Common use of Financial Accounting Requirements Clause in Contracts

Financial Accounting Requirements. The Contractor shall maintain fiscal records, including its books, audit papers, documents, and any other evidence of accounting procedures and practices, which sufficiently and properly reflect all direct and indirect costs of any nature expended in the performance of the Contract. Furthermore, the Contractor shall maintain all financial accounting records in accordance with IDOI requirements. Accounting records shall be maintained separately for the Contractor’s Hoosier Care Connect line of business and provided to FSSA as requested. If the Contractor does not provide Hoosier Care Connect specific information, FSSA may terminate the Contract. As applicable, the Contractor shall incorporate the performance and financial data of risk-bearing subcontractors. The Contractor shall make full disclosure, and the State shall review, ownership and control information for the Contractor, any subcontracting entities or providers as required by 42 CFR 455.100 through 455.106 as directed in the MCE Policies and Procedures Manual and as required by 42 CFR 438.604(a)(6), 42 CFR 438.606, 42 CFR 455.104(b)(1)(i)-(iii), 42 CFR 455.104(b)(2)-(4), 42 CFR 438.230, 42 CFR 438.608(c), and 42 CFR 438.602(c). The Contractor must notify FSSA of any person or corporation with five percent (5%) or more of ownership or controlling interest in the Contractor and must submit financial statements for these individuals or corporations. Additionally, annual audits must include an annual actuarial opinion of the Contractor’s IBNR claims specific to the Hoosier Care Connect program. Authorized representatives or agents of the State and the Federal Government must have access to the Contractor’s accounting records and the accounting records of its subcontractors upon reasonable notice and at reasonable times during the performance and/or retention period of the Contract for purposes of review, analysis, inspection, audit and/or reproduction. In addition, the Contractor must file with the IDOI Commissioner the financial and other information required by the IDOI. Copies of any accounting records pertaining to the Contract must be made available by the Contractor within ten (10) calendar days of receiving a written request from the State for specified records. If such original documentation is not made available as requested, the Contractor must provide transportation, lodging and subsistence at no cost, for all state and/or federal representatives to carry out their audit functions at the principal offices of the Contractor or other locations of such records. FSSA, IDOI and other state and federal agencies and their respective authorized representatives or agents must have access to all accounting and financial records of any individual, partnership, firm or corporation insofar as they relate to transactions with any department, board, EXHIBIT 1.B. SCOPE OF WORK commission, institution or other state or federal agency connected with the Contract. The Contractor must maintain financial records pertaining to the Contract, including all claims records, for three (3) years following the end of the federal fiscal year during which the Contract is terminated, or when all state and federal audits of the Contract have been completed, whichever is later, in accordance with 45 CFR 75.361. Accounting records pertaining to the Contract must be retained until final resolution of all pending audit questions and for one (1) year following the termination of any litigation relating to the Contract if the litigation has not terminated within the three (3) year period. Financial records should address matters of ownership, organization and operation of the Contractor's financial, medical and other record keeping systems. In addition, FSSA requires Contractors to produce the following financial information, upon request: • Tangible net equity (TNE) or risk-based capital at balance sheet date; • Cash and cash equivalents; • Claims payment, XXXX, reimbursement, fee-for-service claims, provider contracts by line of business; • Appropriate insurance coverage for medical malpractice, general liability, property, worker’s compensation and fidelity bond, in conformance with state and federal regulations; • Revenue sufficiency by line of business /group and program; • Renewal rates or proposed rates by line of business; • Corrective action plans and implementation records of corrective action taken to remedy noncompliance with any financial requirements, if applicable; • Financial, cash flow and medical expense projections by line of business; • Underwriting plan and policy by line of business; • Premium receivable analysis by line of business; • Affiliate and inter-company receivables; • Current liability payables by line of business; • Medical liabilities by line of business; and • Copies of any correspondence to and from the IDOI.

