subcontractor's activities undertaken pursuant to the Contractor/subcontractor agreement. The provision of such records shall be provided by a surety company licensed at no expense to SCDHHS;
5.1.29 That the Contractor and authorized to do business in the State of New York. Such bonds subcontractor shall be identical in all respects to responsible for resolving any disputes that may arise between the form of bonds attached hereto as Exhibit E, with no variations, additions, or deletions to such form of bonds. Premiums for required bonds must be included in the Subcontractor's bid price. The Subcontractor shall be required to submit two (2) originals parties, and that no dispute shall disrupt or interfere with the provisions of such bonds, one services to the Medicaid MHN program member;
5.1.30 Include a conflict of which interest clause as stated in §13.33 of this Contract between the Contractor and SCDHHS;
5.1.31 Specify that the subcontractor must adhere to the Quality Assessment Performance Improvement (QAPI) and Case Management (CM) requirements as outlined in MHN Policy and Procedure Guide. The QAPI and CM requirements shall be submitted to CUCF by the Construction Manager immediately after receipt. With respect to performance and payment bonds submitted by Subcontractors hereunder, the Construction Manager agrees, immediately upon receipt included as part of the bondssubcontract between the Contractor and the subcontractor;
5.1.32 All subcontractors shall give the Contractor immediate notification in writing by certified mail of any administrative legal action or complaint filed and prompt notice of any claim made against subcontractor by a subcontractor, or member which may result in litigation related in any way to execute an irrevocable assignment in accordance this Contract with SCDHHS. The Contractor shall assure that all responsibilities related to the form of assignment attached hereto as Exhibit F. The Construction Manager shall submit such executed assignment to CUCF at the time it submits the original bonds. As additional security for the faithful performance of such subcontracts, the Construction Manager shall deduct and retain from all subcontractor progress payments five percent (5%) of the amount certified to be due thereunder.
(d) Each such subcontract shall require that the Subcontractor carry the types and amounts, proportionate to its subcontract, of insurance set forth in this Agreement and Appendix I hereof. All required policies shall be are performed in accordance with the terms and conditions set forth in this Agreement. Proof of insurance shall be provided to CUCF in accordance with this Agreement.
(e) Each such subcontract shall contain the provisions set forth in the following articles of this Agreement, and shall require the Subcontractor’s compliance with the same.
(1) Article 10.4 (concerning substantial completion)Contract;
(2) Article 10.5 (concerning damages 5.1.33 Contain no provision which provides incentives, monetary or otherwise, for delay the withholding of medically necessary care. See MHN Policy and extensions of time)Procedure Guide, Incentive Plans;
(3) Article 10.6 (concerning payment)
(4) Article 28 (concerning method of payment for Extra Work);
(5) Article 29 (concerning 5.1.34 Specify that the Resolution of Disputes);
(6) Article 31 (concerning omitted work);
(7) Article 38 (concerning Labor Law Requirements);
(8) Article 39 (concerning Payroll Reports);
(9) Article 42 (concerning method of payment and retained percentages);
(10) Article 41 (concerning Noise Control Code Provisions);
(11) Article 45 (concerning termination without cause);
(12) Article 46 (concerning termination for cause);
(13) Article 49 (concerning Supplies, Labor, Services, Materials, and Tax Exemption)
(14) Article 51 (concerning Locally Based Enterprise Program);
(15) Article 65 (concerning Ultra Low Sulfur Diesel Fuel)
(16) Article 66 (concerning Ultra Low Sulfur Diesel Fuel - Consolidated Construction Act); and
(17) Article 68 (concerning Participation by Minority-Owned and Women-Owned Business Enterprises).
(f) Each such subcontract subcontractor shall contain the same terms and conditions with respect to damage for delay, and not less than the following: The [name of the Subcontractor] agrees to make no claim for damages for delay in the performance of this Agreement occasioned by any act or omission by CUCF or by assign any of its representatives, and agrees that for all delays it shall be compensated fully by an extension of time to complete performance duties and/or responsibilities under this Contract without the prior written consent of the workContractor;
5.1.35 Specify that Contractor shall not prohibit or otherwise restrict a network provider/subcontractor from advising a member about the health status of the member or medical care or treatment for the member’s condition or disease, regardless of whether benefits for such care or treatment are provided under the contract, if the network provider/subcontractor is acting within the lawful scope of practice.
5.1.36 In accordance with Title VI of the Civil Rights Act of 1964 (42 U.S.C. 2000d et. seq.) (2001, as amended) and its implementing regulation at 45 C.F.R. Part 80 (2001, as amended), the Provider must take adequate steps to ensure that persons with limited English skills receive free of charge the language assistance necessary to afford them meaningful and equal access to the benefits and services provided hereinunder this agreement.
(g) 5.1.37 Contain no provision which restricts a network provider/subcontractor from contracting with another managed care entity.
