1. PACE CONTRACTOR REQUIREMENTS ESP requires that contracted providers meet the following guidelines:

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1 ESP POLICIES AND PROCEDURES TITLE: Contract Management and Compliance Oversight WRITTEN BY: Aimee Kindorf SECTION: 1 Administration, C Provider I. PURPOSE To implement a system that ensures all providers to the Elder Service Plan (ESP) of the East Boston Neighborhood Health Center (EBNHC) are contracted in accordance with CMS regulations guiding PACE (the Program of All-Inclusive Care for the Elderly), are appropriately licensed, certified and credentialed and have received the necessary orientation and annual training on the PACE benefit, ESP mission and Philosophy, Participant Rights, Grievance and Appeals and Emergency Care Services. II. POLICY(GUIDELINE) The Contracts Manager will service as the liaison between ESP and the Contracted Provider. The Contracts Manager will be responsible for ensuring that all providers of health care or administrative services enter into a signed agreement with ESP in accordance with the requirements as outlined below. III. PROCEDURES 1. PACE CONTRACTOR REQUIREMENTS ESP requires that contracted providers meet the following guidelines: A. Providers that furnish administrative or care-related services to ESP Participants, with the exception of emergency care, must enter a written contract with EBNHC. The ESP Contracts Manager will maintain these documents in the CONTRACT file. Additional copies will be filed with the EBNHC Medical Staff Office. B. ESP must contract only with entities that meet all of the applicable Federal and State requirements, included but not limited to, the following: Page 1 of 7

2 An organizational contractor, such as a hospital or skilled nursing facility, who meets Medicare or Medicaid participation requirements A practitioner or supplier who meets Medicare or Medicaid requirements applicable to the service it furnishes. A contractor who agrees to comply with PACE requirements with respect to service delivery, participant s rights, and quality assessment and performance improvement. A contractor who is accessible to participants, located either within or near the service area. C. Each party entering into the contract must designate an official Contract Liaison to coordinate the contract management and compliance oversight activities. D. Contracts must contain at a minimum the required provisions as specified by CMS Regulations pertaining to PACE Programs and published in the Federal Register on October 1, 2002 (42 CFR Part 460: Medicare and Medicaid Programs; Programs of All-inclusive Care for the Elderly (PACE); Program Revisions.) (See REQUIRED CONTRACT PROVISIONS) 2. REQUIRED CONTRACT PROVISIONS Per PACE regulations, contracts must contain the following language. ESP has created a standard contract template which contains these provisions and includes other necessary clauses relating to the terms of the contract and specific service provided. A. Each contract must be in writing and include the following information: a. Name of contracted provider b. Services furnished c. Payment rate and method d. Terms of the contract, including beginning and ending dates, methods of extension, renegotiations and termination. B. Contractor agreement to furnish only those services authorized by the PACE Interdisciplinary Team (IDT). C. Contractor agreement to accept payment from the PACE organization (ESP) as payment in full and not bill Participants, CMS, the State administering agency or private insurers. D. Contractor agreement to hold harmless CMS, the State and ESP Participants if the ESP does not pay for services performed by the Contractor in accordance with the contract. E. Contractor agreement not to assign the contract or delegate duties under the contract unless it obtains prior written approval from the PACE organization (ESP). F. Contractor agreement to submit reports required by the PACE organization (ESP). G. Contractor agreement to cooperate with the competency evaluation program and direct participant care requirements specified in the Contracted Provider Manual as applicable to the services it furnishes. Page 2 of 7

3 H. Contractor agreement to identify a Contract Liaison for the ESP Contracts Manager to work with. I. For IDT members or PACE administrative staff who are not employed by the PACE organization (ESP), the contract must stipulate that those individuals: a. Agree to perform all duties related to the position as described in PACE regulations; b. Participate in IDT meetings as required; and c. Agree to be accountable to the PACE organization 3. COMPLIANCE MONITORING ESP will perform and extensive compliance audit before the initiation of all contracts and on an annual basis in accordance with the following requirements: A. The Elder Service Plan has designated the Contract Manager to work with the Contracted Provider Liaison to ensure compliance by all contracted staff within the agency/organization. B. The ESP Contracts Manager will conduct annual reviews with the Contracted Provider Liaison to verify the following requirements are met. Compliance with all State and Federal requirements in your respective setting, including a verified current certifications or licenses for the organization/facility and staff positions. Not to have been excluded from participation in the Medicare or Medicaid programs by searching the OIG Exclusions Database: Maintain in effect, valid, current professional liability insurance coverage at the level required by ESP, as specified in your provider contract. **Conduct CORI screenings to meet the requirements of CFR (a) regarding persons with criminal convictions. Contractors and staff shall not have been convicted of any criminal offense which could jeopardize the health, safety or wellbeing of any participant, included but not limited to physical, sexual, drug or alchohol abuse. **Be screened to ensure they are free of communicable diseases. **Ensure staff competencies are completed prior to performing patient care and that that an initial and annual review of skills/competencies necessary for performance of the position are completed and documented. **Complete training on the PACE benefit, Participant s Rights, Grievance and Appeals Process and Emergency Plan. Page 3 of 7

