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2021-350-EMS-E-WellCare Health Plans of NC Inc-Medicaid managed care
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2021-350-EMS-E-WellCare Health Plans of NC Inc-Medicaid managed care
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Last modified
7/20/2021 11:32:10 AM
Creation date
7/20/2021 11:31:26 AM
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Contract
Date
6/30/2021
Contract Starting Date
6/30/2021
Contract Ending Date
7/1/2021
Contract Document Type
Contract
Amount
$770,000.00
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<br /> <br /> Page 16 of 48 <br />that such individual agrees to assume responsibility for providing inpatient Covered Services to Covered Persons <br />who are patients of the applicable Practitioner. <br /> <br />2.2 Acceptance of New Patients. To the extent that Practitioner is accepting new patients, such <br />Practitioner must also accept new patients who are Covered Persons with respect to the Products in which such <br />Practitioner participates. Practitioner shall notify Company in writing 45 days prior to such Practitioner’s decision <br />to no longer accept Covered Persons with respect to a particular Product. In no event will an established patient of <br />any Practitioner be considered a new patient. <br /> <br />2.3 Preferred Drug List/Drug Formulary. If applicable to the Covered Person’s coverage, <br />Practitioners shall use commercially reasonable efforts, when medically appropriate under the circumstances, to <br />comply with formulary or preferred drug list when prescribing medications for Covered Persons. <br /> <br />2.4 National Committee for Quality Assurance (“NCQA”) Accreditation of WellCare’s <br />Standards. Each Practitioner agrees to: i) cooperate with Quality Management and Improvement (“QI”) activities; <br />ii) maintain the confidentiality of a Covered Persons information and records pursuant to the Agreement; and iii) <br />allow the Company to use Practitioner’s performance data. <br /> <br />3 Ancillary Providers. If Provider or Contracted Provider is an ancillary provider (including but not <br />limited to a home health agency, durable medical equipment provider, sleep center, pharmacy, ambulatory surgery <br />center, nursing facility, laboratory or urgent care center)(“Ancillary Provider”), the following provisions apply. <br /> <br />3.1 Acceptance of New Patients. To the extent that Ancillary Provider is accepting new patients, <br />such Ancillary Provider must also accept new patients who are Covered Persons with respect to the Products in which <br />such Ancillary Provider participates. Ancillary Provider shall notify Company in writing 45 days prior to such <br />Ancillary Provider’s decision to no longer accept Covered Persons with respect to a particular Product. In no event <br />will an established patient of any Ancillary Provider be considered a new patient. <br /> <br />3.2 National Committee for Quality Assurance (“NCQA”) Accreditation of WellCare’s <br />Standards. Each ancillary provider agrees to: i) cooperate with Quality Management and Improvement (“QI”) <br />activities; ii) maintain the confidentiality of a Covered Persons information and records pursuant to the Agreement; <br />and iii) allow the Company to use ancillary provider’s performance data. <br /> <br />4 FQHC. If Provider or a Contracted Provider is a federally qualified health center (“FQHC”), the <br />following provisions apply. <br /> <br />4.1 FQHC Insurance. To the extent FQHC’s employees are deemed to be federal employees <br />qualified for protection under the Federal Tort Claims Act (“FTCA”) and WellCare has been provided with <br />documentation of such status issued by the U.S. Department of Health and Human Services (such status to be referred <br />to as “FTCA Coverage”), Section 5.1 of this Agreement will not apply to those Contracted Providers with FTCA <br />Coverage. FQHC shall provide evidence of such FTCA Coverage to WellCare at any time upon request. FQHC <br />shall promptly notify WellCare if, any time during the term of this Agreement, any Contracted Provider is no longer <br />eligible for, or if FQHC becomes aware of any fact or circumstance that would jeopardize, FTCA Coverage. Section <br />5.1 of this Agreement will apply to a Contracted Provider immediately upon such Contracted Provider’s loss of FTCA <br />Coverage for any reason. <br /> <br />5 Facility Providers. If Provider or a Contracted Provider is a facility (including but not limited to <br />Clinic, FQHC, LTAC, Nursing Home, Rehab, Rural Health Clinic, Skilled Nursing) (“Facility Provider”) the <br />following provision applies. <br /> <br />5.1 National Committee for Quality Assurance (“NCQA”) Accreditation of <br />WellCare’s Standards. Each facility agrees to: i) cooperate with Quality Management and Improvement (“QI”) <br />DocuSign Envelope ID: 2EC1F0FD-FAF9-4B42-B52E-D419F55A6210
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