3-13-2 Prevention 3-14 Grievances and Complaints 3-15 Indemnification 3-16 Insurance 3-17 Lobbying Disclosure 3-18 Medical Records Requirements 3-19 Membership and Marketing Materials 3-19-1 Use of FHKC and Florida KidCare Marketing Materials 3-19-2 Requirements for Member Materials 3-20 Notification Requirements 3-21 Premium Rate Provisions 3-21-1 Premium Rate 3-21-2 Additional Requirements for Premium 3-21-3 Experience Adjustment 3-21-4 Annual Experience Adjustment Reporting Requirements 3-21-5 Quarterly Medical Loss Ratio Reporting Requirements 3-22 Premium Rate Modifications 3-22-1 Annual Adjustment Request 3-22-2 Annual Premium Rate Adjustment Denials 3-22-3 Change in Benefit Schedule 3-22-4 Specialty Fee Arrangements 3-23 Program Integrity 3-23-1 Excluded Providers 3-23-2 Physician Identifiers National Provider Identifier (NPI) – 3-23-3 Conflict of Interest Safeguards 3-24 Quality Management 3-24-1 Quality Improvement Plans 3-24-2 Quality Improvement Plan Committee 3-24-3 External Quality Review 3-25 Records Retention and Accessibility 3-26 Refusal of Coverage 3-27 Regulatory Filings 3-28 Reporting Requirements 3-29 Subrogation Rights 3-30 Termination of Participation 3-31 Use of Subcontractors and Affiliates 3-32 Reimbursement Requirements 3-32-1 Out of Network Providers 3-32-2 Reimbursement to Federally Qualified Health Centers and Health Clinics 3-33 Performance Standards SECTION 4 TERMS AND CONDITIONS 4-1 Amendment 4-2 Assignment 4-3 Attachments 4-4 Attorney Fees 4-5 Bankruptcy 4-6 Change of Controlling Interest 4-7 Confidentiality 4-8 Conflicts of Interest; Non-Solicitation 4-8-1 Conflicts of Interest
3-13-2 Prevention 3-14 Grievances and Complaints 3-15 Indemnification 3-16 Insurance 3-17 Lobbying Disclosure 3-18 Medical Records Requirements 3-19 Membership and Marketing Materials 3-19-1 Use of FHKC and Florida KidCare Marketing Materials 3-19-2 Requirements for Member Materials 3-20 Notification Requirements 3-21 Premium Rate Provisions 3-21-1 Premium Rate 3-21-2 Additional Requirements for Premium 3-21-3 Experience Adjustment 3-21-4 Annual Experience Adjustment Reporting Requirements 3-21-5 Quarterly Medical Loss Ratio Reporting Requirements 3-22 Premium Rate Modifications 3-22-1 Annual Adjustment Request 3-22-2 Annual Premium Rate Adjustment Denials 3-22-3 Change in Benefit Schedule 3-22-4 Specialty Fee Arrangements 3-23 Program Integrity 3-23-1 Excluded Providers 3-23-2 Physician Identifiers – National Provider Identifier (NPI) 3-23-3 Conflict of Interest Safeguards 3-24 Quality Management 3-24-1 Quality Improvement Plans 3-24-2 Quality Improvement Plan Committee 3-24-3 External Quality Review 3-25 Records Retention and Accessibility 3-26 Refusal of Coverage 3-27 Regulatory Filings 3-28 Reporting Requirements 3-29 Subrogation Rights 3-30 Termination of Participation 3-31 Use of Subcontractors and Affiliates 3-32 Reimbursement Requirements 3-32-1 Out of Network Providers 3-32-2 Reimbursement to Federally Qualified Health Centers and Health Clinics 3-33 Performance Standards SECTION 4 TERMS AND CONDITIONS 4-1 Amendment 4-2 Assignment 4-3 Attachments 4-4 Attorney Fees 4-5 Bankruptcy 4-6 Change of Controlling Interest 4-7 Confidentiality 4-8 Conflicts of Interest; Non-Solicitation 4-8-1 Conflicts of Interest
Revised-Draft-ITN-Contract-Draft-B.docx