Common use of Program Integrity Requirements Clause in Contracts

Program Integrity Requirements. A. The Contractor shall comply with state and federal law and regulations, including, but not limited to, 42 CFR 433.32, 42 CFR 433.51, 42 CFR 431.800 et. seq., 42 CFR 440.230, 42 CFR 440.260, 42 CFR 455 et. seq., 42 CFR 456 et. seq., 42 CFR 456.23, 22 CCR 51490, 22 CCR 51490.1, 22 CCR 51341.1, 22 CCR 51159, WIC 14124.1, and WIC 14124.2; 42 CFR 438.600, 42 CFR 438.602, 42 CFR 438.608. B. The Contractor shall comply with the provisions of 42 CFR 438.600(a), (b), and (c), 438.604, 438.606 and 438.608, regarding the certification of accurate data submitted by the Contractor to DHCS and which require the Contractor to have administrative or management arrangements or procedures and a mandatory compliance plan designed to guard against fraud and abuse. 1) The management arrangements or procedures shall include: a) Written policies and procedures and standards of conduct that articulate the Contractor’s commitment to comply with all applicable federal and State standards; b) The designation of a compliance officer and a compliance committee that are accountable to senior management; c) Effective training and education for the compliance officer, the Contractor’s employees and all subcontractor; d) Effective lines of communication between the compliance officer and the Contractor’s employees and subcontractor; e) Enforcement of standards through well publicized disciplinary guidelines; f) Provision for internal and subcontractor monitoring and auditing; and g) Provision for prompt response to detected offenses and for development of corrective action initiatives relating to this Agreement and any subcontracts relating to this Agreement, i. The Contractor’s shall provide the following data certified by the Contractor’s Chief Executive Officer, Chief Financial Officer or an individual who has delegated authority to sign for and reports directly to the CEO or CFO: a. Enrollment information; b. Encounter data; c. Other information required by DHCS and contained in Intergovernmental Agreements, proposals and related documents for purposes of developing MCE payments; and d. The certification of this information must attest, based on best knowledge, information and belief as follows: (i) To the accuracy, completeness and truthfulness of the data; (ii) To the accuracy, completeness and truthfulness of the documents specified by DHCS; and (iii) The certification must be submitted concurrently with the certified data. C. The Contractor shall comply with the provisions of 42 CFR 438.610: 1) The Contractor may not knowingly have a relationship of the type described in paragraph (2)(i) of this section with the following: i. An individual who is debarred, suspended, or otherwise excluded from participating in procurement activities under the Federal Acquisition Regulation or from participating in nonprocurement activities under regulations issued under Executive Order No. 12549 or under guidelines implementing Executive Order No. 12549. ii. An individual who is an affiliate, as defined in the Federal Acquisition Regulation, of a person described in paragraph (1)(i) of this section.

Program Integrity Requirements. A. The Contractor shall comply with state and federal law and regulations, including, but not limited to, 42 CFR 433.32, 42 CFR 433.51, 42 CFR 431.800 et. seq., 42 CFR 440.230, 42 CFR 440.260, 42 CFR 455 et. seq., 42 CFR 456 et. seq., 42 CFR 456.23, 22 CCR 51490, 22 CCR 51490.1, 22 CCR 51341.1, 22 CCR 51159, WIC 14124.1, and WIC 14124.2; 42 CFR 438.600, 42 CFR 438.602, 42 CFR 438.608. B. The Contractor shall comply with the provisions of 42 CFR 438.600(a), (b), and (c), 438.604, 438.606 and 438.608, regarding the certification of accurate data submitted by the Contractor to DHCS and which require the Contractor to have administrative or management arrangements or procedures and a mandatory compliance plan designed to guard against fraud and abuse. 1) The management arrangements or procedures shall include: a) Written policies and procedures and standards of conduct that articulate the Contractor’s commitment to comply with all applicable federal and State standards; b) The designation of a compliance officer and a compliance committee that are accountable to senior management; c) Effective training and education for the compliance officer, the Contractor’s employees and all subcontractor; d) Effective lines of communication between the compliance officer and the Contractor’s employees and subcontractor; e) Enforcement of standards through well publicized disciplinary guidelines; f) Provision for internal and subcontractor monitoring and auditing; and g) Provision for prompt response to detected offenses and for development of corrective action initiatives relating to this Agreement and any subcontracts relating to this Agreement, i. The Contractor’s shall provide the following data certified by the Contractor’s Chief Executive Officer, Chief Financial Officer or an individual who has delegated authority to sign for and reports directly to the CEO or CFO: a. Enrollment information; b. Encounter data; c. Other information required by DHCS and contained in Intergovernmental Agreements, proposals and related documents for purposes of developing MCE payments; and d. The certification of this information must attest, based on best knowledge, information and belief as follows: (i) To the accuracy, completeness and truthfulness of the data; (ii) To the accuracy, completeness and truthfulness of the documents specified by DHCS; and (iii) The certification must be submitted concurrently with the certified data. C. The Contractor shall comply with the provisions of 42 CFR 438.610: 1) The Contractor may not knowingly have a relationship of the type described in paragraph (2)(i) of this section with the following: i. An individual who is debarred, suspended, or otherwise excluded from participating in procurement activities under the Federal Acquisition Regulation or from participating in nonprocurement activities under regulations issued under Executive Order No. 12549 or under guidelines implementing Executive Order No. 12549. ii. An individual who is an affiliate, as defined in the Federal Acquisition Regulation, of a person described in paragraph (1)(i) of this section.