1
Exhibit 10(w)
(Contract Period 01/01/92 - 12/31/92)
HEALTH INSURANCE BENEFITS FOR THE AGED AND DISABLED
(Contract With Eligible Organization Pursuant to
section 1876 of the Social Security Act)
CONTRACT (No. H1036)
Between
The Secretary of the Department of Health and Human Services,
who has delegated authority to the Administrator of the
Health Care Financing Administration, hereinafter referred to as HCFA, and
HUMANA MEDICAL PLAN, INC
(hereinafter referred to as the Organization).
The Secretary and the Organization, a health maintenance organization
or competitive medical plan which has been determined to be an
eligible organization by the Administrator of the Health Care
Financing Administration under CFR 417.406, agree to the following for
the purposes of section 1876 of the Social Security Act:
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Article I
Term of Contract
The Contract Shall Begin on 01/01/92, and end on 12/31/92. The contract will
be automatically renewed for successive periods of one year unless the
Organization or HCFA gives written notice of intention not to renew the
contract at least 90 days before the end of the current period. (Additional
requirements concerning nonrenewal of contracts, binding on both HCFA and the
Organization, may be found at 42 CFR 417.492.) This contract supersedes any
previous contract under sections 1833 or 1876 of the Social Security Act (the
Act).
Article II
Election of Payment Method
Under section 1876(a) of the Act the Organization may elect a method of payment
for which it is eligible and qualified, and will be accordingly governed by the
statute and regulations which pertain to that method. The Organization
agrees to receive payment:
(initial one selection below)
x 1. On a risk basis under section 1876(g) of the Act, subject to the
---- provisions of Article V;
2. On a reasonable cost basis under section
---- 1876(h) of the Act, subject to the provisions
of Article VI and its implementing
regulations at 42 CFR 417.530-417.576.
Select one option (see 42 CFR 417.532(c)):
1. (direct payment of
----- Organization's providers by
HCFA)
2. (direct payment
----- of Organization's providers
by the Organization)
If option 2, list names of providers to be paid by the
Organization:
-------------------------------------------
-------------------------------------------
(list others separately)
3. On a risk basis under section 1876(g) for new
---- Medicare enrollees and payment on a
reasonable cost basis for unconverted,
current non-risk Medicare enrollees, subject
to the provisions of Articles V and VI.
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Article III
Geographic Area
The Organization agrees that the contract shall be effective for the geographic
area described in the attachment to this contract. (Modifications to the
geographic area during the period of the contract are governed by Article VII.)
Article IV
General Conditions
A. The Organization agrees to comply with the law, regulations, and
general instructions of the Health Care Financing Administration
(HCFA) which concern the participation of health maintenance
organizations (HMOs) and competitive medical plans (CMPs) in the
Medicare program.
B. As part of its ongoing quality assurance program:
1. The Organization agrees to comply with the requirements for
Peer Review Organization (PRO) review of services furnished to
Medicare enrollees as set forth in Subchapter D of Chapter IV,
Title 42, Code of Federal Regulations 417.478(a).
2. The Organization shall furnish to the Peer Review Organization
(PRO) requested on-site access to or copies of patient care
records and other pertinent data, and permit the PRO or its
subcontractor to examine its operations and records as
necessary for the PRO to carry out its functions under the
Act.
3. Each organization receiving payment on a risk basis will
maintain a written agreement with a utilization and quality
control Peer Review Organization with which HCFA has a
contract under Part B of Title XI of the Act for the area in
which the Organization is located. In accordance with
sections 1154(a)(4)(B) and (a)(14) of the Act, the agreement
must provide for the review of services (including both
inpatient and outpatient services) provided by the
organization pursuant to this contract for the purpose of
determining whether such
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services meet professionally recognized standards of health
care, including whether appropriate services have not been
provided or have been provided in inappropriate settings. The
agreement must also provide for review by the PRO of all
written complaints filed by Medicare beneficiaries or their
representatives about the quality of services provided by the
Organization. The cost of such agreement will be paid by HCFA
directly to the PRO on behalf of the Organization.
4. Each Organization receiving payment on a risk basis must
ensure that all hospitalization data required on HCFA Form
1450 (UB-82) for Medicare enrollees discharged between April
1, 1987 and July 31, 1988 is submitted to the fiscal
intermediary or other HCFA designated entity.