Financial Accounting Requirements. The Contractor shall maintain fiscal records, including its books, audit papers, documents, and any other evidence of accounting procedures and practices, which sufficiently and properly reflect all direct and indirect costs of any nature expended in the performance of the Contract. Furthermore, the Contractor shall maintain all financial accounting records in accordance with IDOI requirements. Accounting records shall be maintained separately for the Contractor’s Hoosier Care Connect line of business and provided to FSSA as requested. If the Contractor does not provide Hoosier Care Connect specific information, FSSA may terminate the Contract. As applicable, the Contractor shall incorporate the performance and financial data of risk-bearing subcontractors. The Contractor shall make full disclosure, and the State shall review, ownership and control information for the Contractor, any subcontracting entities or providers as required by 42 CFR 455.100 through 455.106 as directed in the MCE Policies and Procedures Manual and as required by 42 CFR 438.604(a)(6), 42 CFR 438.606, 42 CFR 455.104(b)(1)(i)-(iii455.104(b)(1), 42 CFR 455.104(b)(2)-(4), 42 CFR 438.230, 42 CFR 438.608(c), and 42 CFR 438.602(c). The Contractor must notify FSSA of any person or corporation with five percent (5%) or more of ownership or controlling interest in the Contractor and must submit financial statements for these individuals or corporations. The Contractor shall submit the date of birth and Social Security Number (SSN) of any individual with an ownership or controlling interest in the Contractor and its subcontractors. The Contractor shall submit other tax identification number of any corporation with an ownership or controlling interest in the Contractor and any subcontractor in which the Contractor has a five percent (5%) or more controlling interest. The Contractor shall submit the name and address of any person (individual or corporation) with an ownership or control interest in the Contractor. The address for corporate entities must include as applicable primary business address, every business location, and P.O. Box address. Additionally, annual audits must include an annual actuarial opinion of the Contractor’s IBNR claims specific to the Hoosier Care Connect program. Authorized representatives or agents of the State and the Federal Government must have access to the Contractor’s accounting records and the accounting records of its subcontractors upon reasonable notice and at reasonable times during the performance and/or retention period of the Contract for purposes of review, analysis, inspection, audit and/or reproduction. In addition, the Contractor must file with the IDOI Commissioner the financial and other information required by the IDOI. Copies of any accounting records pertaining to the Contract must be made available by the Contractor within ten (10) calendar days of receiving a written request from the State for specified records. If such original documentation is not made available as requested, the Contractor must provide transportation, lodging and subsistence at no cost, for all state and/or federal representatives to carry out their audit functions at the principal offices of the Contractor or other locations of such records. FSSA, IDOI and other state and federal agencies and their respective authorized representatives or agents must have access to all accounting and financial records of any individual, partnership, firm or corporation insofar as they relate to transactions with any department, board, EXHIBIT 1.B. SCOPE OF WORK commission, institution or other state or federal agency connected with the Contract. The Contractor must maintain financial records pertaining to the Contract, including all claims records, for three (3) years following the end of the federal fiscal year during which the Contract is terminated, or when all state and federal audits of the Contract have been completed, whichever is later, in accordance with 45 CFR 75.361. Accounting records pertaining to the Contract must be retained until final resolution of all pending audit questions and for one (1) year following the termination of any litigation relating to the Contract if the litigation has not terminated within the three (3) year period. Financial records should address matters of ownership, organization and operation of the Contractor's financial, medical and other record keeping systems. In addition, FSSA requires Contractors to produce the following financial information, upon request: • ▪ Tangible net equity (TNE) or risk-based capital at balance sheet date; • ▪ Cash and cash equivalents; • ▪ Claims payment, XXXXIBNR, reimbursement, fee-for-service claims, provider contracts by line of business; • ▪ Appropriate insurance coverage for medical malpractice, general liability, property, worker’s compensation and fidelity bond, in conformance with state and federal regulations; • ▪ Revenue sufficiency by line of business /group and program; • ▪ Renewal rates or proposed rates by line of business; • ▪ Corrective action plans and implementation records of corrective action taken to remedy noncompliance with any financial requirements, if applicable; • ▪ Financial, cash flow and medical expense projections by line of business; • ▪ Underwriting plan and policy by line of business; • ▪ Premium receivable analysis by line of business; • ▪ Affiliate and inter-company receivables; • ▪ Current liability payables by line of business; • ▪ Medical liabilities by line of business; and • ▪ Copies of any correspondence to and from the IDOI.