5.1.38 In removing all ambiguity concerning the resolution of every dispute between event the Construction Manager and Contractor discontinues operations, any network provider who terminates its Subcontractors related to contract with the Project, each such subcontract shall contain the provision regarding the resolution of disputes set forth at Article 29 hereof, including, without limitation, the provision regarding the appeal from CUCF decisions Contractor as set forth at Article 29 hereof; such provisions shall apply to every dispute between the Subcontractor and the Construction Manager related to the Project. Excluding decisions that are the a result of this dispute resolution process discontinuation shall receive their share of any cost savings agreed upon with the Contractor. 6 EDUCATION, SELECTION AND ENROLLMENT PROCESS The South Carolina Department of Health and are disputed by Human Services (SCDHHS) determines eligibility for Medicaid for all coverage groups except for Supplemental Security Income (SSI). The Social Security Administration (SSA) determines eligibility for SSI. Once SCDHHS or SSA determines an applicant eligible for Medicaid, the Construction Manager or its Subcontractor, which the process requires to be appealed otherwise, either the Construction Manager or a Subcontractor must commence the resolution of a dispute pursuant to the provisions of this Article upon written notice to the other and to CUCF that such dispute will be resolved by CUCF.
(h) Such subcontracts shall require that the Subcontractor agree not to make any claim against CUCF, its officers, agents or employees, by reason of such subcontract or any acts or omissions of the Construction Manager; provided however, such restrictions shall not apply to (1) demands filed by Subcontractors pursuant to Article 10.6 hereof, or (2) disputes submitted by Subcontractors pursuant to dispute resolution provisions contained pertinent eligibility information is entered in the subcontractMedicaid Eligibility Determination System (MEDS). The rights afforded to potential MHN members are detailed in MHN Policy and Procedure Guide, as described in paragraph 10.2.2(g)Members’ ▇▇▇▇ of Rights.
(i) Such subcontracts shall stipulate that the Subcontractor, without any further notification or other process, give its unconditional consent for its insurance carrier to release directly to CUCF documentation verifying its actual rate for workers’ compensation insurance.
Appears in 1 contract
Sources: Contract for the Purchase and Provision of Services
Subcontract Requirements. Subcontracts between the Construction Manager and Subcontractors for construction work for the Project shall be in accordance Contractor’s Subcontracts, including those entered into with Providers,must comply with the provisions requirements set forth belowSec. 12 of Ex. B, unless Part 4. However, nothing in this Sec. 12 precludes do not Contractor from including additional terms and conditions in its Subcontracts provided that such additional terms and conditions do not conflict or otherwise authorized in a written directive from the Director.
(a) Such subcontracts shall require that all labor performed and all material furnished thereunder shall strictly comply with all requirements of this Agreement.
(b) Each such subcontract shall incorporate the material terms of this Agreement, including all addenda and appendices to it, and the DDCM Safety Requirements. Such subcontracts shall contain provisions approved in advance by the Director regarding, at least: (1) time for completion; (2) assessment of liquidated damages, (3) warranties and/or guarantees, (4) the provision required hereunder pertaining to the resolution of disputes related to this Agreement, (5) M/WBE compliance, and (6) compliance with anti-discrimination provisions.
(c) Each such subcontract shall require that the Subcontractor who is party to it provide performance and payment bonds, each of which shall be in an amount equal to 100% of the subcontract price, and shall name the Construction Manager as obligee thereunder. Such bonds shall be provided by a surety company licensed and authorized to do business in the State of New York. Such bonds shall be identical in all respects to the form of bonds attached hereto as Exhibit E, with no variations, additions, or deletions to such form of bonds. Premiums for required bonds must be included in the Subcontractor's bid price. The Subcontractor shall be required to submit two (2) originals of such bonds, one of which shall be submitted to CUCF by the Construction Manager immediately after receipt. With respect to performance and payment bonds submitted by Subcontractors hereunder, the Construction Manager agrees, immediately upon receipt of the bonds, to execute an irrevocable assignment in accordance amend with the form of assignment attached hereto as Exhibit F. The Construction Manager shall submit such executed assignment to CUCF at the time it submits the original bonds. As additional security for the faithful performance of such subcontracts, the Construction Manager shall deduct and retain from all subcontractor progress payments five percent (5%) of the amount certified to be due thereunder.
(d) Each such subcontract shall require that the Subcontractor carry the types and amounts, proportionate to its subcontract, of insurance requirements set forth in herein and as otherwise required under this Agreement and Appendix I hereofContract. All In no event shall Contractor delegate or otherwise assign to third parties the responsibility for performing any Work required policies shall be in accordance under this Contract without first entering into a Subcontract that complies with the terms and conditions set forth of this Contract. In all such instances, Contractor shall, at a minimum, include all of the following standards, terms, and conditions in this Agreement. Proof all of insurance shall be provided its Subcontracts:
a. General Standards
(1) To the extent Contractor Subcontracts any services or obligations to CUCF in accordance with this Agreementa Subcontractor, Subcontractor must perform the services and meet the obligations and terms and conditions as if the Subcontractor is the Contractor.
(e2) Each Contractor shall ensure that all Subcontracts: (i) are in writing, (ii) specify the Subcontracted Work and reporting responsibilities, (iii) are in compliance with the requirements described below in this Sec. 12, Ex. B,Part 4 and any other requirements identified in this Contract, and (iv) incorporate the applicable provisions of this Contract, based on the scope of Work subcontracted such subcontract shall contain that the provisions of the Subcontract are the same as or substantively similar to the applicable provisions of this Contract.
(3) Contractor must evaluate and document all prospective Subcontractors’ readiness and ability to perform the scope of Work set forth in the following articles applicable Subcontract prior to the effective date of this Agreementthe Subcontract. OHA shall have the right to request, and Contractor shall require the Subcontractor’s compliance with the same.
provide within five (15) Article 10.4 (concerning substantial completion);
(2) Article 10.5 (concerning damages for delay and extensions of time);
(3) Article 10.6 (concerning payment)days after request by OHA, all readiness review evaluations
(4) Article 28 (concerning method of payment Contractor shall ensure that all Subcontractors are screened for Extra Work);exclusion from participation in federal programs. In the event a Subcontractor is so excluded, Contractor is prohibited from subcontracting to such Subcontractor any Work or obligations required to be performed under this Contract.