4 Agreement to abide by the philosophy, practices and protocols of the PACE organization. **Denotes a requirement for Direct Participant Care Staff Only. C. The ESP Contracts Manager will document the initial and annual compliance review by completing the Contract Compliance Monitoring Checklist. A copy along with any supporting documentation will be stored in the Quality and Compliance File. A second copy for all direct care contractors will be sent to Linda Panzini at the EBNHC Medical Staff Office. D. The Medical Staff Office is responsible for managing the credentialing process for all ESP contracted physicians who see patients at EBNHC facilities. The Medical Staff Office will work in conjunction with the ESP Contracts Manager to ensure that ESP contracted physicians and certain mid-level practitioners are appropriately credentialed through Boston Medical Center and have valid licenses and certifications to practice their medical specialty in the state of Massachusetts. 4. PLAN OF CORRECTION A. For any Contracted Provider not meeting any of the above requirements, ESP will issue a Plan of Correction. The Plan of Correction will address the following: o The Objective The goal of the Plan of Correction o The Guideline The requirement that has not been met o Plan of Action What the Contractor will do to meet this guideline. o ESP Monitoring What ESP will do to ensure the Contractor is taking steps towards meeting the requirement. A copy of the Plan of Correction will be stored in the Quality and Compliance File and with the Medical Staff Office. B. Once the Contractor has met all of the requirements, a new Contract Compliance Monitoring Checklist will be completed and stored in the Quality and Compliance file. A second copy will also be given to the Medical Staff Office for all Contractors who render direct care. 5. MISCELLANEOUS A. ESP must maintain a current list of its contractors. Copies must be made available to anyone upon request. B. ESP must furnish a signed copy of each signed contract for inpatient care to the Centers for Medicare and Medicaid Services (CMA) and the State Division of Medical Assistance (DMA). Page 4 of 7

5 Attachment 1 Compliance Monitoring Checklist Please complete the following checklist for Compliance Monitoring as required by Federal PACE legislation and the Massachusetts Division of Medical Assistance. Your signature will verify compliance with all items listed below. Name of Contractor Contract Initiation Address of Contractor Type of Services of Review Onsite? Yes No Where Contractor Liaison All Requirements Met? Yes No Yes No 1. Agency complies with State and Federal requirements and has not been excluded from participation in the Medicare and/or MassHealth programs. 2. Contractor has verified certifications/licenses 3. Contractor has valid professional liability insurance 4. Contractors conduct CORI screening 5. Contracted staff screened for communicable diseases 6. Staff competencies are completed prior to performing patient care. 7. Initial and annual review of skills/competencies necessary for performance of the position are completed and documented. 8. Staff possess the required experience per PACE regulations. 9. Staff has received training and/or information regarding: ESP Mission and Philosophy PACE benefit ESP Participant Rights ESP Grievance and Appeals Process ESP Emergency Plan 10. Contract staff for certain administrative and IDT roles: Perform all duties related to the position; Participate in IDT meetings as necessary; Are accountable to the Elder Service Plan. 11. Agreement to abide by philosophy, practices and protocols of the PACE organization. Page 5 of 7

6 Attachment 1 Required Attachments Copies of relevant certifications and/or licenses. Copy of medical malpractice or other applicable insurance binder. Copy of JCAHO certification, if applicable. Internal CORI screening policy and procedures. Internal Communicable Disease Screening policy and procedures. Internal policy and procedures for assessing direct care worker skills and competencies necessary to perform the job. Aimee Kindorf Elder Service Plan Contracts Manager Contractor Liaison Signature Page 6 of 7

7 Attachment 2 East Boston Neighborhood Health Center Elder Service Plan CONTRACT COMPLIANCE PLAN OF CORRECTION OBJECTIVE: GUIDELINE: CONTRACTOR PLAN OF ACTION: ESP MONITORING: ESP Authorized Signature Signature of Contractor Liaison Macintosh HD:Users:miranda:Desktop: Contract Management and Compliance Oversight.doc Page 7 of 7