5. Each Organization receiving payment on a risk basis must
provide the hospital with any information necessary for the
completion of HCFA Form 1450 (UB-82) which the hospital must
submit to the intermediary for any discharges after July 31,
1988.
For purposes of this section, Peer Review Organization (PRO) is also deemed
reference to other appropriate entitles with which HCFA has contracted pursuant
to Section 1154(a)(4)(C) of the Act.
C. The Organization agrees to comply with:
1. Sections 1318(a) and (c) of the Public Health Service Act
which pertain to disclosure of certain financial information;
2. Sections 1301(c)(1) and (c)(8) of the Public Health Service
Act, which relate to fiscal, administrative, and management
requirements and liability arrangements to protect all members
of the organization; and to notify HCFA 60 days prior to any
changes in its insolvency arrangements; and
3. The reporting requirements in 42 CFR 417.107(j)(1) which
pertain to the monitoring of an organization's continued
compliance. For purposes of this paragraph, references in
that section to an "HMO" are also deemed references to a
"CMP."
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D. The Organization agrees to comply with Title VI of the Civil Rights
Act of 1964 (and pertinent regulations at 45 CFR Part 80),
section 504 of the Rehabilitation Act of 1973 (and pertinent
regulations at 45 CFR Part 84), and the Age Discrimination Act of 1975
(and pertinent regulations at 45 CFR Part 91).
E. The Organization agrees to the following:
1. HCFA may evaluate, through inspection or other means, the
quality, appropriateness, and timeliness of services furnished
under the contract to the Organization's Medicare enrollees;
2. HCFA may evaluate, through inspection or other means, the
facilities of the organization when there is reasonable
evidence of some need for that inspection;
3. HCFA, the Comptroller General, or their designees may audit or
inspect any books and records of the organization or its
transferee that pertain to any aspect of services performed,
reconciliation of benefit liabilities, and determination of
amounts payable under the contract;
4. HCFA may evaluate, through inspection or other means, the
enrollment and disenrollment records for the current contract
period and three prior periods, when there is reasonable
evidence of some need for that inspection;
5. The right to inspect, evaluate, and audit, will extend through
three years from the date of the final settlement for any
contract period unless -
a. HCFA determines there is a special need to retain a
particular record or group of records for a longer
period and notifies the Organization at least 30 days
before the normal disposition date;
b. There has been a termination, dispute, fraud, or
similar fault by the Organization, in which case the
retention may be extended to three years from the
date of any resulting final settlement; or
C. HCFA determines that there is a reasonable
possibility of fraud, in which case it may reopen a
final settlement at any time.
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F. The Organization shall submit to HCFA (in such form and detail as the
HCFA shall prescribe in regulations and general instructions), the
following reports:
1. Data pertaining to health insurance claim numbers from
beneficiaries, which shall be transmitted initially and on a
continuing basis, as required to annotate the health insurance
master file;
2. Statistical data on provider services and on medical and other
services;
3. Enrollment and actuarial data; and
4. Any other reports or data that HCFA may require.
G. The Organization agrees to report all enrollment, disenrollment, and
other beneficiary characteristic records according to HCFA program
instructions. All records must be transmitted 1) through an approved
HCFA systems contractor, or 2) over data transmission lines directly
to HCFA, or 3) on magnetic tape unless otherwise prescribed by HCFA.
All electronic transmissions and tapes must be totally compatible and
consistent with the relevant HCFA computer record systems.
H. The Organization shall furnish to organizations serving as carriers
and intermediaries under Title XVIII, information necessary to allow
the carriers or intermediaries to make proper payment under Title
XVIII for Medicare beneficiaries enrolled in the Organization.
I. The Organization agrees to require all entities related to the
Organization, as determined under 42 CFR 417.484 (a), to agree that -
1. HCFA, the Comptroller General, or their designees have the
right to inspect, evaluate, and audit any pertinent books,
documents, papers, and records of the subcontractor involving
transactions related to the subcontractor; and
2. The right under this section to information for any particular
contract period will exist for a period equivalent to that
specified in section E(5) of this Article.
