State of california

Subcontracts.

1. 
   No subcontract terminates the legal responsibility of the Contractor to the Department to assure that all activities under this contract are carried out.
   

2. 
   All subcontracts shall be in writing.
   

3. 
   All inpatient subcontracts shall require that subcontractors maintain necessary licensing and certification.
   

4. 
   Each subcontract shall contain:
   

1. 
   Full disclosure of the method and amount of compensation or other consideration to be received by the subcontractor from the Contractor.
   

2. 
   Specification of the services to be provided.
   

3. 
   Specification that the subcontract shall be governed by, and construed in accordance with, all laws and regulations, and all contractual obligations of the Contractor under this contract.
   

4. 
   Specification of the term of the subcontract including the beginning and ending dates, as well as methods for amendment, termination and, if applicable, extension of the subcontract. The subcontract must be subject to full or partial termination if the subcontractor’s performance is inadequate.
   

5. 
   The nondiscrimination and compliance provisions of this contract as described in Exhibit D, Section 6.
   

6. 
   Subcontractor's agreement to submit reports as required by the Contractor.
   

7. 
   The subcontractor's agreement to make all of its books and records pertaining to the goods and services furnished under the terms of the subcontract available for inspection, examination or copying by the Department, DHCS, HHS, the Comptroller General of the United States, and other authorized federal and state agencies, or their duly authorized representatives. The subcontract shall also state that inspection shall occur at all reasonable times, at the subcontractor's place of business, or at such other mutually agreeable location in California, in a form maintained in accordance with the general standards applicable to such book or record keeping, for a term of at least five years from the close of the state fiscal year in which the subcontract was in effect.
   

8. 
   Subcontractor’s agreement that assignment or delegation of the subcontract shall be void unless prior written approval is obtained from the Contractor.
   

9. 
   Subcontractor’s agreement to hold harmless both the State and beneficiaries in the event the Contractor cannot or does not pay for services performed by the subcontractor pursuant to the subcontract.
   

10. 
    The subcontractor's agreement to comply with the Contractor's policies and procedures on advance directives and the Contractor's obligations for Physician Incentive Plans, if applicable based on the services provided under the subcontract.
    

11. 
    A requirement that the Contractor’s monitor the subcontractor and the subcontractor’s obligation to provide a corrective action plan if deficiencies are identified.
    

15. Program Integrity Requirements.

1. 
   The Contractor shall comply with the provisions of Title 42, CFR, Sections 438.604, 438.606 and 438.608, regarding the certification of accurate data submitted by the Contractor to the State and which require the Contractor to have administrative or management arrangements or procedures designed to guard against fraud and abuse.
   

2. 
   The Contractor shall comply with the provisions of Title 42, CFR, Section 438.610, which relate to prohibited affiliations with individuals or affiliates of individuals debarred, suspended, or otherwise excluded from participating in procurement activities under the Federal Acquisition Regulation or from participating in non-procurement activities under regulations issued under Executive Order No. 12549 or under the guidelines implementing Executive Order No. 12549.
   

3. 
   Pursuant to Title 42, CFR, Section 438.214(d), the Contractor shall not employ or contract with providers or other individuals and entities excluded from participation in federal health care programs (as defined in section 1128B(f) of the Social Security Act) under either Section 1128, 1128A, or 1156 of the Social Security Act. Federal financial participation is not available for amounts expended for providers excluded by Medicare, Medicaid, or the State Children's Insurance Program, except for emergency services.
   

4. 
   The Contractor shall periodically check the Office of the Inspector General’s List of Excluded Individuals/Entities and the Medi Cal Suspended and Ineligible Provider List (S & I List) to prevent employment of, or payments to, any individuals or entities on those lists, and per DMH Letter Number 10-05, this must be satisfied prior to Medi-Cal certification of any individual or organizational provider. If the provider is listed on either the Office of the Inspector General’s List of Excluded Individuals/Entities or the Medi Cal S & I List, the Contractor shall not certify or pay any provider with Medi-Cal funds, and any such inappropriate payments or overpayments may be subject to recovery and/or be the basis for other sanctions by the appropriate authority.
   

5. 
   Report. Pursuant to 42 CFR, Section 455.1(a)(1), the Contractor must report fraud and abuse information to the Department.
   

1. 
   If the Contractor identifies an issue or receives notification of a complaint concerning an incident of possible potential fraud or abuse, the Contractor shall conduct an internal investigation to determine the validity of the issue/complaint, regarding potential fraud and/or abuse, and develop and implement corrective action, if needed. The majority of potential fraud or abuse issues are expected to be resolved at the Contractor level.
   