(5) Article 29 (concerning the Resolution of Disputes);Contractor shall ensure that all Subcontractors and their employees undergo a criminal background check prior to starting any Work identified in this Contract.
(6) Article 31 (concerning omitted work);
(7) Article 38 (concerning Labor Law Requirements);
(8) Article 39 (concerning Payroll Reports);
(9) Article 42 (concerning method of payment Contractor shall not have the right to Subcontract certain obligations and retained percentages);
(10) Article 41 (concerning Noise Control Code Provisions);
(11) Article 45 (concerning termination without cause);
(12) Article 46 (concerning termination for cause);
(13) Article 49 (concerning SuppliesWork required to be performed under in this Contract. Work, Labor, Services, Materialsactivities, and Tax Exemption)
(14) Article 51 (concerning Locally Based Enterprise Program);
(15) Article 65 (concerning Ultra Low Sulfur Diesel Fuel)
(16) Article 66 (concerning Ultra Low Sulfur Diesel Fuel - Consolidated Construction Act); and
(17) Article 68 (concerning Participation by Minority-Owned and Women-Owned Business Enterprises).
(f) Each such subcontract other obligations that Contractor shall contain the same terms and conditions with respect to damage for delay, and not less than the following: The [name of the Subcontractor] agrees to make no claim for damages for delay in the performance of Subcontract are identified throughout this Agreement occasioned by any act or omission by CUCF or by any of its representatives, and agrees that for all delays it shall be compensated fully by an extension of time to complete performance of the work, as provided herein.
(g) In removing all ambiguity concerning the resolution of every dispute between the Construction Manager and its Subcontractors related to the Project, each such subcontract shall contain the provision regarding the resolution of disputes set forth at Article 29 hereof, including, without limitation, the provision regarding the appeal from CUCF decisions as set forth at Article 29 hereof; such provisions shall apply to every dispute between the Subcontractor and the Construction Manager related to the ProjectContract. Excluding decisions that are the result of this dispute resolution process and are disputed by the Construction Manager or its Subcontractor, which the process requires to be appealed otherwise, either the Construction Manager or a Subcontractor must commence the resolution of a dispute pursuant Subject to the provisions of this Article upon Section 12, Ex. B,Part 4, Contractor may Subcontract obligations and Work required to be performed under this Contract that is not expressly identified as an exclusion. In accordance with 42 CFR §438.230(b)(1), no Subcontract may terminate or
(7) Contractor shall provide to OHA via Administrative Notice, a Subcontractor Assignment Report in which Contractor shall summarize in list form all activities required to be performed under this Contract that have been subcontracted to a Subcontractor. The Subcontractor Assignment Report must be provided to OHA by no later than January 31 of each Contract Year and within thirty (30) days after there has been any change in a Subcontractor. The Subcontractor Assignment Report shall also include all of the following:
(a) The legal name of the Subcontractor;
(b) The scope of Work being subcontracted;
(c) Copies of ownership disclosure form, if applicable;
(d) Any ownership stake between Contractor and the Subcontractor; and
(e) An attestation that Contractor (i) conducted a readiness review of the Subcontractor, (ii) confirmed that the Subcontractor was and is not an excluded from participation in federal program, (iii) confirmed all Subcontractor employees are subject to criminal background checks, and (iv) that the written notice Subcontract entered into with the Subcontractor meets all of the requirements set forth in this Ex. B, Part 4 and other applicable provisions of this Contract
(8) In addition to the obligations identified as being precluded from Subcontracting under this Sec. 12, Ex. B, Part 4 of this Contract and as may be set forth in any other provision of this Contract, the following obligations of Contractor under this Contract shall not be subcontracted or otherwise delegated to a third party:
(a) Oversight and to CUCF that such dispute will be resolved by CUCFMonitoring of Quality Improvement activities; and
(b) Adjudication of Appeals in a Member Grievance and Appeal process.
(h9) Such subcontracts shall require that the If deficiencies are identified in Subcontractor agree not to make performance for any claim against CUCFfunctions outlined in this Contract, its officers, agents or employeeswhether those deficiencies are identified by Contractor, by reason of such subcontract OHA, or any acts their designees, Contractor agrees to require its Subcontractor to respond and remedy those deficiencies within the timeframe determined by OHA. Such obligations and timeframes shall be included in all Subcontracts.
(10) Contractor shall ensure that Subcontractors and Providers do not bill Members for services that are not covered under this Contract unless there is a full written disclosure or omissions waiver (also referred to as an agreement to pay) on file, signed by the Member, in advance of the Construction Manager; provided howeverservice being provided, such restrictions shall not apply to (1) demands filed by Subcontractors pursuant to Article 10.6 hereof, or (2) disputes submitted by Subcontractors pursuant to dispute resolution provisions contained in the subcontract, as described in paragraph 10.2.2(gaccordance with OAR 410-141-3420(5).
(i11) In accordance with Exhibit I of this Contract, Contractor shall provide every Provider and Subcontractor, at the time it enters into a contract or Subcontract, its OHA-approved written procedures for its Grievance and Appeal System..