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J. The Organization agrees -
1. To submit to HCFA -
a. All financial information required under 42 CFR
417.530 through Section 417.576 and for final
settlement; and
b. Any other information necessary for the
administration or evaluation of the Medicare program.
2. To comply with the requirements set forth in 42 CFR Part 420,
Subpart C, pertaining to the disclosure of ownership and
control information;
3. To comply with the requirements of the Privacy Act, as
implemented by 45 CFR Part 5b and Subpart B or Part 401 of 42
CFR, with respect to any system of records developed in
performing carrier or intermediary functions under 42 CFR
417.532 and section 417.533; and
4. To meet the confidentially requirement of 42 CFR 482.24 for
medical records and for all other information on enrollees,
not covered under item 3 above, that is contained in its
records or obtained from HCFA or others.
5. To provide prompt payment (consistent with the provisions of
section 1816(c)(2) and 1842(c)(2)) of claims submitted for
services and items furnished to individuals pursuant to this
contract, if the services or items are not furnished under a
contract between the Organization and the provider or
supplier.
K. Pursuant to 42 CFR 417.476 conditions of qualification set forth at 42
CFR 417.410 through section 417.418 may be waived by HCFA. However,
for each of such qualifying conditions waived, this contract must
contain -
1. The specific terms of the waiver;
2. The expiration date of the waiver;
3. Any other information required by HCFA.
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L. The Organization shall provide and supply (1) full and complete
information as to ownership of a subcontractor with whom such
organization has had during the previous twelve months, business
transactions in an aggregate amount in excess of $25,000, and (2) full
and complete information as to any significant business transactions
during the five year period ending on the date of HCFA's request,
between the Organization and any wholly-owned supplier or between the
Organization and any subcontractor. The required information must be
provided in the manner required under section 1866(b)(2)(c)(ii) of
the Act.
M. The Organization shall notify HCFA of loans and other special
financial arrangements which are made between the Organization and
subcontractors, affiliates and related parties.
N. The Organization agrees -
1. That for the duration of the contract, the Organization shall
have an enrolled membership at least one-half of which
consists of individuals who are not entitled to benefits under
Medicare or Medicaid. HCFA may suspend enrollment or payment
to the Organization or terminate this contract if this
requirement is not met.
2. To submit quarterly reports of its commercial enrollment,
Medicaid enrollment and Medicare enrollment in the geographic
area defined by Article III of this contract.
0. The Organization agrees that no marketing material may be distributed
by an organization to (or for the use of) individuals eligible to
enroll or enrolled in the organization under this contract unless at
least 45 days before the distribution, the Organization has submitted
the material to HCFA for review, and HCFA has not disapproved the
distribution of the material.
P. The Organization agrees to allow eligible beneficiaries to enroll
under this contract during any open enrollment period required by
HCFA through regulations. The Organization agrees to accept
beneficiaries up to the limit of its capacity as approved by HCFA.
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Q. Upon termination of this contract, the Organization agrees:
1. To give its Medicare enrollees a written notice of the
termination at least 60 days before the termination date;
2. To be responsible for the cost of the notice;
3. To submit a copy of the notice to HCFA for review;
4. If the Organization is a risk contractor, to include with the
required notice a written description of alternatives
available for obtaining Medicare services after termination.
R. The Organization hereby provides assurances to HCFA that in the event
the Organization ceases to provide items and services under this
contract, the Organization shall provide or arrange for supplemental
coverage of benefits under Title XVIII of the Act related to a
pre-existing condition with respect to any exclusion period, to all
individuals enrolled with the entity who receive benefits under Title
XVIII, for the lesser of six months or the duration of such period.
S. The Organization agrees to review and act upon requests for
reconsideration from its Medicare enrollees within 60 days of receipt
of the reconsideration request for the provision or payment of
services or items which were initially denied. In those cases where
the Organization will continue to deny services or items or payment
for services or items, in whole or in part, the Organization must
forward the beneficiaries' reconsideration requests along with the
Organization's written explanation and documentation to HCFA or its
contractor within 60 days of receipt of the reconsideration request.
In those cases where HCFA or its contractor determines that the
Organization should provide services or items previously denied, or
HCFA or its contractor determines that the Organization has financial
liability for services or items received, the Organization must pay
for or provide those services to the beneficiary within 60 days of the
receipt of HCFA's or its contractor's determination.
