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05/11/2021
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05/11/2021
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8/16/2021 10:57:56 AM
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8/16/2021 10:54:54 AM
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Meetings
Meeting Type
BCC Regular Meeting
Document Type
Agenda Packet
Meeting Date
05/11/2021
Meeting Body
Board of County Commissioners
Board of County Commissioners
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2.2 Provider Requirements. <br />(a) Credentials. EDH will require each Provider, including physicians and healthcare facilities, <br />to cooperate with EDH's credentialing program. Such credentialing program may require such Providers to meet <br />National Committee for Quality Assurance credentialing standards or Joint Commission on Hospital Accreditation <br />credentialing standards.. EDH may also require Providers to comply with additional credentialing practices and <br />programs, and EDH may require Providers to provide EDH with documentation supporting such credentialing: <br />(b) Information Regarding Providers. EDH will request that Providers provide EDH with <br />accurate and complete information such that EDH can effectively inform Sponsor and Participants about the <br />availability, quality, and efficacy of the medical services offered by each Provider through the EDH member website. <br />Providers shall be solely responsible for the accuracy and completeness of such information. <br />2.3 Utilization and Quality Assurance. <br />(a) Utilization Stroteay. EDH will use commercially reasonable efforts to assist Sponsor with <br />the performance of Sponsor's obligation to for and deliver a written utilization strategy relating .to the <br />Network and Network Services, as further described in Exhibit A attached to this Agreement. <br />(b) Notices to Participants. At a minimum, EDH will provide a written notice approved by <br />Sponsor to all Participants advising them of the identity of, and relationship among EDH, the Participant, and <br />Sponsor. <br />(c) Participant Reports. Following appropriate HIPAA standards for the transfer of <br />information relating to any Participant, EDH will periodically provide Sponsor with reports summarizing: <br />(a) utilization of the Network and Network Services by Participants and (b) the medical outcomes of Participants <br />utilizing the Network and Network Services for an Episode of Care. Upon reasonable written request, EDH will <br />provide Sponsor access to pertinent documents maintained by EDH and required in connection with such reports, <br />subject to the confidentiality requirements contained in Article 6 of this Agreement. <br />2.4 Parties Are Not Providers. The Parties acknowledge and agree that neither Party will provide <br />medical advice, render any medical judgment, or make any medical recommendation (as to any Provider or medical <br />treatment) to any Participant or to any other person or entity. The Parties further acknowledge and agree that <br />Providers shall be solely responsible for (a) all matters relating to medical treatment and/or procedures of <br />Participants and (b) all advisement, evaluation, recommendation, or other similar responsibility or obligation relating <br />to medical treatments and/or procedures of Participants. <br />2.S Participant Clearance to Travel. From time to time, a Participant may be required to travel by <br />automobile or airplane to a Provider for an Episode of Care. The Parties acknowledge and agree that it shall be the <br />sole responsibility of Participant to obtain advice from the Provider or the Participant's Treating Physician whether, <br />in such physician's independent medical opinion, Participant is fit to travel to Provider's location. Utilizing <br />appropriate HIPAA standards regarding the release of medical records, EDH will assist a Participant, or the <br />Participant's representative, with the collection and transfer of medical records and other documentation among <br />the Participant, Treating Physician, and Provider. <br />2.6 Limited Role of EDH. The Parties acknowledge and agree that EDH's role is strictly limited to <br />offering the Network and providing the Network Services. The Parties further.acknowledge and agree that EDH is <br />not a fiduciary of Sponsor or the Plan,.and EDH shall not be deemed to have any discretionary authority or control <br />regarding management of Sponsor or management or interpretation of the Plan. The Parties further acknowledge <br />and agree that EDH does not assume, insure, guaranty, or underwrite the liability, responsibility, or performance of <br />any other party. The Parties further acknowledge and agree that EDH shall have no responsibility for collecting <br />premiums or contributions for insurance coverage or for establishing a premium fiduciary account. <br />-3- 54 <br />
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