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The following language will be included in all provider contracts and subcontracts, effective immediately. SUBJECTION OF PROVIDER CONTRACT/SUBCONTRACT This provider contract/subcontract shall be subject to the applicable material terms and conditions of the contract between the contractor and the State and shall also be governed by and construed in accordance with all laws, regulations and contractual obligations incumbent upon the contractor. COMPLIANCE WITH FEDERAL AND STATE LAWS AND REGULATIONS The provider/subcontractor agrees that it shall carry out its obligations as herein provided in a manner prescribed under applicable federal and State laws, regulations, codes, and guidelines including New Jersey licensing board regulations, the Medicaid, NJ Kid Care, and NJ Family Care State Plans, and in accordance with procedures and requirements as may from time to time be promulgated by the United States Department of Health and Human Services. APPROVAL OF PROVIDER CONTRACTS/SUBCONTRACTS AND AMENDMENTS The provider/subcontractor understands that the State reserves the right in its sole discretion to review and approve or disapprove this provider contract/subcontract and any amendments thereto. EFFECTIVE DATE This provider contract/subcontract shall become effective only when the contractor’s agreement with the State takes effect. NON-RENEWAL/TERMINATION OF PROVIDER CONTRACT/SUBCONTRACT The provider/subcontractor understands that the contractor shall notify DMAHS at least 30 days prior to the effective date of the suspension, termination, or voluntary withdrawal of the provider/subcontractor from participation in the contractor’s network. Administrative documents, including but not limited to credentialing files, appointment books, prescription log books, correspondence of any kind with contractor, DMAHS, CMS, any other managed care contractor, Medicaid recipient, contracts with subcontractors, and contracts with billing service providers; and 4. Personal contributions to care for NJ Family Care C enrollees and copayments for NJ Family Care D enrollees shall be collected in accordance with the attached schedule. The provider/subcontractor shall also indemnify and hold the State harmless from any claims of alleged violations of the Americans with Disabilities Act by the subcontractor/provider.

If the termination was “for cause,” the contractor's notice to DMAHS shall include the reasons for the termination. The contractor shall not prohibit or restrict the provider/subcontractor from engaging in medical communications with the provider’s/subcontractor’s patient, either explicit or implied, nor shall any provider manual, newsletters, directives, letters, verbal instructions, or any other form of communication prohibit medical communication between the provider/subcontractor and the provider’s/subcontractor’s patient. The provider/subcontractor agrees to forward to [insert HMO name] copies of all grievances alleging discrimination against enrollees because of race, color, creed, sex, religion, age, national origin, ancestry, marital status, sexual or affectional orientation, physical or mental handicap for review and appropriate action within three (3) business days of receipt by the provider/subcontractor. OBLIGATION TO PROVIDE SERVICES AFTER THE PERIOD OF THE CONTRACTOR’S INSOLVENCY AND TO HOLD ENROLLEES AND FORMER ENROLLEES HARMLESS 1. The provider/subcontractor agrees that this provision shall survive the termination of this provider contract/subcontract regardless of the reason for termination, including insolvency of the contractor, and shall be construed to be for the benefit of the contractor or enrollees. The provider/subcontractor agrees that this provision supersedes any oral or written contrary agreement now existing or hereafter entered into between the provider/subcontractor and enrollees, or persons acting on their behalf, insofar as such contrary agreement relates to liability for payment for or continuation of covered services provided under the terms and conditions of this continuation of benefits provisions. The provider/subcontractor agrees that any modification, addition, or deletion to this provision shall become effective on a date no earlier than thirty (30) days after the approval by the State. The provider/subcontractor shall comply with the prohibition against billing members contained in 42 CFR 438.106, N. All records required to be kept to fully disclose the extent of services provided to Medicaid recipients, pursuant to NJAC -9.8(b) (1). RECORD MAINTENANCE The provider/subcontractor shall agree to maintain all of its books and records in accordance with the general standards applicable to such book or record keeping. RECORD RETENTION The provider/subcontractor hereby agrees to maintain an appropriate recordkeeping system for services to enrollees. Three (3) years after final payment is made under the provider contract/subcontract and all pending matters are closed.

The provider/subcontractor warrants that it will hold the State harmless and indemnify the State from any liability which may be imposed upon the State as a result of any failure of the provider/subcontractor to be in compliance with the ADA.

Where applicable, the provider/subcontractor must abide by the provisions of section 504 of the federal Rehabilitation Act of 1973, as amended, regarding access to programs and facilities by people with disabilities. The provider/subcontractor shall not discriminate against eligible persons or enrollees on the basis of their health or mental health history, health or mental health status, their need for health care services, amount payable to the provider/subcontractor on the basis of the eligible person's actuarial class, or pre-existing medical/health conditions. The provider/subcontractor shall comply with the Civil Rights Act of 1964 (d), the regulations (45 CFR Parts 80 & 84) pursuant to that Act, and the provisions of Executive Order 11246, Equal Opportunity, dated September 24, 1965, the New Jersey anti-discrimination laws including those contained within N.

The provider/subcontractor shall accept assignment of an enrollee and not discriminate against eligible enrollees because of race, color, creed, religion, ancestry, marital status, sexual orientation, national origin, age, sex, physical or mental handicap in accordance with Title VI of the Civil Rights Act of 1964, 42 USC Section 2000d, Section 504 of the Rehabilitation Act of 1973, 29 USC Section 794, the Americans with Disabilities Act of 1990 (ADA), 42 USC Section 12132, and rules and regulations promulgated pursuant thereto, or as otherwise provided by law or regulation. In providing health care benefits, the provider/subcontractor shall not directly or indirectly, through contractual, licensing, or other arrangements, discriminate against Medicaid/NJ Family Care beneficiaries who are “qualified individuals with a disability” covered by the provisions of the ADA.

Brings a proceeding voluntarily or has a proceeding brought against it involuntarily, under the Bankruptcy Act; 6. Those laboratory service providers with a certificate of waiver shall provide only those tests permitted under the terms of their waiver. The provider/subcontractor agrees to assist the contractor as necessary in meeting its obligations under its contract with the State to identify, investigate, and take appropriate corrective action against fraud, waste, and/or abuse (as defined in 42 CFR 455.2) in the provision of health care services. If the State has withheld payment and/or initiated a recovery action against the provider/subcontractor, or withheld payments pursuant to 42 CFR 455.23 and NJAC -9.10(a), the contractor shall have the right to withhold payments from the provider/subcontractor and/or forward those payments to the State. The contractor and its providers, and subcontractors, whether or not they are enrolled Medicaid providers, shall cooperate fully with state and federal oversight and prosecutorial agencies, including but not limited to, DMAHS, MFD, DOH, MFCU, HHS-OIG, FBI, DEA, FDA, and the U. Such cooperation shall include providing access to all necessary recipient information, medical and clinical information, correspondence, documents, computer files, and appropriate staff. MFD shall have the right to recover directly from providers and enrollees in the contractor’s network for the audits and investigations MFD solely conducts.