Services previously denied will be arranged by the Organization in a
manner consistent with services normally provided by the
Organization.
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T. If any Medicare beneficiaries residing in the Organization's service
area are members of another risk-based contracting organization which
nonrenews or terminates its contract, your Organization (if under a
risk-based contract) agrees to hold a special 30-day terminations open
enrollment period to enroll those Medicare beneficiaries enrolled in
the other risk-contracting organization at the time of termination or
nonrenewal of the other organization's contract.
This requirement will apply only to those Medicare beneficiaries
enrolled in the other risk-sharing contracting organization who reside
in your Organization's service area. The terminations open enrollment
period must be conducted during the period designated by HCFA. You
will be given notice 30 days before the start of the open enrollment
period.
This does not preclude an organization from requesting a
capacity waiver as described at 42 CFR 417.426(b)(1).
U. As part of advance directives requirements, the Organization agrees:
1. To inform all Medicare enrollees at the time of enrollment of
their right (under State law whether statutory or recognized
by the courts of the State) to accept or refuse treatment and
to execute an advance directive, such as living wills or
durable powers of attorney, and of the Organization's written
policies on implementation of that right;
2. To document in the individual's medical records whether or not
an individual has executed an advance directive;
3. To not condition treatment or otherwise discriminate on the
basis of whether an individual has executed an advance
directive;
4. To comply with State law (whether statutory or recognized by
the courts of the State) on advance directives; and
5. To provide (individually or with others) for education for
staff and the community on advance directives.
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V. The Organization, if it has a risk contract, agrees not to employ or
contract with, directly or indirectly, entities or individuals
excluded from participation in Medicare or Medicaid under sections
1128 or 1128A of the Act, for the provision of health care,
utilization review, medical social work, or administrative services.
Article V
Conditions For Payment on a Risk Basis
The following conditions apply to the Organization if it selected, in Article
II of this contract, to be paid on a risk basis method under section 1876(g) of
the Act, or if it selected to be paid on a risk basis and paid on a reasonable
cost basis for unconverted, current non-risk Medicare enrollees:
A. Except as provided for in Article V.(D)., HCFA shall make payment
under this contract for services rendered to Medicare enrollees on a
risk basis as provided in regulations.
B. The Organization agrees to maintain, and make available to HCFA upon
request, books, records, documents, and other evidence of accounting
procedures and practices that -
1. Are sufficient to -
a. Establish component rates of the adjusted community
rate (ACR) for determining additional and
supplementary benefits; and
b. Determine the rates utilized in setting premiums for
State insurance agency purposes.
2. Include at least any records or financial reports filed with
other Federal agencies or State authorities.
C. The Organization has the right to appeal a determination that the
Organization's ACR computation is not acceptable, pursuant to the
provisions of 42 CFR 417.594(e)(2).
D. To the extent that the Organization's members are unconverted, current
non-risk Medicare enrollees, the Organization agrees to fully comply
with the conditions in Article VI.
E. The Organization agrees, as required by section 1876(g)(2) of the Act,
that if the ACR (as reduced for the actuarial value of the coinsurance
and deductibles) is less than the average
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of the per capita rates of payment to be made under section 1876(a)(1)
for Medicare members enrolled under the risk basis method of payment,
the Organization shall provide its Medicare members with additional
benefits described at section 1876(g)(3), selected by the
Organization, and which HCFA finds are at least equal in value to the
difference between the average per capita payment and the adjusted
community rate (as so reduced). This condition shall not apply to an
organization which agrees to accept a lesser payment to the extent
that there is no longer a difference between the average per capita
payment and the adjusted community rate (as so reduced).
F. The Organization agrees -
1. To publicly offer and provide at least the level of Medicare
covered benefits approved in the ACR. The Organization
may choose to offer more services or to impose lower premiums
or other charges (in the form of deductibles or coinsurance)
than approved in the ACR.
However, such complimentary services or waived premiums or
other charges must be approved in advance by HCFA and remain
in effect throughout the contract period.