2. 
   If the Contractor’s internal investigation concludes that fraud or abuse has occurred or is suspected, the issue is egregious, or beyond the scope of the Contractor’s ability to pursue, the Contractor shall report the issue to the Department for review and disposition.
   
3. 
   The Department is to be notified if the Contractor discontinues a provider contract or disciplines a provider due to a fraud or abuse issue. The Department will, in turn, notify DHCS.
   

6. 
   Service Verification. Pursuant to Title 42, CFR, Section 455.1(a)(2), the Contractor shall have a way to verify with beneficiaries that services were actually provided.
   

7. 
   Conflict of Interest. The contract specifies conflict of interest safeguards for officers and employees of the state and local entity, with responsibilities relating to contracts with MCOs and/or to the default enrollment process under the State Plan Amendment option that are at least as effective as the federal safeguards found under Section 27 of the Office of Federal Procurement Policy Act (41 USC 423).
   

1. 
   The Contractor will disclose the name, address, date of birth, and Social Security Number of any managing employee, as that term is defined in Title 42, CFR, Section 455.101. However, for purposes of this disclosure, Contractor may use the business address for any member of its Board of Supervisors.
   

2. 
   The Contractor shall provide any such disclosure upon execution of this contract, upon its extension or renewal, and within 35 days after any change in Contractor ownership or upon request of the Department or DHCS.
   

2) The Contractor shall ensure that its subcontractors/network providers submit the disclosures below to the Contractor regarding the network providers’ (disclosing entities’) ownership and control. The Contractor's network providers must be required to submit updated disclosures to the Contractor upon submitting the provider application, before entering into or renewing the network providers’ contracts, and within 35 days after any change in the subcontractor/network provider’s ownership or upon request of the Department or DHCS.

a. What Disclosures Must be Provided:

1. 
   The name and address of any person (individual or corporation) with an ownership or control interest in the network provider. The address for corporate entities shall include, as applicable, a primary business address, every business location, and a P.O. Box address;
   

2. 
   Date of birth and Social Security Number (in the case of an individual);
   

3. 
   Other tax identification number (in the case of a corporation with an ownership or control interest in the managed care entity or in any subcontractor in which the managed care entity has a 5 percent or more interest);
   

4. 
   Whether the person (individual or corporation) with an ownership or control interest in the Contractor’s network provider is related to another person with ownership or control interest in the same or any other network provider of the Contractor as a spouse, parent, child, or sibling; or whether the person (individual or corporation) with an ownership or control interest in any subcontractor in which the managed care entity has a 5 percent or more interest is related to another person with ownership or control interest in the managed care entity as a spouse, parent, child, or sibling;
   

5. 
   The name of any other disclosing entity in which the Contractor or subcontracting network provider has an ownership or control interest; and
   

6. 
   The name, address, date of birth, and Social Security Number of any managing employee of the managed care entity.
   

3) To Whom Must the Disclosures be Provided. All disclosures must be provided to the Medicaid agency.

1) The following information must be disclosed:

1. 
   The ownership of any subcontractor with whom the Contractor has had business transactions totaling more than $25,000 during the 12-month period ending on the date of the request; and,
   

2. 
   Any significant business transactions between the Contractor and any wholly owned supplier, or between the Contractor and any subcontractor, during the 5-year period ending on the date of the request.
   

2. 
   Contractor must obligate Network Providers to submit the same disclosures regarding network providers’ as noted under subsection 1(a) and (b) within 35 days upon request.
   

C. Disclosures Related to Persons Convicted of Crimes – Contractor shall submit the following disclosures to the Department regarding the Contractor’s management:

1. 
   The identity of any person who is a managing employee of the Contractor who has been convicted of a crime related to federal health care programs. (Title 42, CFR, Section 455.106(a)(1), (2).)
   

2. 
   The identity of any person who is an agent of the Contractor who has been convicted of a crime related to federal health care programs. (Title 42, CFR, Section 455.106(a)(1), (2).) For this purpose, the word "agent" has the meaning described in Title 42, CFR, Section 455.101.
   

3. 
   The Contractor shall supply the disclosures before entering into the contract and at any time upon the Department‘s request.
   

1. 
   Network providers should submit the same disclosures to Contractor regarding the network providers’ owners, persons with controlling interest, agents, and managing employees’ criminal convictions. Network providers shall supply the disclosures before entering into the contract and at any time upon the Department’s request.