(12) Contractor shall Monitor the performance of all Subcontractors on an ongoing basis and perform, at least once a year, a formal, a review of compliance of all Subcontracted obligations and other responsibilities, performance, deficiencies, and areas for improvement. Such subcontracts review shall stipulate be documented in an Annual Subcontractor Performance Report wherein Contractor, which must be completed within sixty (60) days after the annual anniversary of the effective date of the Subcontract. Contractor shall make a conclusion in each Annual Subcontractor Performance Report as to whether a Subcontractor has complied with all the terms and conditions of this Contract that are applicable to the Work performed by Subcontractor .
(13) The Annual Subcontractor Performance Report must include at a minimum the following elements:
(a) An assessment of the quality of Subcontractor’s performance of contracted Work;
(b) Any complaints or Grievances filed in relation to Subcontractor’s Work;
(c) Any late submission of reporting deliverables or incomplete data;
(d) Whether employees of the Subcontractor are screened and Monitored for federal exclusion from participation in Medicaid;
(e) The adequacy of Subcontractor’s compliance functions; and
(f) Any deficiencies that have been identified by OHA related to work performed by Subcontractor.
(14) Contractor shall provide a copy of each Annual Subcontractor Performance Report to OHA via Administrative Notice, iwithin thirty (30) days of completion. Contractor shall oversee and be responsible for the satisfactory performance of any functions or responsibilities it has delegated to a Subcontractor.
(15) In the event Contractor identifies deficiencies or areas for improvement, Contractor shall cause Subcontractor to take Corrective Action Plan. In addition, Contractor shall provide, via Administrative Notice, OHA’s Contract Administrator with a copy of the CAP documenting the deficiencies, actions required of the Subcontractor to remedy the deficiencies, and the time frame for completing such required actions. The foregoing Administrative Notice shall be made within fourteen (14) days after providing the Corrective Action Plan to the applicable Subcontractor.
(16) Contractor shall provide with an update on the status of the Corrective Action Plan at such time that the Subcontractor has been successfully removed from Corrective Action or, of the Subcontractor, without any further notification or other process, give its unconditional consent ’s failure to fully remedy the underlying deficiency if the deadline for its insurance carrier such remedy has passed. Such update shall be provided to release directly to CUCF documentation verifying its actual rate for workers’ compensation insuranceOHA via Administrative Notice within 14 days after the intended original completion date set forth in the applicable CAP.
Appears in 1 contract
Sources: Health Plan Services Contract
Subcontract Requirements. Contractor shall ensure that Subcontracts between executed with Providers seek to apply best practices in the Construction Manager management of its Provider Network. The requirements of this section do not prevent the Contractor from including additional terms and Subcontractors for construction work conditions in its subcontracts to meet the legal obligations or system requirements of the Contractor. Contractor ensures that the following standards are included in its Subcontracts:
a. General Standards
(1) Subject to the provisions of this section, Contractor may subcontract any or all of the Work to be performed under this Contract. No Subcontract may terminate or limit Contractor’s legal responsibility to OHA for the Project timely and effective performance of Contractor’s duties and responsibilities under this Contract. Any and all Corrective Action, Sanctions, recovery amounts and enforcement actions are solely the responsibility of the Contractor.
(2) Contractor shall be offer contracts to all Medicaid eligible IHCPs in accordance with the provisions set forth belowarea they serve and provide access to specialty and primary care within their networks to CCO-enrolled Indian Health Services beneficiaries seen and referred by IHCPs, unless otherwise authorized in a written directive from regardless of the DirectorIHCPs status as contracted provider within the Contractor’s network.
(a) Such subcontracts shall require that all labor performed If the Contractor and all material furnished thereunder shall strictly comply IHCP do not reach an agreement on the terms of the contract within six months, the IHCP may request the assistance of a state representative to assist with all requirements negotiation of this Agreementthe contract.
(b) Each such subcontract shall incorporate The state will use an informal process to facilitate an in-person meeting with the material terms of this Agreement, including all addenda Contractor and appendices IHCP to it, and the DDCM Safety Requirements. Such subcontracts shall contain provisions approved in advance by the Director regarding, at least: (1) time for completion; (2) assessment of liquidated damages, (3) warranties and/or guarantees, (4) the provision required hereunder pertaining to assist with the resolution of disputes related to this Agreement, (5) M/WBE compliance, and (6) compliance with anti-discrimination provisionsissues.
(c) Each such subcontract shall require that If an informal process does not lead to an agreement, the Subcontractor who is party to it provide performance Contractor and payment bonds, each of which IHCP will use the existing dispute resolution process (OAR 410-141-3269). The informal process shall be in an amount equal to 100% of the subcontract price, used as guidance and shall name the Construction Manager as obligee thereunder. Such bonds shall will not be provided by a surety company licensed and authorized to do business in the State of New York. Such bonds shall be identical in all respects to the form of bonds attached hereto as Exhibit E, with no variations, additions, or deletions to such form of bonds. Premiums for required bonds must be included in the Subcontractor's bid price. The Subcontractor shall be required to submit two (2) originals of such bonds, one of which shall be submitted to CUCF by the Construction Manager immediately after receipt. With respect to performance and payment bonds submitted by Subcontractors hereunder, the Construction Manager agrees, immediately upon receipt of the bonds, to execute an irrevocable assignment in accordance with the form of assignment attached hereto as Exhibit F. The Construction Manager shall submit such executed assignment to CUCF at the time it submits the original bonds. As additional security for the faithful performance of such subcontracts, the Construction Manager shall deduct and retain from all subcontractor progress payments five percent (5%) of the amount certified to be due thereunderbinding.