The only mid-year changes that are permitted are those which
are entirely advantageous to Medicare enrollees. Premiums and
copayments may be reduced at any time during the year, but
once they are reduced, they cannot be increased later on
during the same contract period. Benefits for which there is
no charge may be added at any time during the contract period,
but also must remain in place for the remainder of the
contract period. HCFA should be advised of any expanded
benefits or decreases in premiums or copayments arising
in the middle of a contract period.
Waived premiums and complimentary services provided solely to
members of an employer group are governed by the
Organization's contract with the employer.
2. Nothing in this article may be interpreted as a waiver or
compromise of any appeal rights to which the Organization may
be entitled under Title XVIII of the Act and implementing
regulations.
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Article VI
Conditions of the Reasonable Cost Method
of Payment
The following conditions apply to the Organization if it selected in Article II
of this contract to be paid on the Reasonable Cost Method under section 1876(h)
of the Act, or if it selected to be paid on a risk basis and paid on a
reasonable cost basis for unconverted, current non-risk Medicare enrollees:
A. HCFA shall make payment under this contract for services rendered to
Medicare enrollees on a reasonable cost basis as provided in
regulations.
B. The Organization agrees to maintain books, records, documents, and
other evidence of accounting procedures and practices that -
1. Are sufficient to -
a. Ensure an audit trail; and
b. Properly reflect all direct and indirect costs
claimed to have been incurred under the contract; and
2. Include at least records of the following:
a. Ownership, organization, and operation of the
Organization's financial, medical and other
recordkeeping systems;
b. Financial statements for the current contract period
and three prior periods;
c. Federal income tax or information returns for the
current contract period and three prior periods;
d. Assets acquisition, lease, sale, or other action;
e. Agreements, contracts, and subcontracts;
f. Franchise, marketing, and management agreements;
g. Schedules of charges for the Organization's fee-
for-service patients;
h. Matters pertaining to costs of operations;
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i. Amounts of income received, by source and payment;
j. Cash flow statements;
k. Any financial reports filed with other Federal
programs or State authorities.
C. The Organization has the right to appeal any final determination of
costs pursuant to the reimbursement appeals procedures contained in
the regulations at 42 CFR Part 405, Subpart R.
D. The Organization shall make available for the purposes specified in
paragraphs 1-4 of section D of Article IV, its premises, physical
facilities, and equipment, its records relating to its Medicare
enrollees, the records specified in 42 CFR 417.480, and any additional
relevant information that HCFA may require.
E. The Organization agrees that -
1. Upon HCFA's request it will provide, subsequent to an
accounting period, an independently certified financial
statement of its per capita incurred cost, based on the types
of components of expenses otherwise reimbursable under Title
XVIII, for providing services described in section 1876(a)(1),
including its method of allocating costs between individuals
enrolled under this section and other individuals enrolled
with the Organization, such statements to be provided in
accordance with accounting procedures prescribed by HCFA;
2. Failure to report such information may be deemed evidence of
likely overpayment upon which basis collection action may be
taken;
3. The required financial statements will be consolidated to
include an accounting for the costs of entities related to the
Organization by common ownership or control;
4. Allowable costs for a related organization may not include
costs for the types of expense otherwise reimbursable under
Title XVIII, in excess of an amount which would be determined
to be reasonable in accordance with regulations;
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5. In any case in which compensation is paid substantially in
excess of what is normally paid for similar services by
similar practitioners, such compensation may, as appropriate,
be considered a distribution of profits.
F. The Organization agrees to comply with the requirements of section
1833(a)(1)(A) of the Act and its implementing regulations, 42 CFR
417.800 through 42 CFR 417.810, for members who have not been
converted from any previous Health Care Prepayment Plan (HCPP)
contract(s) or arrangement(s).
Article VII
Modification, Termination or Non-renewal
This contract may be modified at any time by written consent of both parties
(the Organization and HCFA). If the contract is modified, the Organization
must notify its Medicare enrollees of any changes that HCFA determines are
appropriate for notification. It may be terminated by either party in
accordance with the provisions of 42 CFR 417.494 or a decision by either party
not to renew the contract may be made in accordance with the provisions of
42 CFR 417.492.
Article VIII
Any revisions to applicable provisions of Title XI or Title XVIII of the Act,
Title XIII of the Public Health Service Act, implementing regulations, policy
issuances and instructions apply as of their effective date.
