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Docusign Envelope lD: CEBC6B3C-DFA1-4B6C-AFE8-6A4A634400B0 <br />Medicare Advantage Organization ("MA organization"): a public or private entity organized and <br />licensed by a State as a risk-bearing entity (with the exception of provider-sponsored organizations <br />receiving waivers) that is certified by CMS as meeting the MA contract requirements. CFIPW is <br />the MA organization for purposes of this Agreement. <br />Member or Enrollee: for purposes of this Agreement, is a Medicare Advantage eligible individual <br />who has enrolled in or elected coverage through CFIPW. <br />Provider: (1) any individual who is engaged in the delivery of health care services in a State and is <br />licensed or certified by the State to engage in that activity in the State; and (2) any entity that is <br />engaged in the delivery of health care services in a State and is licensed or certified to deliver those <br />services if such licensing or certification is required by State law or regulation. <br />Related entity: any entity that is related to the MA organization by common ownership or control <br />and (l) performs some of the MA organization's management functions under contract or <br />delegation; (2) furnishes services to Medicare enrollees under an oral or written agreement; or <br />(3) leases real property or sells materials to the MA organization at a cost of more than $2,500 <br />during a contract period. <br />Facilitv Agreement Requirements. The parties agree to the following terms and conditions: <br />l. HHS, the Comptroller General, or their designees have the right to audit, evaluate, and <br />inspect any pertinent information for any particular contract period, including, but not limited to, <br />any books, contracts, computer or other electronic systems (including medical records and <br />documentation of the first tier, downstream, and entities related to CMS' contract with CHPW, <br />through ten (10) years from the final date ofthe final contract period ofthe contract entered into <br />between CMS and CHPW or from the date of completion of any audit, whichever is later.142 <br />c.F.R. $$ 422.504(iX2Xi) and (ii)l <br />2. Facility will comply with the confidentiality and enrollee record accuracy requirements, <br />including: (1) abiding by all Federal and State laws regarding confidentiality and disclosure of <br />medical records, or other health and enrollment information, (2) ensuring that medical <br />information is released only in accordance with applicable Federal or State law, or pursuant to <br />court orders or subpoenas, (3) maintaining the records and information in an accurate and timely <br />manner, and (4) ensuring timely access by enrollees to the records and information that pertain to <br />them. 142 C.F.R. $ $ 422. s 04(a)( I 3 ) and 422.t t8l <br />3. Enrollees will not be held liable for payment of any fees that are the legal obligation of <br />cHPw. [42 c.F.R. $$ 422.504(D(3XD and 422.504(g)(tXi)] <br />4. For all enrollees eligible for both Medicare and Medicaid, enrollees will not be held <br />liable for Medicare Part A and B cost sharing when the State is responsible for paying such <br />amounts. Providers will be informed of Medicare and Medicaid benefits and rules for enrollees <br />eligible for Medicare and Medicaid. Facility may not impose cost-sharing that exceeds the <br />amount of cost-sharing that would be permitted with respect to the individual under title XIX if <br />the individual were not enrolled in such a plan. Providers will: (l) accept the MA plan payment <br />as payment in full, or (2) bill the appropriate State source. [42 C.F.R. $$ 422.504(i)(3)(i) and <br />a22.sOa(g)(1Xi)l <br />2020Facllity Exh B2B - MAProv Page 44 of51 Contract #5908-662684