(d) Each such subcontract shall require that Upon agreement of terms as addresses in (1)(b), Contractor and IHCP must finalize and approve the Subcontractor carry the types and amounts, proportionate to its subcontract, contract within 90 days of insurance set forth in this Agreement and Appendix I hereof. All required policies shall be in accordance with the terms and conditions set forth in this Agreement. Proof of insurance shall be provided to CUCF in accordance with this Agreementreaching an agreement.
(e) Each such subcontract shall contain the provisions set forth in the following articles of this Agreement, and shall require the Subcontractor’s compliance with the same.
(1) Article 10.4 (concerning substantial completion);
(2) Article 10.5 (concerning damages for delay and extensions of time);
(3) Article 10.6 The following requirements of this Contract may not be subcontracted:
(concerning payment)a) Oversight and monitoring of Quality Improvement activities; and
(b) Adjudication of final Appeals in a Member Grievance and Appeal process.
(4) Article 28 Contractor shall negotiate a rate of reimbursement with Fully Qualified Health Centers (concerning method FQHCs) and Rural Health Centers (RHCs) that is not less than the level and amount of payment which the Contractor would make for Extra Work);the same service(s) furnished by a Provider which is not a FQHC or RHC, consistent with the requirements of 42 USC
(5) Article 29 Contractor shall ensure that Subcontractors and Providers do not bill Members for services that are not covered under this Contract unless there is a full written disclosure or waiver (concerning also referred to as agreement to pay) on file signed by the Resolution Member, in advance of Disputes);the service being provided, in accordance with OAR 410-141-0420.
(6) Article 31 Contractor is prohibited from paying for an item or service (concerning omitted work);other than an emergency item or service, not including items or services furnished in an emergency room of a hospital) for home health care services provided by an agency or organization, unless the agency provides the state with a surety bond as specified in Section 1861(o)(7) of the Social Security Act.
(7) Article 38 (concerning Labor Law Requirements);Contractor shall provide every Provider or Subcontractor, at the time it enters into a contract or subcontract its OHA approved written procedures for its Grievance System and ensure compliance.
(8) Article 39 (concerning Payroll ReportsContractor shall monitor the Subcontractor’s performance on an ongoing basis and perform at least once a year a formal review of compliance with delegated responsibilities and Subcontractor performance, deficiencies or areas for improvement, in accordance with 42 CFR 438.230(b)(1);. As specific in the aforementioned CFRs, the
(9) Article Contractor’s written agreement with the Subcontractor shall:
(a) Provide for the termination of the Subcontract or imposition of other Sanctions by Contractor if the Subcontractor’s performance is inadequate to meet the requirements of this Contract; and
(b) Require Subcontractor to comply with the requirements of 42 CFR 438.6 that are applicable to the Work required under the subcontract; and
(concerning method c) Require Subcontractor to comply with all the requirements of Exhibit B, Part 8,
(d) Require Subcontractor to submit Valid Claims for services including all the fields and information needed to allow the claim to be processed without further information from the Provider, and within time frames that assure all corrections have been made within four months of the Date of Service. Contractor and its Subcontractors may, by mutual agreement, establish an alternative payment and retained percentages);schedule not to exceed the minimum requirements.
(10) Article 41 (concerning Noise Control Code Provisions);Contractor shall provide Members written notice of termination of any Subcontractor, within 15 days after receipt or issuance of the termination notice, to each Member who received his or her primary care from, or was seen on a regular basis by, the terminated Subcontractor.
(11) Article 45 Contractor shall meet, and require its Participating Providers to meet, OHP standards for timely access to care and services, taking into account the urgency of the need for services as specified in OAR 410-141-3220. This requirement includes the Participating Providers offering hours of operation that are not less than the hours of operation offered to Contractor’s commercial Members (concerning termination without causeas applicable);.
(12) Article 46 (concerning Contractor shall notify OHA in writing within 30 days of terminating any Subcontractor or Participating Provider contract when such termination for cause);is the result of failure to meet requirements under the contract, deficiencies identified through compliance monitoring of the Subcontractor or Participating Provider, or any other for-cause termination.
(13) Article 49 (concerning SuppliesMinority-Owned, Labor, Services, Materials, and Tax Exemption)
(14) Article 51 (concerning Locally Based Enterprise Program);
(15) Article 65 (concerning Ultra Low Sulfur Diesel Fuel)
(16) Article 66 (concerning Ultra Low Sulfur Diesel Fuel - Consolidated Construction Act); and
(17) Article 68 (concerning Participation by MinorityWoman-Owned and Women-Owned Emerging Small Business Enterprises)(“MWESB”) Participation.
(fa) Each such subcontract shall contain the same terms As noted in Oregon Executive Order 12-03: “Minority-owned and conditions with respect Woman-owned businesses continue to damage for delay, be a dynamic and not less than the following: The [name fast-growing sector of the SubcontractorOregon economy. Oregon is committed to creating an environment that supports the ingenuity and industriousness of Oregon’s Minority Business Enterprise [MBE] agrees and Woman Business Enterprise [WBE]. Emerging Small Business [ESB] firms are also an important sector of the state’s economy.”
