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Delegated Vendor Compliance Attestation

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CMS and DHS require any organization or individual that contracts with Health Partners Plans (HPP) to provide administrative or healthcare service functions on HPP's behalf to comply with various compliance program requirements. By completing the following attestation, you certify that your organization is committed to fulfilling Medicare, Medicaid and/or CHIP Compliance Program requirements and any Compliance Program Requirements implemented by Health Partners Plans.



For existing HPP Delegated Vendors, this attestation must be submitted back to HPP within 30 days of notification.


Lines of Business

(Select all HPP lines of business that your organization performs services for.)
Medicare
Medicaid
CHIP


Code of Business Conduct and Compliance Program Policy Distribution:

(Select 1 option that best describes your organization’s actions or enter an explanation in the comment box.)
HPP's Code of Business Conduct (COBC) and Compliance Program Policies were made available to our organization in 2021. We have provided HPP’s COBC/Compliance Program Policies to all of our employees initially within 90 days of hire or contracting, upon revision, and will continue to provide them annually thereafter.
My organization’s Code of Conduct and/or Compliance Program Policies are materially similar to HPP’s COBC and Compliance Program Policy content and were provided to all of our employees in 2021 within 90 days of hire and upon revision. We will continue to provide them annually thereafter.
If the organization does not adopt and comply with HPP's COBC and Compliance Policy, or a materially similar version, please explain below:


OIG/SAM/Medicheck Exclusion Screening:

(Select the option below or enter an explanation in the comment box.)
In 2021 my organization reviewed the OIG LEIE, SAM EPLS and Medicheck (applicable to work related to HPP's Medicaid/CHIP lines of business) prior to the hiring or contracting of all personnel involved in the administration or delivery of HPP benefits and monthly thereafter.
If the organization did not perform exclusion screenings as stated above, please explain below:


Reporting Mechanisms:

(Select the option below or enter an explanation in the comment box.)
In 2021, internal employees were informed of their obligation and how to report any suspected or detected non-compliance or potential FWA for internal investigation. The reporting mechanisms ensure confidentiality and allow for anonymity, as desired. In addition, we don't allow retaliation or intimidation against anyone who reports in good faith. In turn, our organization reports any applicable incidents to HPP as they arise.
If the language stated above does not align with the actions of your organization, please explain below:


Offshore Subcontractor Reporting

During 2021, my organization and/or any of our downstream/related entities (CHECK ONE) Did DID NOT engage in offshore operations for any administrative or healthcare services related to HPP business. If your organization and/or any of our downstream/related entities engaged in offshore operations related to HPP business, please complete the "Offshore Subcontractor Attestation" for each entity, located on the Delegated Vendor Information webpage.





Medicare Only Downstream Entity Status

Please indicate if your organization contracted with downstream entities during 2021 to perform HPP related services:

Yes, my organization contracted with downstream entities to perform HPP-related services in 2021.
No, my organization did not contract with downstream entities to perform HPP-related services in 2021.




As an authorized representative for the organization named below, I certify that I have reviewed and understand all of the requirements within HPP's vendor policy, that the above statements are true to the best of my knowledge, and that my organization maintains records that support our compliance.


























Please direct questions or concerns regarding this attestation to MedicareFDR@hpplans.com.