Financial Accounting Requirements. The Contractor shall maintain fiscal records, including its books, audit papers, documents, and any other evidence of accounting procedures and practices, which sufficiently and properly reflect all direct and indirect costs of any nature expended in the performance of the Contract. Furthermore, the Contractor shall maintain all financial accounting records in accordance with IDOI requirements. Accounting records shall be maintained separately for the Contractor’s Hoosier Care Connect line of business and provided to FSSA as requested. If the Contractor does not provide Hoosier Care Connect specific information, FSSA may terminate the Contract. As applicable, the Contractor shall incorporate the performance and financial data of risk-bearing subcontractors. The Contractor shall make full disclosure, and the State shall review, ownership and control information for the Contractor, any subcontracting entities or providers as required by 42 CFR 455.100 through 455.106 as directed in the MCE Policies and Procedures Manual and as required by 42 CFR 438.604(a)(6), 42 CFR 438.606, 42 CFR 455.104(b)(1)(i)-(iii), 42 CFR 455.104(b)(2)-(4), 42 CFR 438.230, 42 CFR 438.608(c), and 42 CFR 438.602(c). The Contractor must notify FSSA of any person or corporation with five percent (5%) or more of ownership or controlling interest in the Contractor and must submit financial statements for these individuals or corporations. Additionally, annual audits must include an annual actuarial opinion of the Contractor’s IBNR claims specific to the Hoosier Care Connect program. Authorized representatives or agents of the State and the Federal Government must have access to the Contractor’s accounting records and the accounting records of its subcontractors upon reasonable notice and at reasonable times during the performance and/or retention period of the Contract for purposes of review, analysis, inspection, audit and/or reproduction. In addition, the Contractor must file with the IDOI Commissioner the financial and other information required by the IDOI. Copies of any accounting records pertaining to the Contract must be made available by the Contractor within ten (10) calendar days of receiving a written request from the State for specified records. If such original documentation is not made available as requested, the Contractor must provide transportation, lodging and subsistence at no cost, for all state EXHIBIT 1.C SCOPE OF WORK and/or federal representatives to carry out their audit functions at the principal offices of the Contractor or other locations of such records. FSSA, IDOI and other state and federal agencies and their respective authorized representatives or agents must have access to all accounting and financial records of any individual, partnership, firm or corporation insofar as they relate to transactions with any department, board, EXHIBIT 1.B. SCOPE OF WORK commission, institution or other state or federal agency connected with the Contract. The Contractor must maintain financial records pertaining to the Contract, including all claims records, for three (3) years following the end of the federal fiscal year during which the Contract is terminated, or when all state and federal audits of the Contract have been completed, whichever is later, in accordance with 45 CFR 75.361. Accounting records pertaining to the Contract must be retained until final resolution of all pending audit questions and for one (1) year following the termination of any litigation relating to the Contract if the litigation has not terminated within the three (3) year period. Financial records should address matters of ownership, organization and operation of the Contractor's financial, medical and other record keeping systems. In addition, FSSA requires Contractors to produce the following financial information, upon request: • ▪ Tangible net equity (TNE) or risk-based capital at balance sheet date; • ▪ Cash and cash equivalents; • ▪ Claims payment, XXXX, reimbursement, fee-for-service claims, provider contracts by line of business; • ▪ Appropriate insurance coverage for medical malpractice, general liability, property, worker’s compensation and fidelity bond, in conformance with state and federal regulations; • ▪ Revenue sufficiency by line of business /group and program; • ▪ Renewal rates or proposed rates by line of business; • ▪ Corrective action plans and implementation records of corrective action taken to remedy noncompliance with any financial requirements, if applicable; • ▪ Financial, cash flow and medical expense projections by line of business; • ▪ Underwriting plan and policy by line of business; • ▪ Premium receivable analysis by line of business; • ▪ Affiliate and inter-company receivables; • ▪ Current liability payables by line of business; • ▪ Medical liabilities by line of business; and • ▪ Copies of any correspondence to and from the IDOI.