(b) Contractor shall take reasonable steps, such as through a quote, bid, proposal, or similar process, to make no claim ensure that MWESB certified firms are provided an equal opportunity to compete for damages for delay and participate in the performance of any subcontracts under this Agreement occasioned by any act or omission by CUCF or by any Contract. If there may be opportunities for subcontractors to work on the Contract, it is the expectation of its representativesOHA that the Contractor will take reasonable steps to ensure that MWESB certified firms, as referenced on: ▇▇▇▇://▇▇▇.▇▇▇▇▇▇▇▇▇▇.▇▇▇/how-we-can-help/COBID/, are provided an equal opportunity to compete for and agrees that for all delays it shall be compensated fully by an extension of time to complete participate in the performance of the work, as provided hereinany subcontracts under this Contract.
(g) In removing all ambiguity concerning the resolution of every dispute between the Construction Manager and its Subcontractors related to the Project, each such subcontract shall contain the provision regarding the resolution of disputes set forth at Article 29 hereof, including, without limitation, the provision regarding the appeal from CUCF decisions as set forth at Article 29 hereof; such provisions shall apply to every dispute between the Subcontractor and the Construction Manager related to the Project. Excluding decisions that are the result of this dispute resolution process and are disputed by the Construction Manager or its Subcontractor, which the process requires to be appealed otherwise, either the Construction Manager or a Subcontractor must commence the resolution of a dispute pursuant to the provisions of this Article upon written notice to the other and to CUCF that such dispute will be resolved by CUCF.
(h) Such subcontracts shall require that the Subcontractor agree not to make any claim against CUCF, its officers, agents or employees, by reason of such subcontract or any acts or omissions of the Construction Manager; provided however, such restrictions shall not apply to (1) demands filed by Subcontractors pursuant to Article 10.6 hereof, or (2) disputes submitted by Subcontractors pursuant to dispute resolution provisions contained in the subcontract, as described in paragraph 10.2.2(g).
(i) Such subcontracts shall stipulate that the Subcontractor, without any further notification or other process, give its unconditional consent for its insurance carrier to release directly to CUCF documentation verifying its actual rate for workers’ compensation insurance.
Appears in 1 contract
Sources: Health Plan Services Contract
Subcontract Requirements. Subcontracts between the Construction Manager and Subcontractors for construction work for the Project shall be in accordance with the provisions set forth below, unless otherwise authorized in a written directive from the Director.
(a) Such subcontracts shall require that all labor performed and all material furnished thereunder shall strictly comply with all The requirements of this Agreement.
(b) Each such subcontract Section 13, Ex. B-Part 4 do not prevent the Contractor from including additional terms and conditions in its subcontracts to meet the legal obligations or system requirements of the Contractor. In no event shall incorporate Contractor delegate or otherwise assign to third parties the material responsibility for performing any Work required under this Contract without first entering into a Subcontract that complies with the terms of this AgreementContract. In all such instances, including Contractor shall, at a minimum, include all addenda and appendices to itof the following standards, terms, and the DDCM Safety Requirements. Such subcontracts shall contain provisions approved conditions in advance by the Director regarding, at least: all of its Subcontracts:
a. General Standards
(1) time for completion; Contractor shall ensure that all Subcontracts are: (2i) assessment of liquidated damagesin writing, (3) warranties and/or guaranteesii)specify the Subcontracted Work and reporting responsibilities, (4iii) comply the provision required hereunder pertaining to the resolution of disputes related to requirements described below in this AgreementS. 13, (5) M/WBE complianceEx. B-Part 4 and any other requirements identified in this Contract, and (6iv) compliance with anti-discrimination provisions.
(c) Each such subcontract shall require that incorporate the Subcontractor who is party applicable provisions of this Contract, based on the scope of Work subcontracted. Contractor must evaluate all prospective Subcontractors’ readiness and ability to it provide performance and payment bonds, each perform the scope of which shall be in an amount equal to 100% of the subcontract price, and shall name the Construction Manager as obligee thereunder. Such bonds shall be provided by a surety company licensed and authorized to do business in the State of New York. Such bonds shall be identical in all respects to the form of bonds attached hereto as Exhibit E, with no variations, additions, or deletions to such form of bonds. Premiums for required bonds must be included in the Subcontractor's bid price. The Subcontractor shall be required to submit two (2) originals of such bonds, one of which shall be submitted to CUCF by the Construction Manager immediately after receipt. With respect to performance and payment bonds submitted by Subcontractors hereunder, the Construction Manager agrees, immediately upon receipt of the bonds, to execute an irrevocable assignment in accordance with the form of assignment attached hereto as Exhibit F. The Construction Manager shall submit such executed assignment to CUCF at the time it submits the original bonds. As additional security for the faithful performance of such subcontracts, the Construction Manager shall deduct and retain from all subcontractor progress payments five percent (5%) of the amount certified to be due thereunder.
(d) Each such subcontract shall require that the Subcontractor carry the types and amounts, proportionate to its subcontract, of insurance set forth in this Agreement and Appendix I hereof. All required policies shall be in accordance with the terms and conditions set forth in this Agreement. Proof of insurance shall be provided to CUCF in accordance with this Agreement.
(e) Each such subcontract shall contain the provisions Work set forth in the following articles of this Agreement, and shall require the Subcontractor’s compliance with the same.
(1) Article 10.4 (concerning substantial completion);applicable Subcontract
(2) Article 10.5 (concerning damages Contractor shall ensure that all Subcontractors are screened for delay and extensions of time);exclusion from participation in federal programs. In the event a Subcontractor is so excluded, Contractor is prohibited from subcontracting to such Subcontractor any Work or obligations required to be performed under this Contract. .
