2021-350-EMS-E-WellCare Health Plans of NC Inc-Medicaid managed care

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Page 26 of 48 Attachment A: Medicaid SCHEDULE A GOVERNMENTAL PROGRAM REQUIREMENTS This Schedule sets forth the special provisions that are specific to the North Carolina Medicaid Product under the State Contract. 1. Compliance. 1.1 Compliance with State and Federal Laws. Participating Provider understands and agrees that it, he or she is subject to all state and federal laws, rules, regulations, waivers, policies and guidelines, and court-ordered consent decrees, settlement agreements, or other court orders that apply to the Agreement and State Contract, and all persons or entities receiving state and federal funds. Participating Provider understands and agrees that any violation by a provider of a state or federal law relating to the delivery of services pursuant to this Agreement, or any violation of the State Contract could result in liability for money damages, and/or civil or crimina l penalties and sanctions under state and/or federal law. (Section VII, Section G(3)(a)). 1.2 Department Authority Related to the Medicaid Program. Participating Provider agrees and understands that in the State of North Carolina, the Department of Health and Human Services (“NC DHHS”) is the single state Medicaid agency designated under 42 C.F.R. § 431.10 to administer or supervise the administration of the state plan for medical assistance. The Division of Health Benefits is designated with administration, provision, and payment for medical assistance under the Federal Medicaid (Title XIX) and the State Children’s Health Insurance (Title XXI) (CHIP) programs. The Division of Social Services (DSS) is designated with the administration and determination of eligibility for the two programs. (Section VII, G(3)(e)). 1.3 Credentialing. Each Participating Provider shall be enrolled as a Medicaid provider as required by 45 C.F.R. § 455.410 and maintain enrollment for the term of the Agreement. Participating Provider shall maintain licensure, accreditation, and credentials sufficient to meet WellCare’s network participation requirements, as outlined in WellCare’s Provider Manual and its Credentialing and Re-credentialing Policy. Participating Provider shall notify WellCare of changes in the status of any information relating to Participating Provider’s professional credentials. Participating Provider shall complete reenrollment or re-credentialing before renewal of the Agreement as set forth below: (a) during the provider credentialing transition period, no less frequently than every five (5) years; and (b) during the provider credentialing under full implementation, no less frequently than every three (3) years, except as otherwise permitted by the NC DHHS. (Section VII, G(1)(f)) 1.4 Liability Insurance. Participating Provider shall maintain professional liability insurance coverage in an amount acceptable to WellCare. Participating Provider shall notify WellCare of subsequent changes in the status of Participating Provider’s professional liability insurance on a timely basis. (Section VII, G(1)(g)). 1.5 Utilization Management. Participating Provider shall comply with WellCare’s utilization management programs, quality management programs, and provider sanction programs, except to the extent that any of these programs conflict with Participating Provider’s professional or ethical responsibility or interfere with Participating Provider’s ability to provide information or assistance to patients. WellCare utilizes only NC Medicaid’s Clinical Coverage Policies for utilization management/clinical guidelines and other NC DHHS-approved utilization management/clinical guidelines. (Section VII, G(1)(o)). DocuSign Envelope ID: 2EC1F0FD-FAF9-4B42-B52E-D419F55A6210