County Medically Indigent Services Program (CMISP) - Enrolled Provider Agreement Participation Requirements
Provider shall comply with all applicable Federal, State, and County statutes, regulations, ordinances and directives.
Provider agrees to retain necessary records for a minimum of seven years from the date of discharge and for minors at least one year after the minor patient’s 18th birthday, but in no case less than the seven years from the date of discharge. Provider also agrees to furnish these records and any information regarding payments claimed for services, on request, to a duly authorized representative of the County of Sacramento.
Provider agrees and assures County that Provider and any subcontractors shall comply with all applicable federal, state, and local Antidiscrimination laws, regulations, and ordinances and to not unlawfully
discriminate, harass, or allow harassment against any employee, applicant for employment, employee or agent of County, or recipient of services contemplated to be provided or provided under this Agreement, because of race, ancestry, marital status, color, religious creed, political belief, national origin, ethnic group identification, sex, sexual orientation, age (over 40), medical condition (including HIV and AIDS), or physical or mental disability. Provider shall ensure that the evaluation and treatment of its employees and applicants for employment, the treatment of County employees and agents, and recipients of services are free from such discrimination and harassment.
Provider represents that it is in compliance with and agrees that it will continue to comply with the Americans with Disabilities Act of 1990 (42 U.S.C. § 12101 et seq.), the Fair Employment and Housing Act (Government Code §§ 12900 et seq.), and regulations and guidelines issued pursuant thereto.
Provider’s failure to comply with state and federal child, family and spousal support requirements regarding a Provider’s employees or failure to implement lawfully served wage and earnings assignment orders or notices of assignment relating to child, family, and spousal support obligations shall constitute a default under the agreement. Provider’s failure to cure such default within 90 days of notice by County shall be grounds for termination of the Agreement.
Provider shall state whether dependent health insurance coverage is available to Provider and Provider’s employees, for purposes of compliance with Federal and State law, and County Ordinance (S.C.C. ~ 1-60).
In the event of any dispute arising out of or relating to this agreement, the parties shall attempt, in good faith, to promptly resolve the dispute mutually between themselves. If the dispute cannot be resolved by mutual agreement, nothing herein shall preclude either party’s right to pursue remedy or relief by civil litigation, pursuant to the laws of the State of California.
The County or Provider may terminate the Agreement at any time, by giving thirty (30) days written notification served upon the other party by certified mail. County may give thirty (30) days notice to Provider of changes in conditions or participation, including reimbursement rates, and Provider shall have the option to cancel the Agreement and withdraw from participation on the effective dates of such changes.
Provider shall maintain confidentiality of all patient records under the Agreement. Provider agrees to abide by all federal and state confidentiality statues to include, but not be limited to, California Welfare and Institutions Code Section 18050. County may require release of specific information on any program patient. Provider authorizes release and exchange of information between the State Department of Health Services, Medi-Cal Provider Enrollment, the Medical Board of California and the County.
Provider shall not have or acquire any interest, direct or indirect, which will conflict in any manner with performance of services under this Agreement.
Provider will operate as an independent Provider having no relationship of employer – employee with the County of Sacramento. Neither Provider nor Provider’s employees shall be entitled to any benefits payable to employees
of the County. Provider shall indemnify County from any and all claims that may be made against County based upon any contention by any third party that an employer-employee relationship exists under the Agreement.
Provider shall maintain in force at all times, all applicable licenses, permits, and certifications required for performance of services under the Agreement.
INSURANCE and INDEMNIFICATION:
For work or services provided under this Agreement which are not professional services, Medical Provider shall indemnify, defend, and hold harmless County, its Board of Supervisors, officers, directors, agents, employees and volunteers from and against any and all claims, demands, actions, losses, liabilities, damages, and costs, including reasonable attorneys' fees, arising out of or resulting from the performance of this Agreement except and in proportion to the extent caused by the negligence or willful misconduct of County, its Board of Supervisors, officers, directors, agents, employees and volunteers.
Provider shall maintain insurance limits in force at all times, no less than: general liability: $1,000,000/$2,000,000/occurrence/aggregate; professional liability: $1,000,000 per claim; and, if Provider has employees, workers compensation statutory requirements/employer’s liability $1,000,000/disease/accident, apply. If individual Provider of service will use an automobile in connection with services under the Agreement, then the following automobile liability coverage is required: $100,000 bodily injury per individual, $300,000 bodily injury per accident, and $50,000 property damage. County shall require submittal of Certificates of Insurance to County. Provider shall notify County within five (5) working days of any professional liability, threat, or notice of action filed by or on behalf of any Program patient. Failure to maintain insurance as required in this Agreement may be grounds for material breach of contract.
Provider agrees to accept reimbursement not to exceed the maximum allowable under Medi-Cal regulations as payment in full for services rendered, unless a different amount is specified by DHHS on DHHS’S Procedure Authorization Form.
Provider agrees to fully reimburse County for all payments made when the Provider obtains payment from another responsible party, program, or funding source. For CMISP clients who become Medi-Cal eligible for services rendered and paid by County, Provider agrees to fully reimburse County for all payments made when the County fulfills their obligation to provide Medi-Cal identification information and a Letter of Authorization (LOA), if applicable, in a timely manner. LOA’s for reimbursement are time sensitive and will expire 60 days from date of notification.
The reimbursements to County for Medi-Cal paid services will be reflected on the next Explanation of Benefits (EOB) after all requirements have been met and Provider has been notified timely. It is the Provider’s responsibility to adhere to Medi-Cal regulations when collecting for services converted to Medi-Cal.
Provider enrollment services are limited to specific authorized indigent health care needs in accordance with Sacramento County’s Medically Indigent Services Program (CMISP). This enrollment enables you to provide medical services, pharmacy services, Home Health and other ancillary CMISP services.
Once the application has been accepted, you will receive a signed copy. You will also receive a copy of the CMISP Provider Handbook. If you are a group member, the provider handbook will be sent to the group’s main office. Additional copies will be made available upon request.