Common use of CONTRACTOR’S GENERAL REQUIREMENTS Clause in Contracts

CONTRACTOR’S GENERAL REQUIREMENTS. 3.1. Department will contract with only one organization, Contractor, and will work solely with that organization with respect to all tasks and deliverables to be completed, services to be rendered and performance standards to be met under this Contract. 3.1.1. Contractor shall not be located outside of the United States, per 42 CFR § 438.602(i). 3.1.2. Claims paid by Contractor to a network provider, out-of-network provider, subcontractor or financial institution located outside of the United States will not be considered in the development of actuarially sound capitation rates per 42 CFR § 438.602(i). 3.2. Contractor may be privy to internal policy discussions, contractual issues, price negotiations, confidential medical information, Department financial information, advance knowledge of legislation and other Confidential Information. In addition to all other confidentiality requirements of the Contract, Contractor shall also consider and treat any such information as Confidential Information and shall only disclose it in accordance with the terms of the Contract. 3.3. Contractor shall work cooperatively with Department staff and, if applicable, the staff of other State Contractors to ensure the completion of the Work. Department may, in its sole discretion, use other Contractors to perform activities related to the Work that are not contained in the Contract or to perform any of Department’s responsibilities. In the event of a conflict between Contractor and any other State Contractor, the State will resolve the conflict and Contractor shall abide by the resolution provided by the State. 3.4. Contractor shall inform Department on current trends and issues in the healthcare marketplace and provide information on new technologies in use that may impact Contractor’s responsibilities under this Contract. 3.5. Contractor shall maintain complete and detailed records of all meetings, system development life cycle documents, presentations, project artifacts and any other interactions or deliverables related to the project described in the Contract. Contractor shall make such records available to Department upon request, throughout the term of the Contract. 3.6. Contractor shall participate in special workgroups created by Department or other state agencies as directed by Department and shall provide requested deliverables to support these workgroups in accordance with agreed-upon terms and deadlines established by the workgroups. 3.7. Contractor shall use Department-developed definition for the following terms, when applicable and when available: appeal; co-payment; durable medical equipment; emergency room care; emergency services; excluded services; grievance; habilitation services and devices; health insurance; home health care; hospice services; hospitalization; hospital outpatient care; medically necessary; network; non- participating provider; physician services; plan; preauthorization; prescription drug coverage; primary care physician; PCP; participating provider; premium; provider; rehabilitation services and devices; skilled nursing care; specialist; and urgent care. 3.8. Contractor Performance Management