ACA Section 1557 Coordinator Clause Samples
ACA Section 1557 Coordinator. The terms and conditions of Section 24, Exhibit E in the Medicaid Contract are incorporated by reference and have the same force and effect as though they are fully set forth herein. The terms and conditions of Exhibit F in the Medicaid Contract are incorporated by reference and have the same force and effect as though they are fully set forth herein.
1. Delivery System Network Provider Monitoring and Reporting Overview
a. Contractor shall employ or enter into Network Provider agreements with, in accordance with the standards set forth in CFR § 438.206, Ex. B, Part 4 and any other applicable provisions of this Contract, enough Providers to meet the needs of its Members in all categories of service, and types of service Providers, such that Members have timely and appropriate access to services. Contractor shall develop its Provider Network that is consistent with 42 CFR § 438.68, 42 CFR § 457.1230, and OAR 410-141-3515. Contractor shall only employ or otherwise contract with Providers who agree to provide services to HOP, COFA, Veteran, and Medicaid Members and who comply with all applicable state and federal non-discrimination laws including, without limitation, ORS 659A.440 through 659A.409 and the federal Civil Rights Act. Contractor shall incorporate the priorities from its Community Health Assessment, its Community Health
b. The terms and conditions of Paragraph b of Section 1, Exhibit G in the Medicaid Contract are incorporated by reference and have the same force and effect as though they are fully set forth herein.
c. The terms and conditions of Paragraph c of Section 1, Exhibit G in the Medicaid Contract are incorporated by reference and have the same force and effect as though they are fully set forth herein.
d. The terms and conditions of Paragraph d of Section 1, Exhibit G in the Medicaid Contract are incorporated by reference and have the same force and effect as though they are fully set forth herein.
e. Contractor shall promptly and fully remedy any Provider Network deficiencies identified through the course of self-assessment, in the event of a Material Change, or as a result of OHA Monitoring, or EQRO review under the Medicaid Contract.
f. The terms and conditions of Paragraph f of Section 1, Exhibit G in the Medicaid Contract are incorporated by reference and have the same force and effect as though they are fully set forth herein.
g. The terms and conditions of Paragraph g of Section 1, Exhibit G in the Medicaid Contract are incorporated...
ACA Section 1557 Coordinator a. As required by Section 1557 of the ACA, if Contractor employs fifteen (15) or more persons, then Contractor must designate and authorize at least one (1) employee to coordinate Contractor’s compliance with its responsibilities under Section 1557 in its health programs and activities, including the investigation of any grievance communicated to it alleging noncompliance with Section 1557 or alleging any action that would be prohibited by Section 1557 (“Section 1557 Coordinator”). As appropriate, Contractor may assign one or more designees to carry out some of these responsibilities, but the Section 1557 Coordinator must retain ultimate oversight for ensuring coordination with Contractor’s compliance.
b. Contractor must ensure that, at minimum, its Section 1557 Coordinator:
(1) Receives, reviews, and processes grievances, filed under the grievance procedure as set forth in § 92.8(c);
(2) Coordinates Contractor’s recordkeeping requirements as set forth in § 92.8(c);
(3) Coordinates effective implementation of Contractor’s language access procedures as set forth in § 92.8(d);
(4) Coordinates effective implementation of Contractor’s effective communication procedures as set forth in § 92.8(e);
(5) Coordinates effective implementation of Contractor’s reasonable modification procedures as set forth in § 92.8(f); and
(6) Coordinates training of relevant employees as set forth in § 92.9, including maintaining documentation required by such section. Exhibit F – Insurance Requirements Exhibit G – Reporting of Delivery System Network Providers, Cooperative Agreements, and Hospital Adequacy
1. Delivery System Network Provider Monitoring and Reporting Overview
a. Contractor shall employ or enter into Network Provider agreements with, in accordance with the standards set forth in CFR § 438.206, Ex. B, Part 4 and any other applicable provisions of this Contract, enough Providers to meet the needs of its Members in all categories of service, and types of service Providers, such that Members have timely and appropriate access to services. Contractor shall develop its Provider Network that is consistent with 42 CFR § 438.68, 42 CFR
b. If necessary to ensure access to an adequate Provider Network, Contractor may be required to contract with Providers located outside of the defined Service Area.
c. Contractor shall Monitor, document, report and evaluate its Provider Network as set forth in this Ex. G.
d. Contractor’s obligations under Para. c, above of this Ex. G, shall inc...