Article IX
General Contracting Requirements
A. FACILITIES NONDISCRIMINATION CLAUSE
The following provisions are applicable to and shall be included in
all leases of real estate entered into for the administration of this
agreement:
"As used in this clause, the term 'Facility' means stores, shops,
restaurants, cafeterias, restrooms, and any other facility of a public
nature in the building in which the space covered by this lease is
located.
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"The lessor agrees that he will not discriminate by segregation or
otherwise against any person or persons because of race, color,
religion, sex, or national origin in furnishing or by refusing to
furnish, to such person or persons, the use of any facility including
any or all services, privileges, accommodations, and activities
provided thereby. Nothing herein shall require the furnishing to the
general public of the use of any facility customarily furnished by the
lessor solely to tenants, their employees, customers, patients,
clients, guests and invitees.
"It is agreed that the lessor's noncompliance with the provisions of
this clause shall constitute a material breach of this lease. In the
event of such noncompliance, the lessee may take appropriate action to
enforce compliance, may terminate this lease or may pursue such other
remedies as may be provided by law. In the event of termination, the
lessor shall be liable for all excess costs of the lessee in acquiring
substitute space. Substitute space will be obtained in as close
proximity to the lessor's building as is feasible and moving costs
will be limited to the actual expenses thereof as incurred.
"The lessor agrees to include, or to require the inclusion of the
foregoing provisions of this clause (with the terms "lessor" and
"lessee" appropriately modified) in every agreement or concession
pursuant to which any person other than the lessor operates or has the
right to operate any facility. Nothing herein contained, however,
shall be deemed to require the lessor to include or require the
inclusion of the foregoing provisions of this clause in any existing
agreement or concession arrangement or one in which the contracting
party other than the lessor has the unilateral right to renew or
extend the agreement or arrangement, until the expiration of the
existing agreement or arrangement and the unilateral right to renew
or extend. The lessor also agrees that it will take any and all
lawful actions as expeditiously as possible with respect to any such
agreement as the contracting agency may direct to enforce this clause,
including but not limited to termination of the agreement or
concessions and institution of court action."
B. DISCLOSURE OF INFORMATION
The following clause shall be included in all subcontracts entered
into either for the performance of functions required for the
administration of this agreement or where a subcontractor, his agents,
officers or employees might
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reasonably be expected to have access to information within the
purview of section 1106 of the Social Security Act and regulations
prescribed pursuant thereto:
"The contractor agrees to establish and maintain procedures and
controls so that no information contained in its records or obtained
from HCFA or from others in carrying out the terms of this subcontract
shall be used by or disclosed by it, its agents, officers, or
employees except as provided in said section 1106 of the Social
Security Act and regulations prescribed thereunder."
C. AUTOMATIC TERMINATION OF SUBCONTRACT CLAUSE
The following provision are applicable to and shall be included in all
subcontracts entered into hereafter (except for the purchase of items
and equipment), including leases of real property which exceed the
term of this agreement except where HCFA agrees to its omission.
Failure of the Contractor to include the clause in such subcontract
without the written agreement of HCFA to its omission, shall make the
related costs incurred after the effective date of the nonrenewal or
termination, unallowable.
Notwithstanding the following, if the Contractor wishes to continue
the subcontract relative to its own business after the contract
between HCFA and the Contractor has been terminated or nonrenewed, it
may do so provided it assures HCFA in writing that HCFA's obligations
will terminate at the time the Medicare contract terminates or is
nonrenewed subject to the termination cost provisions provided for in
the contract.
The clause is as follows: "In the event the Medicare contract between
HCFA and (Name of Contractor) is terminated or nonrenewed, the
contract between (Name of Contractor) and (Name of Firm) will be
terminated unless HCFA and (Name of Contractor) agree to the contrary.
Such termination shall be accomplished by delivery of written notice
to (Name of Firm) of the date upon which said termination will become
effective."
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D. PROHIBITION AGAINST USE OF HCFA FUNDS TO INFLUENCE
LEGISLATION OR APPROPRIATIONS
The following provision is applicable to this agreement:
No part of any funds under this agreement shall be used to pay the
salaries or expenses of any Contractor, or any agent acting for the
Contractor, to engage in any activity designed to influence
legislation or appropriations pending before the Congress.