Financial Accounting Requirements. The Contractor shall maintain fiscal records, including its books, audit papers, documents, and any other evidence of accounting procedures and practices, which sufficiently and properly reflect all direct and indirect costs of any nature expended in the performance of the Contract. Furthermore, the Contractor shall maintain all financial separate accounting records in accordance with IDOI requirementsfor the HIP lines of business that incorporate performance and financial data of subcontractors, as appropriate, particularly risk-bearing subcontractors. Accounting The Contractor’s accounting records shall be maintained separately for in accordance with the Contractor’s Hoosier Care Connect line of business and provided to FSSA as requestedIDOI requirements. If the Contractor does not provide Hoosier Care Connect HIP-specific information, FSSA may terminate the Contract. As applicable, the The Contractor shall incorporate the performance and financial data of risk-bearing subcontractorsprovide documentation that its accounting records are compliant with IDOI standards. The Contractor shall make full disclosure, and the State shall review, ownership and control information for the Contractor, any subcontracting entities or providers as required by 42 CFR 455.100 through 455.106 455.100-106, as directed in the MCE Policies and Procedures Manual and as required by 42 CFR 438.604(a)(6), 42 CFR 438.606, 42 CFR 455.104(b)(1)(i)-(iii), 42 CFR 455.104(b)(2)-(4), 42 CFR 438.230, 42 CFR 438.608(c), and 42 CFR 438.602(c438.608(c)(2). The Contractor must shall notify FSSA of any person or corporation with five percent (5%) or more of ownership or controlling interest in the Contractor and must shall submit financial statements for these individuals or corporations. Additionally, annual Annual audits must shall include an annual actuarial opinion of the Contractor’s IBNR incurred but not received claims (IBNR) specific to the Hoosier Care Connect HIP program. Authorized representatives or agents of the State and the Federal Government must federal government shall have access to the Contractor’s accounting records and the accounting records of its subcontractors upon reasonable notice and at reasonable times during the performance and/or retention period of the Contract for purposes of review, analysis, inspection, audit and/or reproduction. In addition, the Contractor must shall file with the IDOI State Insurance Commissioner the financial and other information required by the IDOI. Copies of any accounting records pertaining to the Contract must shall be made available by the Contractor within ten (10) calendar days of receiving a written request from the State for specified records. If such original documentation is not made available as requested, the Contractor must shall provide transportation, lodging and subsistence at no cost, for all state and/or federal representatives to carry out their audit functions at the principal offices of the Contractor or other locations of such records. FSSA, IDOI IDOI, OMPP and other state and federal agencies and their respective authorized representatives or agents must shall have access to all accounting and financial records of EXHIBIT 1 SCOPE OF WORK – HEALTHY INDIANA PLAN any individual, partnership, firm or corporation insofar as they relate to transactions with any department, board, EXHIBIT 1.B. SCOPE OF WORK commission, institution or other state or federal agency connected with the Contract. The Contractor must shall maintain financial records pertaining to the Contract, including all claims records, for three (3) years following the end of the federal fiscal year during which the Contract is terminated, or when all state and federal audits of the Contract have been completed, whichever is later, in accordance with 45 CFR 75.361. Accounting records pertaining to the Contract must be retained until final resolution of all pending audit questions 74.53, which sets retention and access requirements for one (1) year following the termination of any litigation relating to the Contract if the litigation has not terminated within the three (3) year periodrecords. Financial records should address matters of ownership, organization and operation of the Contractor's financial, medical and other record keeping systems. In additionHowever, FSSA requires Contractors accounting records pertaining to produce the following financial information, upon request: • Tangible net equity (TNE) or risk-based capital at balance sheet date; • Cash Contract shall be retained until final resolution of all pending audit questions and cash equivalents; • Claims payment, XXXX, reimbursement, fee-for-service claims, provider contracts by line of business; • Appropriate insurance coverage for medical malpractice, general liability, property, worker’s compensation and fidelity bond, in conformance with state and federal regulations; • Revenue sufficiency by line of business /group and program; • Renewal rates or proposed rates by line of business; • Corrective action plans and implementation records of corrective action taken to remedy noncompliance with any financial requirements, if applicable; • Financial, cash flow and medical expense projections by line of business; • Underwriting plan and policy by line of business; • Premium receivable analysis by line of business; • Affiliate and inter-company receivables; • Current liability payables by line of business; • Medical liabilities by line of business; and • Copies of any correspondence to and from the IDOI.one

