Ordinance 2014-66 - Laserfiche WebLink

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Confidential PROGRAM SCHEDULE Program Name: Commercial Fully Subsidized Program Program Brands: Prime*, Prime MCA, and other brand names for the Commercial Fully Subsidized Program communicated to Facility by Healthways from time to time Member Type: Commercial Program Description: The Program is offered to Members of the Sponsoring Organization. The Program includes basic fitness membership services for Members provided through a network of facilities; also included in the Program are all facets presented in the Duties and Obligations of Facility section of the Agreement. 1. Program Duties and Obligations of Facility. In exchange for the compensation to be paid by Healthways, Facility shall perform the following services: a) Program Implementation Process. To prepare for Program commencement, Facility agrees to participate in the following 1) coordination with Healthways of electronic reporting containing the required data elements; and 2) Healthways- scheduled and led training. b) Introductory Orientation for Prime Members. Facility shall offer the Program to all Members identified by Healthways as eligible for the Program. In addition to a basic fitness membership at no cost to the Member, Facility shall provide Members with an added value program component (i.e., a thirty (30) minute personalized orientation session or personal training session). c) Reporting Obligations of Facility. Facility shall report Program utilization to Healthways on a monthly basis. Program utilization reporting shall consist of all a) Program forms, and b) Member visits for the month. Facility shall prepare a report of daily visits and utilization from the month summarizing activity and containing the required data elements and submit it electronically to Healthways no later than the fifth (5`) day of the following month. The required file format and data elements are defined in the Reference Guide. The Parties to this Agreement shall work cooperatively to establish correct and acceptable electronic monthly utilization data reporting; Healthways may provide technical support to Facility if necessary. d) Program Training for Facility Staff. Facility staff who have regular contact with Members are required to participate in Healthways training prior to commencement of the Program and as needed thereafter to account for staff turnover and to ensure proper service for Members. 2. Medicaid Compliance for Program(s) Provided to Medicaid Recipients. In recognition that Sponsoring Organization and its subcontractors may be obligated to comply with all applicable federal governmental regulations regarding services to Medicaid members, including the rules and regulations of the Centers for Medicare and Medicaid Services (CMS), Healthways and Facility mutually agree to comply with the following for services provided to Medicaid members. a) Compliance with Federal and State Laws. Healthways and Facility acknowledge that payments made to Facility under this Agreement may be made from federal funds. Therefore, in connection with all services rendered under the Agreement, Healthways and Facility agree to comply with the requirements of the contracts between Healthways' customers and CMS (the "CMS Contracts "), and all applicable federal and state laws and regulations and CMS guidance and instructions, including, but not limited to all Medicaid laws, such as the Medicare Modernization Act and the regulations contained in 42 CFR Parts 422 and 423; all applicable state and federal privacy and security requirements, including but not limited to the confidentiality, privacy and security provisions for Medicare health plans contained in the regulations found at 42 CFR 422.118 and 42 CFR 423.136; and all applicable laws, regulations and guidance designed to prevent fraud, waste or abuse of federal funds, including the False Claims Act (31 U.S.C. 3729 et seq.), the Anti - kickback statute (Social Security Act § 112813(b)), and HIPAA administrative simplification rules (45 CFR Parts 160, 162, and 164). b) Right to Inspect. Healthways and Facility acknowledge and agree that the Department of Health and Human Services (HHS), the Comptroller General, or their designees, or any applicable state or federal governmental entity, or Sponsoring Organization, shall have the right to inspect, evaluate, and audit any pertinent contracts, books, C4 FC V2014 -2 6 of 10