(3) Article 10.6 (concerning payment)Contractor shall ensure that all Subcontractors undergo a criminal background check prior to starting any work identified in this Contract.
(4) Article 28 (concerning method of payment for Extra Contractor shall not have the right to Subcontract certain obligations and Work required to be performed under in this Contract. Work);
(5) Article 29 (concerning the Resolution of Disputes);
(6) Article 31 (concerning omitted work);
(7) Article 38 (concerning Labor Law Requirements);
(8) Article 39 (concerning Payroll Reports);
(9) Article 42 (concerning method of payment and retained percentages);
(10) Article 41 (concerning Noise Control Code Provisions);
(11) Article 45 (concerning termination without cause);
(12) Article 46 (concerning termination for cause);
(13) Article 49 (concerning Supplies, Labor, Services, Materialsactivities, and Tax Exemption)
(14) Article 51 (concerning Locally Based Enterprise Program);
(15) Article 65 (concerning Ultra Low Sulfur Diesel Fuel)
(16) Article 66 (concerning Ultra Low Sulfur Diesel Fuel - Consolidated Construction Act); and
(17) Article 68 (concerning Participation by Minority-Owned and Women-Owned Business Enterprises).
(f) Each such subcontract other obligations that Contractor shall contain the same terms and conditions with respect to damage for delay, and not less than the following: The [name of the Subcontractor] agrees to make no claim for damages for delay in the performance of Subcontract are identified throughout this Agreement occasioned by any act or omission by CUCF or by any of its representatives, and agrees that for all delays it shall be compensated fully by an extension of time to complete performance of the work, as provided herein.
(g) In removing all ambiguity concerning the resolution of every dispute between the Construction Manager and its Subcontractors related to the Project, each such subcontract shall contain the provision regarding the resolution of disputes set forth at Article 29 hereof, including, without limitation, the provision regarding the appeal from CUCF decisions as set forth at Article 29 hereof; such provisions shall apply to every dispute between the Subcontractor and the Construction Manager related to the ProjectContract. Excluding decisions that are the result of this dispute resolution process and are disputed by the Construction Manager or its Subcontractor, which the process requires to be appealed otherwise, either the Construction Manager or a Subcontractor must commence the resolution of a dispute pursuant Subject to the provisions of this Article upon Section 13, Ex. B-Part 4, Contractor may Subcontract obligations and Work required to be performed under this Contract that is not expressly identified as an exclusion. In accordance with 42 CFR §438.230(b)(1), no Subcontract may terminate or limit Contractor’s legal responsibility to OHA for the timely and effective performance of Contractor’s duties and responsibilities under this Contract. A breach of this Contract by a Subcontractor shall be deemed a breach of Contractor and Contractor shall be liable for such Subcontractor breach. Any and all Corrective Action, Sanctions (as defined in Ex. B-Part 9, S. 1, P. b. ), Recoupment, Withholding and other recovered amounts and enforcement actions are solely the responsibility of the Contractor. Contractor retains all legal responsibility and shall not have the right to Subcontract the responsibility for monitoring and oversight of Subcontracted activities. Contractor retains, In accordance with 42 CFR §438.230(b)(1), remains liable for fully complying with all terms and conditions of this Contract.
(5) Contractor shall document provide, at the time the proposed Subcontract is provided to OHA under SP.(1), of this P.a, S.13 of this Ex. B-Part 4, a summary in list form of all activities required to be performed under this Contract that have been subcontracted to a Subcontractor in the applicable Subcontract (“Subcontractor Report”). The Subcontractor Report shall also include all of the following:
(a) The legal name of the Subcontractor;
(b) The scope of Work being subcontracted;
(c) Copies of ownership disclosure form, if applicable;
(d) Copies of all written notice agreements with Subcontractors to ensure all contracts meet the requirements outlined in 42 CFR §438.230;
(e) Any ownership stake between Contractor and the Subcontractor.
(6) In addition to the obligations identified as being precluded from subcontracting in this S. 13, Ex. D-Part 4 of this Contract and in any other provision of this Contract, the following obligations of Contractor under this Contract shall not be subcontracted or otherwise delegated to a third party:
(a) Oversight and monitoring of Quality Improvement activities; and
(b) Adjudication of Appeals in a Member Grievance and Appeal process.
(7) If deficiencies are identified in Subcontractor performance for any functions outlined in this Contract, whether those deficiencies are identified by Contractor, by OHA, or their designees, Contractor agrees to CUCF require its Subcontractor to respond and remedy those deficiencies within the timeframe determined by OHA. Such obligations and timeframes shall be included in all subcontracts.
(8) Contractor shall ensure that Subcontractors and Providers do not bill Members for services that are not covered under this Contract unless there is a full written disclosure or waiver (also referred to as agreement to pay) on file signed by the Member, in advance of the service being provided, in accordance with OAR 410-141-0420.
(9) In accordance with Exhibit I of this Contract, Contractor shall provide every Provider and Subcontractor, at the time it enters into a contract or Subcontract its OHA-approved written procedures for its Grievance and Appeal System and ensure compliance with all federal and State requirements for Member Grievance and Appeals.
(10) Contractor shall monitor the Subcontractor’s performance on an ongoing basis and perform at least once a year a formal, written review of compliance of all subcontracted obligations and other responsibilities, Subcontractor performance, deficiencies or areas for improvement (“Annual Subcontractor Performance Report”). Such review and report shall determine whether a Subcontractor has complied with all the terms and conditions of this Contract that are applicable to the Work performed by Subcontractor .
