OF PERFORMANCE BOND
76
50.
ACCUMULATED FUND DEFICIT
76
51.
ADVANCES, DISTRIBUTIONS, LOANS AND INVESTMENTS
76
52.
FINANCIAL VIABILITY STANDARDS
77
53.
SEPARATE INCORPORATION
78
54.
MERGER, REORGANIZATION AND CHANGE OF OWNERSHIP
78
55.
COMPENSATION
78
56.
PAYMENTS TO CONTRACTORS
80
57.
CAPITATION ADJUSTMENTS
81
58.
MEMBER BILLING AND LIABILITY FOR PAYMENT
82
59.
REINSURANCE
82
60.
COORDINATION OF BENEFITS
86
61.
COPAYMENTS
90
62.
MEDICARE SERVICES AND COST SHARING
90
63.
MARKETING
91
64.
CORPORATE COMPLIANCE
91
65.
RECORDS RETENTION
92
66.
DATA EXCHANGE REQUIREMENTS
93
67.
ENCOUNTER DATA REPORTING
94
68.
ENROLLMENT AND CAPITATION TRANSACTION UPDATES
95
69.
PERIODIC REPORT REQUIREMENTS
96
70.
REQUESTS FOR INFORMATION
96
71.
DISSEMINATION OF INFORMATION
96
72.
OPERATIONAL AND FINANCIAL READINESS REVIEWS
96
73.
OPERATIONAL AND FINANCIAL REVIEWS
97
74.
SANCTIONS
97
75.
BUSINESS CONTINUITY AND RECOVERY PLAN
99
76.
TECHNOLOGICAL ADVANCEMENT
99
77.
PENDING LEGISLATIVE / OTHER ISSUES
99
78.
RESERVED
100
79.
RESERVED
100
80.
RESERVED
100
SECTION E: CONTRACT TERMS AND CONDITIONS
101
1)
APPLICABLE LAW
101
2)
AUTHORITY
101
3)
ORDER OF PRECEDENCE
101
4)
CONTRACT INTERPRETATION AND AMENDMENT
101
5)
SEVERABILITY
101
6)
RELATIONSHIP OF PARTIES
101
7)
ASSIGNMENT AND DELEGATION
101
8)
INDEMNIFICATION
102
9)
INDEMNIFICATION -- PATENT AND COPYRIGHT
102
10)
COMPLIANCE WITH APPLICABLE LAWS, RULES AND REGULATIONS
102
11)
ADVERTISING AND PROMOTION OF CONTRACT
102
12)
PROPERTY OF THE STATE
103
13)
THIRD PARTY ANTITRUST VIOLATIONS
103
14)
RIGHT TO ASSURANCE
103
15)
TERMINATION FOR CONFLICT OF INTEREST
103
16)
GRATUITIES
103
17)
SUSPENSION OR DEBARMENT
103
18)
TERMINATION FOR CONVENIENCE
104
19)
TEMPORARY MANAGEMENT/OPERATION OF A CONTRACTOR AND TERMINATION
104
20)
TERMINATION - AVAILABILITY OF FUNDS
105
21)
RIGHT OF OFFSET
105
22)
NON-EXCLUSIVE REMEDIES
105
23)
NON-DISCRIMINATION
105
24)
EFFECTIVE DATE
105
25)
INSURANCE
105
26)
DISPUTES
106
27)
RIGHT TO INSPECT PLANT OR PLACE OF BUSINESS
106
28)
INCORPORATION BY REFERENCE
107
29)
COVENANT AGAINST CONTINGENT FEES
107
30)
CHANGES
107
31)
TYPE OF CONTRACT
107
32)
AMERICANS WITH DISABILITIES ACT
107
33)
WARRANTY OF SERVICES
107
34)
NO GUARANTEED QUANTITIES
107
35)
CONFLICT OF INTEREST
107
36)
CONFIDENTIALITY AND DISCLOSURE OF CONFIDENTIAL INFORMATION
107
37)
COOPERATION WITH OTHER CONTRACTORS
108
38)
ASSIGNMENT OF CONTRACT AND BANKRUPTCY
108
39)
OWNERSHIP OF INFORMATION AND DATA
108
40)
AUDITS AND INSPECTIONS
109
41)
LOBBYING
109
42)
CHOICE OF FORUM
109
43)
DATA CERTIFICATION
109
44)
OFF SHORE PERFORMANCE OF WORK PROHIBITED
109
45)
FEDERAL IMMIGRATION AND NATIONALITY ACT
109
46)
IRS W-9 FORM
110
47)
CONTINUATION OF PERFORMANCE THROUGH TERMINATION
110
SECTION F: RESERVED
111
SECTION G: RESERVED
112
SECTION H: RESERVED
113
SECTION I: RESERVED
114
SECTION J: LIST OF ATTACHMENTS
115
ATTACHMENT A: RESERVED
116
ATTACHMENT B: MINIMUM NETWORK STANDARDS (BY GEOGRAPHIC SERVICE AREA)
117
ATTACHMENT C: RESERVED
128
ATTACHMENT D: SAMPLE LETTER OF INTENT
129
ATTACHMENT E: RESERVED
134
ATTACHMENT F: CONTRACTORS CHART OF DELIVERABLES
135
ATTACHMENT G: AUTO-ASSIGNMENT ALGORITHM
143
ATTACHMENT H(1): ENROLLEE GRIEVANCE SYSTEM STANDARDS AND POLICY
147
ATTACHMENT H(2): PROVIDER CLAIM DISPUTE STANDARDS AND POLICY