Contracted Health Care Provider Compliance Attestation
The Centers for Medicare & Medicaid Services (CMS) requires any organization or individual that contracts with Health Partners Plans (HPP) to provide administrative or healthcare services to beneficiaries to comply with various CMS program requirements. By completing the following attestation, you certify that your organization is committed to ensuring compliance with HPP and CMS requirements. Additional information on the below requirements can be found on our website at:
This attestation must be submitted back to HPP within 30 calendar days from the date of request.
Code of Conduct and Compliance Policies for Contracted Health Care Providers
HPP complies with CMS' Code of Business Conduct (COBC) and Compliance Policy distribution requirements. HPP provides access to HPP's COBC and Compliance Policy via HPP’s Provider Manual and Medicare FDR Webpage.
If your organization does not comply with and distribute HPP's COBC and Compliance Policy, or its own similar versions, please provide an explanation below:
OIG/SAM Exclusion Screening
(Select the option below or enter an explanation in the comment box.)
Downstream Entity Status
Please indicate here if your organization contracts with downstream entities to perform HPP related healthcare services:
(Note: Downstream Entities are Healthcare Providers, organizations or other entities that are contracted with your organization to perform HPP related healthcare services. Internal employees of your organization are not considered to be downstream entities.)
Organizations with Downstream Entities
My organization takes the following actions to ensure its downstream entities are aware of and comply with the compliance requirements communicated in HPP’s COBC and Compliance Program Policy:
(Select 1 option that best describes your organization’s actions or enter an explanation in the comment box.):
If the Organization either does not comply with CMS’ COBC & Compliance Policies distribution requirements, or satisfies the requirements via a different method not listed above, please provide an explanation below.
As authorized representative for the below named organization, 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.