Lobbying costs are defined in and are unallowable in accordance with
Federal Acquisition Regulation 31-205-22.
E. LIQUIDATED DAMAGES IN SUBCONTRACTS
The following provisions are applicable to and shall be included in
any subcontract entered into or renewed under this agreement
containing a liquidated damages provision which related solely to
Medicare:
The Health Care Financing Administration (HCFA), after consultation
with the Contractor, shall have the right to determine that the
specified levels of performance have not been attained by the
subcontractor. In such event, HCFA may direct the Contractor to
notify the subcontractor of HCFA's determination that liquidated
damages apply and to set-off the liquidated damages against the
subcontractor. HCFA shall reimburse the Contractor for all reasonable
costs relating to this activity and shall honor any judgement or award
rendered against the Contractor directly resulting from the
enforcement of such provision as directed by HCFA. Failure of the
Contractor to timely comply with such direction, shall constitute
cause for the application of any and all administrative, statutory,
and judicial remedies which may be available to HCFA pursuant to this
agreement, including but not limited to, offsetting an amount
equivalent to the amount of such unenforced liquidated damages. In
the event that such offset is made, the Contractor shall be obligated
to continue to perform all terms and conditions of this agreement
without additional payment from HCFA attributable to such offset
amounts.
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(Plan # H1036 Contract Period 01/01/92 - 12/31/92)
F. FEDERAL ACQUISITION REGULATIONS INCORPORATED BY REFERENCE
This agreement incorporates the following clauses by reference with
the same force and effect as if they were given in full text. Upon
request, HCFA will make their full text available:
FEDERAL ACQUISITION REGULATION
(48 CFR CHAPTER 1) CLAUSES
52.222-26 Equal Opportunity (April 1984)
52.203-1 Officials Not to Benefit (April 1984)
52.203-5 Covenant Against Contingent Fees (April 1984)
52.219-8 Utilization of Small Business Concerns and Small Disadvantaged Business Concerns (April 1984)
52.219-9 Small Business and Small Disadvantaged Business Subcontracting Plan (April 1984)
52.220-3 Utilization of Labor Surplus Area Concerns (April 1984)
52.220-4 Labor Surplus Area Subcontracting Program (April 1984)
52.222-3 Convict Labor (April 1984)
52.222-21 Certification of Nonsegregated Facilities (April 1984)
52.222-35 Affirmative Action for Special Disabled and Vietnam Era Veterans (April 1984)
52.222-36 Affirmative Action for Handicapped Workers (April 1984)
52.203-7 Fees or Kick-Backs By Subcontractors (Anti-Kickback Act (41 U.S.C. 51-54)) (April 1984)
52.219-13 Utilization of Women-Owned Small Businesses (April 1984)
52.245-5 Government Property (April 1984) Applicable only
to Contractors that have been furnished
Government property.
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(Plan # H1036 Contract Period 01/01/92 - 12/31/92)
Signature of the official authorized to request a change in the
banking information needed for HCFA payment to your
Organization.
/s/ WALTER B. STARK (Signature)
------------------------
Walter B. Stark (Name)
------------------------
Director Cash Management (Title)
------------------------
In witness whereof, the parties hereby execute this contract.
Date January 30 , 1992
------------ --
EFFECTIVE DATE
January 1 , 1992
----------- --
For the Organization
/s/ JOSEPH E. SHYRIH (Signature)
--------------------------
Vice President (Title)
--------------------------
Humana Medical Plan, Inc. (Organization)
--------------------------
3400 Lakeside Drive
Miramar, Florida 33027 (Address)
--------------------------
For the Health Care Financing
Administration
/s/ CONNIE FORSTER (Signature)
--------------------------
for Act. Director
Office of Operation
Office of Prepaid Health Care
Operations and Oversight
Health Care Financing
Administration
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12/02/91 PAGE: 1
GEOGRAPHIC AREA ATTACHMENT
ORGANIZATION HUMANA MEDICAL PLAN, INC - DADE H1036
IN THE STATE OF FL
- THE FOLLOWING COUNTY(IES):
BROWARD DADE
HILLSBOROUGH ORANGE
OSCEOLA PALM BEACH
PASCO PINELLAS
SEMINOLE VOLUSIA
P = PARTIAL COUNTY