Financial Accounting Requirements. The Contractor shall maintain fiscal records, including its books, audit papers, documents, and any other evidence of accounting procedures and practices, which sufficiently and properly reflect all direct and indirect costs of any nature expended in the performance of the Contract. Furthermore, the Contractor shall maintain all financial accounting records in accordance with IDOI requirements. Accounting records shall be maintained separately for the Contractor’s Hoosier Care Connect line of business and provided to FSSA as requested. If the Contractor does not provide Hoosier Care Connect specific information, FSSA may terminate the Contract. As applicable, the Contractor shall incorporate the performance and financial data of risk-bearing subcontractors. The Contractor shall make full disclosure, and the State shall review, ownership and control information for the Contractor, any subcontracting entities or providers as required by 42 CFR 455.100 through 455.106 as directed in the MCE Policies and Procedures Manual and as required by 42 CFR 438.604(a)(6), 42 CFR 438.606, 42 CFR 455.104(b)(1)(i)-(iii), 42 CFR 455.104(b)(2)-(4), 42 CFR 438.230, 42 CFR 438.608(c), and 42 CFR 438.602(c). The Contractor must notify FSSA of any person or corporation with five percent (5%) or more of ownership or controlling interest in the Contractor and must submit financial statements for these individuals or corporations. Additionally, annual audits must include an annual actuarial opinion of the Contractor’s IBNR claims specific to the Hoosier Care Connect program. Authorized representatives or agents of the State and the Federal Government must have access to the Contractor’s accounting records and the accounting records of its subcontractors upon reasonable notice and at reasonable times during the performance and/or retention period of the Contract for purposes of review, analysis, inspection, audit and/or reproduction. In addition, the Contractor must file with the IDOI Commissioner the financial and other information required by the IDOI. Copies of any accounting records pertaining to the Contract must be made available by the Contractor within ten (10) calendar days of receiving a written request from the State for specified records. If such original documentation is not made available as requested, the Contractor must provide transportation, lodging and subsistence at no cost, for all state EXHIBIT 1.C SCOPE OF WORK and/or federal representatives to carry out their audit functions at the principal offices of the Contractor or other locations of such records. FSSA, IDOI and other state and federal agencies and their respective authorized representatives or agents must have access to all accounting and financial records of any individual, partnership, firm or corporation insofar as they relate to transactions with any department, board, EXHIBIT 1.B. SCOPE OF WORK commission, institution or other state or federal agency connected with the Contract. The Contractor must maintain financial records pertaining to the Contract, including all claims records, for three (3) years following the end of the federal fiscal year during which the Contract is terminated, or when all state and federal audits of the Contract have been completed, whichever is later, in accordance with 45 CFR 75.361. Accounting records pertaining to the Contract must be retained until final resolution of all pending audit questions and for one (1) year following the termination of any litigation relating to the Contract if the litigation has not terminated within the three (3) year period. Financial records should address matters of ownership, organization and operation of the Contractor's financial, medical and other record keeping systems. In addition, FSSA requires Contractors to produce the following financial information, upon request: • ▪ Tangible net equity (TNE) or risk-based capital at balance sheet date; • ▪ Cash and cash equivalents; • ▪ Claims payment, XXXXIBNR, reimbursement, fee-for-service claims, provider contracts by line of business; • ▪ Appropriate insurance coverage for medical malpractice, general liability, property, worker’s compensation and fidelity bond, in conformance with state and federal regulations; • ▪ Revenue sufficiency by line of business /group and program; • ▪ Renewal rates or proposed rates by line of business; • ▪ Corrective action plans and implementation records of corrective action taken to remedy noncompliance with any financial requirements, if applicable; • ▪ Financial, cash flow and medical expense projections by line of business; • ▪ Underwriting plan and policy by line of business; • ▪ Premium receivable analysis by line of business; • ▪ Affiliate and inter-company receivables; • ▪ Current liability payables by line of business; • ▪ Medical liabilities by line of business; and • ▪ Copies of any correspondence to and from the IDOI.