(11) The Annual Subcontractor Report must include at a minimum the following elements:
(a) An assessment of the quality of Subcontractor’s performance of contracted Work;
(b) Any complaints or Grievances filed in relation to Subcontractor’s Work;
(c) Any late submission of reporting deliverables or incomplete data;
(d) Whether employees of the Subcontractor are screened and monitored for federal exclusion from participation in Medicaid;
(e) The adequacy of Subcontractor’s compliance functions; and
(f) Any deficiencies that have been identified by OHA related to work performed by Subcontractor.
(12) Contractor shall provide, via Administrative Notice, OHA’s Contract Administrator with a copy of the Annual Subcontractor Report within thirty (30) days of completion. Contractor shall oversee and be responsible for the satisfactory performance of any functions or responsibilities it has delegated to a Subcontractor.
(13) In the event Contractor identifies deficiencies or areas for improvement, Contractor shall cause Subcontractor to take Corrective Action. In addition, Contractor shall provide, via Administrative Notice, OHA’s Contract Administrator with a copy of the Corrective Action Plan documenting the deficiencies, actions required of the Subcontractor to remedy the deficiencies, and the time frame for completing such dispute required actions. The foregoing Administrative Notice shall be made within 14 days after providing the Corrective Action Plan to the applicable Subcontractor.
(14) Contractor shall provide OHA’s Contract Administrator, via Administrative Notice, with an update on the status of the Corrective Action Plan at such time that the Subcontractor
b. Requirements for Written Agreements with Subcontractors
(1) Contractor’s written agreement with the Subcontractor shall:
(a) Provide for the Provider termination of the Subcontract or imposition of other Sanctions by Contractor if the Subcontractor’s performance is inadequate to meet the requirements of this Contract;
(b) Provide for revocation of the delegation of activities or obligations, and specify other remedies in instances where OHA or the Contractor determine the Subcontractor has breached the terms of the Subcontract ;
(c) Require Subcontractor to comply with the requirements of 42 CFR §438.6 that are applicable to the Work required under the Subcontract;
(d) Require Subcontractor to submit Valid Claims for services including all the fields and information needed to allow the claim to be processed without further information from the Provider within timeframes for Encounter Data submission outlined in other sections of this contract;
(e) Specify that the Subcontractor agrees to comply with all applicable Medicaid laws, regulations, including applicable sub-regulatory guidance and contract provisions;
(f) Specify that the Subcontractor agrees that OHA, CMS, the HHS Inspector General or their designees have the right to audit, evaluate, and inspect any books, records, contracts, computers or other electronic systems of the Subcontractor, or of the Subcontractor's contractor, that pertain to any aspect of services and activities performed, or determination of amounts payable under the CCO’s Contract with OHA;
(g) Specify that the Subcontractor will be resolved by CUCF.make available, for purposes of audit, evaluation, or inspection its premises, physical facilities, equipment, books, records, contracts, computer, or other electronic systems relating to its Medicaid Members;
(h) Such subcontracts shall require Specify that the Subcontractor agree not must respond and comply in a timely manner to make any claim against CUCFrequests from OHA or its designee for information or documentation pertaining to work outlined in this contract;
(i) Specify that the Subcontractor agrees that the right to audit by ▇▇▇, its officersCMS, agents the DHHS Inspector General, the Comptroller General or employeestheir designees, by reason of such subcontract or any acts or omissions will exist through 10 years from the final date of the Construction Managercontract period or from the date of completion of any audit, whichever is later; provided howeverand
(j) Specify that if OHA, such restrictions shall not apply to (1) demands filed by Subcontractors pursuant to Article 10.6 hereofCMS, or the DHHS Inspector General determine that there is a reasonable possibility of fraud or similar risk, OHA, CMS, or the DHHS Inspector General may inspect, evaluate, and audit the Subcontractor at any time.
(2) disputes submitted by In the event Contractor issues or receives notice that a Subcontractor’s Subcontract has been terminated, Contractor shall provide, within 15 days after receipt or issuance of the termination notice, written notice of such termination to the Members who received regular care or primary care from the terminated Subcontractor.
(3) Contractor shall meet, and require its Subcontractors pursuant and Participating Providers to dispute resolution provisions contained meet, OHP standards for timely access to care and services, taking into account the urgency of the need for services as specified in OAR 410-141-3220. This requirement includes the subcontract, Participating Providers offering hours of operation that are not less than the hours of operation offered to Contractor’s commercial Members (as described in paragraph 10.2.2(gapplicable).
(i4) Such subcontracts Contractor shall stipulate that provide Administrative Notice to OHA within 30 days of terminating any Subcontractor and include with such Administrative Notice an updated Subcontractors and Delegated Entities Report. Contractor shall provide Administrative Notice to OHA’s Provider Services Unit within 30 days of terminating any Participating Provider contract when such Provider termination is a for-cause termination, including but not limited to the following:
(a) Failure to meet requirements under the Contract or Contractor’s Subcontract with its Subcontractor;
(b) For reasons related to fraud, without any further notification integrity, or quality;
(c) Deficiencies identified through compliance monitoring of the entity; or
(d) Any other process, give its unconditional consent for its insurance carrier to release directly to CUCF documentation verifying its actual rate for workers’ compensation insurancefor-cause termination.
Appears in 1 contract
Sources: Health Plan Services Contract