Fully executed agreement - Laserfiche WebLink

Home Browse Search

that such individual agrees to assume responsibility for providing inpatient Covered Services to Covered Psrsons who are patients of the applicable Practitioner. 2.2 Acceptance of New Patisnts, To the extent that Practitioner is accepting new patients, such Practitioner must also accept new patients who are Covered Persons with respect to the Produots in which such Practitioner participates. Practitioner shall notify Company in writing 45 days prior to such Practitioner's decision to no longer accept Covered Persons with respect to a particular Product. In no event will an established patient of any Practitioner be considered a new patient. 2.3 Prefened Drug Lisj/Drug Formulary. If applicable to the Covered Person's coverage, Practitioners shall use commercially reasonable efforts, when medically appropriate under the circurnstances, to comply with formulary or preferrecl drug list when prescribing medications for Covered Persons. 2.4 National Committee for Ouality Asswance ("NCO.A'l Accrediiation of Health Plans Standmds. Each Practitioner agrees to: i) cooperate with Quality Management and }nprovement ('QI") activities; ii) maintain the confidentiality of a Covered Persons information and records pursuant to the Agreement; and iii) ailow the Company to use Practitioner's performance data. 3, Ancillary Providers, If Provider or Contuacted Provider is an ancillary provider (including but not limited to a chemical dependency services provider, residsntial treatme,lrt facility/behavioral health agency, home health agency, durable medical equipment provider, sleql center, pharmacy, ambulatory srrrgery center, nursing facilitS laboratory, correctional facilities, or urgent care center) ('Ancillary Provider'), the following provisions apply: 3.1 Acceptance ofNew Patients. To the extent tbat Ancillary Provider is accepting new patients, such Ancillary Provicler must also accept new patients who are Covered Persons with rospect to the Products in which such Anci11ary Provider participates. Ancillary Provider shall noti$r Company in writing 45 days prior to such Anciliary Provider's decision to no longer accept Covered Persons with respect to a particular Product. In no event will an established patient of any Ancillary Provider be considered a new patient. 3.2 Nationa-l-Committee fo-r Ouali8 Assurance ("NCOA") Accreditation of I{ealth Plans Standards. Each ancillary provider agrees to: i) cooperate with Quality Management and Improvement ('QI') activities; ii) maintain the confidentiality of a Covered Persons information and records purzuant to the Agreemort; and iii) allow the Company to use ancillary provider's performance data. 4. FQI{C. If Provider or a Contracted Provider is a federally qualified health center ('FQHC"), the following provision applies: 4.1 FQHC"Insurance. To the extent FQHC's employees are deemed to be federai employees qualified for protection under the Federal Tort Claims Act ("FTCA') and }lealth Plan has been provided with clocumentation of such status issued bytheU.S. Department ofHealth andHuman Services (suoh status to be referred to as 'TTCA Coverage"), Section 5.1 of this Agreement will not apply to those Contracted Providers with FTCA Coverage , FQFIC shall provide evidence of suc.h FTCA Coverage to Healft Plan at any time upon request. FQHC shall promptly notifu Heaith I'lan i{ any time during the term of this Agreement, any Contracted Provider is no longer eligible for, or if FQFIC becomes aware of any fact or circumstance that would jeopardize FTCA Coverag€. Section 5.1ofthisAgroementwillapplytoaContractedProviderimmediatelyuponsuchContractedProvider'slossofFTCA Coverage for any reason. 5. Facility Providers. . If Provider or a Contracted Provider is a faoility (including but not limited to clinic, FQI{C, long-term aoute carc (LTAC), nursing home, rehabilitation, nral health clinic (RHC), skilled nnsing) ('Tacility Provider') the fbllowing provision applies: PPA WA - Kittitas County Public Healrh - 05.07 .2A25 - ICMProvi<lerAgreernenl360268 Page?A of24