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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 27 of 48 <br />1.6 Dispute Resolution. Participating Provider shall utilize the applicable dispute resolution procedures <br />outlined in the Agreement to resolve disputes between WellCare and Participating Provider. (Section VII, G(1)(q)). <br /> <br />1.7 Reporting Requirements. Participating Provider shall promptly provide WellCare with the data and <br />information that WellCare requests in order to meet its reporting requirements under the State Contract. (Section VII, <br />J. Table 1). <br /> <br />1.8 Hours of Operation. Participating Provider will offer hours of operation to Covered Persons that are <br />not less than the hours of operation offered to commercial members or comparable to Medicaid fee -for-service, if <br />Participating Provider serves only Medicaid or NC Health Choice members. (Section V, D(1)(d)(iii)). <br /> <br />2. Entire Agreement. The Agreement identifies the documents that constitute the entire contract between the <br />parties. (Section VII, G(1)(a)). <br /> <br />3. Hold Harmless. Participating Provider agrees to hold the Covered Person harmless for charges for any <br />Covered Service. Participating Provider agrees not to bill a Covered Person for Medically Necessary Services <br />covered by WellCare so long as the Covered Person is eligible for coverage. (Section VII, G(3)(b)). Participating <br />Provider will not hold Covered Person’s responsible for any of the following: (a) WellCare’s debts in the event of its <br />insolvency; (b) Covered Services provided to the Covered Person for which: (i) NC DHHS does not pay WellCare, <br />or (ii) NC DHHS, or WellCare, does not pay the Participating Provider; (c) payments for Covered Services furnished <br />under a contract, referral or other arrangement, to the extent that those payments are in excess of the amount that the <br />Covered Person would owe if WellCare covered the services directly. 42 C.F.R. § 438.106. (Section V, C(1)(i)(iii) <br />and Section V, C(2)(r)(iii)). <br /> <br />4. Liability. Participating Provider understands and agrees that NC DHHS does not assume liability for the <br />actions of, or judgments rendered against, WellCare, Payors, its employees, agents or subcontractors. Further, <br />Participating Provider understands and agrees that there is no right of subrogation, contribution, or indemnification <br />against NC DHHS for any duty owed to Participating Provider by WellCare or Payor or any judgment rendered <br />against WellCare or Payor. (Section VII, G(3)(c)). <br /> <br />5. Non-Discrimination. <br /> <br />5.1 Equitable Treatment of Covered Persons. Participating Provider agrees to render provider services <br />to Covered Persons with the same degree of care and skills as customarily provided to Participating Provider’s <br />patients who are not Covered Persons, according to generally accepted standards of medical practice. Participating <br />Provider and WellCare agree that Covered Persons and non-Covered Persons should be treated equitably. <br />Participating Provider agrees not to discriminate against Covered Persons on the basis of race, color, national origin, <br />age, sex, gender, or disability. (Section VII, G(3)(d)). <br /> <br />5.2 Interpreting and Translation Services. Participating Provider shall provide qualified sign language <br />interpreters if closed captioning is not the appropriate auxiliary aid for the Covered Person. Participating Provider <br />shall ensure that Participating Provider’s staff are trained to appropriately communicate with patients with various <br />types of hearing loss. Participating Provider shall report to WellCare, in a format and frequency determined by <br />WellCare, whether hearing loss accommodations are needed and provided and the type of accommodation provided. <br />(Section VII, G(1)(t)). <br /> <br />6. Term; Termination. <br /> <br />6.1 Term. This Attachment is coterminous with the Agreement, unless otherwise agreement by the <br />parties, but in no event will the term of this Attachment exceed the term of the State Contract (including, for avoidance <br />of doubt, any renewals of the State Contract) (Section VII, G(1)(c)). <br /> <br />DocuSign Envelope ID: 2EC1F0FD-FAF9-4B42-B52E-D419F55A6210
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