FLORIDA MEDICAID REGULATORY ... - Ubhonline.com

or sub-unit as defined by s. 768.28, F.S., or a public health entity with statutory
immunity. All such waivers must be approved in writing by the Agency.
3.24 Provider agrees that all physician incentive plans (“PIPs”) shall comply with 42
CFR 417.479, 42 CFR 438.6(h), 42 CFR 422.208, and 42 CFR 422.210, as may be
amended from time to time. Neither OptumHealth, Health Plan, nor Provider may make
a specific payment directly or indirectly under a PIP to a physician or physician group as
an inducement to reduce or limit Medically Necessary services furnished to a Covered
Person. PIPs shall not contain provisions that provide incentives, monetary or otherwise,
for the withholding of Medically Necessary care.
3.25 Provider shall secure and maintain, during the life of the Agreement, workers’
compensation insurance for all of its employees connected with the services provided
under the State Medicaid Contract unless such employees are covered by the protection
afforded by OptumHealth or Health Plan. Such insurance shall comply with Florida’s
Workers’ Compensation Law.
3.26 Any contracts, agreements, or subcontracts entered into by Provider for the
purposes of carrying out any aspect of the State Medicaid Contract shall include
assurances that the individuals who are signing the contract, agreement or subcontract are
so authorized. Such contracts, agreements, or subcontracts shall include all the
requirements of this Appendix and all applicable requirements of the State Medicaid
Contract.
3.27 Provider shall comply with Health Plan’s cultural competency plan.
3.28 Any community outreach materials related to the State Medicaid Contract that are
displayed by Provider shall be submitted to OptumHealth and Health Plan to submit to
the Florida Bureau of Managed Health Care (“BMHC”) for written approval prior to use.
3.29 Provider shall cooperate fully in any investigation by the Agency, MPI, MFCU,
or other state or federal entity, and in any subsequent legal action that may result from
such an investigation. This shall include, but not be limited to, upon request, and as
required by State and/or federal law:
(i) Making available to the Agency, MPI and/or MCFU any and all
administrative, contractual, financial and medical records relating to the delivery
of items or services for which Medicaid monies are expended; and
(ii) Allowing access to the Agency, MPI and/or MFCU to any place of
business and all medical records, as required by State and/or federal law. The
Agency, MPI and MFCU shall have after hour admission. The Agency, MPI
and/or MFCU shall determine the need for special circumstances.
3.30 Provider shall cooperate fully with OptumHealth’s and Health Plan’s procedures
designed to prevent and detect potential or suspected abuse and fraud in the
administration and delivery of services under the State Medicaid Contract. Health Plan is
UnitedHealthcare/AmeriChoice Provider Agreement 7 Confidential and Proprietary
UHC/DOWNSTREAM PROVIDER-MEDICAIDREGAPX.11.09.FL AHCA-B-N-044 12/09-8/12