HEALTH CLINICS
76
35.
PROVIDER MANUAL
77
36.
PROVIDER REGISTRATION
77
37.
SUBCONTRACTS
77
38.
CLAIMS PAYMENT/HEALTH INFORMATION SYSTEM
80
39.
SPECIALTY CONTRACTS
83
40.
HOSPITAL SUBCONTRACTING AND REIMBURSEMENT
83
41.
RESPONSIBILITY FOR NURSING FACILITY REIMBURSEMENT
83
42.
INCENTIVES/PAY FOR PERFORMANCE
84
43.
MANAGEMENT SERVICES AGREEMENT AND COST ALLOCATION PLAN
85
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Acute Care Contract
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44.
MATERIAL CHANGE TO OPERATIONS
85
45.
MINIMUM CAPITALIZATION
85
46.
PERFORMANCE BOND OR BOND SUBSTITUTE
85
47.
AMOUNT OF PERFORMANCE BOND
86
48.
ACCUMULATED FUND DEFICIT
86
49.
ADVANCES, DISTRIBUTIONS, LOANS AND INVESTMENTS
86
50.
FINANCIAL VIABILITY STANDARDS
87
51.
SEPARATE INCORPORATION
88
52.
MERGER, ACQUISITION, REORGANIZATION, JOINT VENTURE AND CHANGE OF
OWNERSHIP
88
53.
COMPENSATION
88
54.
PAYMENTS TO CONTRACTORS
91
55.
CAPITATION ADJUSTMENTS
91
56.
MEMBER BILLING AND LIABILITY FOR PAYMENT
93
57.
REINSURANCE
93
58.
COORDINATION OF BENEFITS/THIRD PARTY LIABILITY
97
59.
COPAYMENTS
99
60.
MEDICARE SERVICES AND COST SHARING
99
61.
MARKETING
100
62.
CORPORATE COMPLIANCE
100
63.
RECORDS RETENTION
103
64.
SYSTEMS AND DATA EXCHANGE REQUIREMENTS
104
65.
ENCOUNTER DATA REPORTING
106
66.
ENROLLMENT AND CAPITATION TRANSACTION UPDATES
107
67.
PERIODIC REPORTING REQUIREMENTS
108
68.
REQUESTS FOR INFORMATION
109
69.
DISSEMINATION OF INFORMATION
109
70.
OPERATIONAL AND FINANCIAL READINESS REVIEWS
109
71.
OPERATIONAL REVIEWS
109
72.
SANCTIONS
110
73.
BUSINESS CONTINUITY AND RECOVERY PLAN
110
74.
MEDICARE REQUIREMENTS
111
75.
PENDING LEGISLATION/OTHER ISSUES
112
76.
PAYMENT REFORM
114
SECTION E: CONTRACT TERMS AND CONDITIONS
115
1.
ADVERTISING AND PROMOTION OF CONTRACT
115
2.
APPLICABLE LAW
115
3.
ARBITRATION
115
4.
ASSIGNMENT AND DELEGATION
115
5.
ASSIGNMENT OF CONTRACT AND BANKRUPTCY
115
6.
AUDITS AND INSPECTIONS
115
7.
AUTHORITY
115
8.
CHANGES
115
9.
CHOICE OF FORUM
116
10.
COMPLIANCE WITH APPLICABLE LAWS, RULES AND REGULATIONS
116
11.
CONFIDENTIALITY AND DISCLOSURE OF CONFIDENTIAL INFORMATION
116
12.
CONFLICT OF INTEREST
116
13.
CONTINUATION OF PERFORMANCE THROUGH TERMINATION
117
14.
CONTRACT
117
15.
CONTRACT INTERPRETATION AND AMENDMENT
117
16.
COOPERATION WITH OTHER CONTRACTORS
117
17.
COVENANT AGAINST CONTINGENT FEES
117
18.
DATA CERTIFICATION
117
19.
DISPUTES
117
20.
E-VERIFY REQUIREMENTS
118
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Acute Care Contract
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21.
EFFECTIVE DATE
118
22.
FEDERAL IMMIGRATION AND NATIONALITY ACT
118
23.
GRATUITIES
118
24.
INCORPORATION BY REFERENCE
118
25.
INDEMNIFICATION
118
26.
INDEMNIFICATION - PATENT AND COPYRIGHT
119
27.
INSURANCE
119
ATTACHMENT E-1
120
28.
IRS W9 FORM
124
29.
LOBBYING
124
30.
NO GUARANTEED QUANTITIES
124
31.
NON-DISCRIMINATION
124
32.
NON-EXCLUSIVE REMEDIES
124
33.
OFF-SHORE PERFORMANCE OF WORK PROHIBITED
124
34.
ORDER OF PRECEDENCE
124
35.
OWNERSHIP OF INFORMATION AND DATA
125
36.
RESERVED
125
37.
RELATIONSHIP OF PARTIES
125
38.
RIGHT OF OFFSET
125
39.
RIGHT TO ASSURANCE
125
41.
RESERVED
125
42.
SEVERABILITY
125
43.
SUSPENSION OR DEBARMENT
126
44.
TEMPORARY MANAGEMENT/OPERATION OF A CONTRACTOR AND TERMINATION
126
45.
TERM OF CONTRACT AND OPTION TO RENEW
127
46.
TERMINATION - AVAILABILITY OF FUNDS
128
47.
TERMINATION FOR CONFLICT OF INTEREST
128
48.
TERMINATION FOR CONVENIENCE
128
49.
THIRD PARTY ANTITRUST VIOLATIONS
128
50.
TYPE OF CONTRACT
128
51.
WARRANTY OF SERVICES
128
SECTION