Common use of Licensure/Certification Clause in Contracts

Licensure/Certification. The Contractor certifies that it is licensed in Rhode Island as an HMO under the provisions of Chapter 27-41, “the HMO Act” or that it will become licensed as a Health Maintenance Organization (HMO) or Health/dental plan (HP) in the State of Rhode Island by the Rhode Island Department of Business Regulation prior to signing an Agreement with EOHHS. If Contractor is not a licensed HMO in Rhode Island, the Contractor certifies that it is either a nonprofit hospital service corporation that is licensed by the Rhode Island Department of Business Regulation (DBR) under Chapter 27-19 of the Rhode Island General Laws, a nonprofit medical service corporation that is licensed by DBR under Chapter 27-20 of the Rhode Island General Laws, or another health insurance entity licensed by DBR, and that it meets the following requirements: • Meets that requirements under R.I. Gen. Laws section 27-18.9-8: Benefit Determination and Utilization Review Act • Is certified as a utilization review entity by a nationally known health utilization management organization. The Contractor agrees to forward to EOHHS any complaints received from the Rhode Island Department of Business Regulation (DBR) or OHIC. The Contractor also agrees to forward to EOHHS a copy of any correspondence sent by the Contractor to DBR or OHIC which pertains to the Contractor’s contract status with any institution or provider group as it relates to it managed Medicaid network. The Contractor shall notify EOHHS of any person or corporation that has five percent (5%) or more ownership or controlling interest in the Contractor. At least annually, and within 30 days of any change in accreditation, the Contractor will inform EOHHS as to whether it has been accredited by a private independent accrediting entity. If the contractor has received accreditation by a private independent accrediting entity, in accordance with 42 CFR § 438.332(b)(1), 42 CFR § 438.332(b)(2), and 42 CFR§ 438.332(b)(3), the Contractor will authorize the private independent accrediting entity to provide EOHHS a copy of its most recent accreditation review, including its accreditation status, survey type, and level (as applicable); recommended actions or improvements, corrective action plans, and summaries of findings; and the expiration date of the accreditation.

Licensure/Certification. The Contractor certifies that it is licensed in Rhode Island as an HMO under the provisions of RI General Laws Chapter 27-41, “the HMO Act” or that it will become licensed as a Health Maintenance Organization (HMO) or Health/dental plan (HP) in the State of Rhode Island by the Rhode Island Department of Business Regulation prior to signing an Agreement with EOHHS. If Contractor is not a licensed HMO in Rhode Island, the Contractor certifies that it is either a nonprofit hospital service corporation that is licensed by the Rhode Island Department of Business Regulation (DBR) under Chapter 27-19 of the Rhode Island General Laws, a nonprofit medical service corporation that is licensed by DBR under Chapter 27-20 of the Rhode Island General Laws, or another health insurance entity licensed by DBR, and that it meets the following requirements: •  Meets that requirements under R.I. RI Gen. Laws section § 27-18.9-8: Benefit Determination and Utilization Review Act •  Is certified as a utilization review entity by a nationally known health utilization management organization. The Contractor agrees to forward to EOHHS any complaints received from the Rhode Island Department of Business Regulation (DBR) or OHIC. The Contractor also agrees to forward to EOHHS a copy of any correspondence sent by the Contractor to DBR or OHIC which pertains to the Contractor’s contract status with any institution or provider group as it relates to it managed Medicaid network. The Contractor shall notify EOHHS of any person or corporation that has five percent (5%) or more ownership or controlling interest in the Contractor. At least annually, and within 30 days of any change in accreditation, the Contractor will inform EOHHS as to whether it has been accredited by a private independent accrediting entity. If the contractor has received accreditation by a private independent accrediting entity, in accordance with 42 CFR §§ 438.332(b)(1), 42 CFR § 438.332(b)(2), and 42 CFR§ 438.332(b)(3), the Contractor will authorize the private independent accrediting entity to provide EOHHS a copy of its most recent accreditation review, including its accreditation status, survey type, and level (as applicable); recommended actions or improvements, corrective action plans, and summaries of findings; and the expiration date of the accreditation.

Licensure/Certification. The Contractor certifies that it is licensed in Rhode Island as an HMO under the provisions of Chapter 27-41, “the HMO Act” or that it will become licensed as a Health Maintenance Organization (HMO) or Health/dental plan (HP) in the State of Rhode Island by the Rhode Island Department of Business Regulation prior to signing an Agreement with EOHHS. If Contractor is not a licensed HMO in Rhode Island, the Contractor certifies that it is either a nonprofit hospital service corporation that is licensed by the Rhode Island Department of Business Regulation (DBR) under Chapter 27-19 of the Rhode Island General Laws, a nonprofit medical service corporation that is licensed by DBR under Chapter 27-20 of the Rhode Island General Laws, or another health insurance entity licensed by DBR, and that it meets the following requirements: • Meets that requirements under R.I. Gen. Laws section 27-18.9-8: Benefit Determination and Utilization Review Act • Is certified as a utilization review entity by a nationally known health utilization management organization. The Contractor agrees to forward to EOHHS any complaints received from the Rhode Island Department of Business Regulation (DBR) or OHIC. The Contractor also agrees to forward to EOHHS a copy of any correspondence sent by the Contractor to DBR or OHIC which pertains to the Contractor’s contract status with any institution or provider group as it relates to it managed Medicaid network. The Contractor shall notify EOHHS of any person or corporation that has five percent (5%) or more ownership or controlling interest in the Contractor. At least annually, and within 30 days of any change in accreditation, the Contractor will inform EOHHS as to whether it has been accredited by a private independent accrediting entity. If the contractor has received accreditation by a private independent accrediting entity, in accordance with 42 CFR § 438.332(b)(1), 42 CFR § 438.332(b)(2), and 42 CFR§ CFR 438.332(b)(3), the Contractor will authorize the private independent accrediting entity to provide EOHHS a copy of its most recent accreditation review, including its accreditation status, survey type, and level (as applicable); recommended actions or improvements, corrective action plans, and summaries of findings; and the expiration date of the accreditation.