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[" Contractor/MCP Name","Subcontractor ID #"," Subcontractor Name","Type of Subcontractor","Applicable County(ies)","Subcontractor Key Personnel (Previously Compliance Officer)","Subcontractor Key Personnel Contact Information (Previously Compliance Contact Information)","Delegated Function(s)\n(Previously one field. Now split into three different columns)",null,null,"Address1","Address2","City","ZIP Code","% of Total Medi-Cal Managed Care Members Assigned","Proportion of Capitated Rates at Risk","Justification of Subcontractor Agreement or Downstream Subcontractor Agreement","Pre-Existing Relationships","Sub-Delegation","Impact on Contractor","Contractor’s Administrative Capacity to Oversee and Monitor Subcontractor and Downstream Subcontractor","Subcontractor’s and Downstream Subcontractor’s Administrative Capacity","Subcontractor’s and Downstream Subcontractors’ Compliance with Applicable Contractual Provisions","Contractor’s Oversight Policy and Procedures","Financial Arrangement","Other Information","Previously Approved Documents"]
["Name of the Managed Care Plan with whom the Subcontractor has an Agreement","Assign each Subcontractor a different number using the format S#. Begin with S1 and proceed in numerical order (e.g. S2, S3, etc.)","Name of the Subcontractor with whom Contractor has a Subcontractor Agreement","Fully Delegated Subcontractor, Partially Delegated Subcontractor, Administrative Subcontractor","County in which Subcontractor is delegated services. ","Name for each of Subcontractor’s key personnel who is responsible for ensuring compliance.","Contact information for each of Subcontractor’s key personnel who is responsible for ensuring compliance (Email & Telephone Number).","Clinical Functions\n\nThe clinical function(s) Contractor is delegating to Subcontractor. Please select all delegated functions from the drop-down list. \n\nIf a Subcontractor is delegated different functions in different counties, please duplicate the Subcontractor entry but specify in each row which functions are delegated in each county.","Administrative Functions\n\nThe administrative function(s) Contractor is delegating to Subcontractor. Please select all delegated functions from the drop-down list. \n\nIf a Subcontractor is delegated different functions in different counties, please duplicate the Subcontractor entry but specify in each row which functions are delegated in each county. ","Administrative - Other\n\nIf 'Other' was selected in Column I, please describe. ","The address for location of the performance of Subcontractor’s functions.",null,null,null,"Percentage of the total Medi-Cal Members assigned to the Subcontractor if applicable.","Proportion of total capitated rates for which the Subcontractor is at risk, if applicable.","Describe the purpose and the justification of the Subcontractor Agreement or Downstream Subcontractor Agreement.","Describe any pre-existing relationship, including any affiliation, parent entity, or prior existing contract between Contractor and Subcontractor, or Subcontractor and Downstream Subcontractor including the duration of such pre-existing relationship.","Indicate if Subcontractor or Downstream Subcontractor is permitted to sub-delegate any functions. If so, describe how Contractor will maintain oversight over delegated functions to Subcontractors and Downstream Subcontractors. Provide citations to provisions in the Subcontractor Agreement and Downstream Subcontractor Agreement to support Contractor’s assertions.","Describe the impact and benefit, if any, the Subcontractor Agreement or Downstream Subcontractor Agreement will have on Contractor’s operations, administrative capacity, and financial viability.","Describe Contractor’s administrative capacity to oversee and monitor Subcontractor and Downstream Subcontractor as applicable.","Describe Subcontractor’s and Downstream Subcontractor’s administrative capacity to perform each delegated function, including but not limited to Subcontractor’s and Downstream Subcontractor’s capacity to perform quality monitoring and community engagement, if applicable.","Detail how the Subcontractor Agreement and Downstream Subcontractor Agreement complies with, and ensures compliance, with all provisions of the Contract applicable to the delegated functions, including appropriate citations to the provisions in the Subcontractor Agreement and Downstream Subcontractor Agreement. Please complete Template C (Contract Requirements Grid) in Exhibit J to indicate which provisions are included in the Subcontractor Agreements and Downstream Subcontractor Agreements, as applicable for each Agreement.","Describe how Contractor will inform Subcontractor and Downstream Subcontractors of Contractor’s oversight policies and procedures.","Contractor must include description of any financial arrangements it has with Subcontractor and Downstream Subcontractor.","Include any other information that would assist DHCS in its review of Contractor’s delegated structure.","(Applicable to annual submissions only) If Contractor has previously submitted documentation to DHCS in connection with the Subcontractor Agreement or Downstream Subcontractor Agreement, either through the Request for Proposal (RFP) process or during the term of this Contract, Contractor must provide any such documentation.\n\nPlease submit any previously approved supplemental documentation with this completed Exhibit. Below, please indicate the title of the supplemental file along with a brief description of its contents. "]
["CalOptima Health","S1","AltaMed Health Network, Inc. ","Partially Delegated Subcontractor","Orange","Jerry Jackson, Chief Compliance Officer\n","EmaiL: XXXX\nTelephone: XXXX","Anesthesiology, Cardiology, Dental Services - Oral Surgery, Dermatology, Endocrinology, ENT/Otolaryngology, Family Medicine/Primary Care, General Surgery, Hematology, HIV/AIDS/Infectious Disease, Hospice, Nephrology, Nuclear Medicine, Oncology, Ophthalmology, Orthopedic Surgery, Pediatrics, Physical Medicine and Rehabilitation, Podiatry, Obstetrics-Gynecology, Pulmonology, Radiology","Claims Processing, Care Coordination, Provider Credentialing, Eligibility Confirmation, Utilization Management, Prior Authorizations","N/A","1401 N Montebello",null,"Montebello",90640,8.3000000000000004E-2,"N/A","Network Adequacy and Member Access","Delegation agreement with AltaMed Health Services Corporation terminated 10.31.24 and transitioned to AltaMed Health Network, Inc. on 11.1.24.","In accordance with CalOptima’s Delegation Agreement and Delegation Oversight Health Network and FDR Annual Audits, Subcontractors and/or Downstream Subcontractors are not permitted to sub-delegate any functions unless the Subcontractor and/or Downstream Subcontractor requests prior permission and receives approval by CalOptima, the Health Network, and/or the FDR. Ultimately, all sub-delegated functions require prior approval by CalOptima.\n\nCalOptima maintains oversight over delegated functions to Subcontractors and Downstream Subcontractors via a variety of methods including but not limited to annual audits, corrective action plans, ongoing monitoring, external audits, and accreditation review, and reporting review.  \n\nApplicable Citations: \n•\tDelegation Agreement. Section 2.c. – Subdelegation (notice and approval requirements for subdelegation)\n•\tDelegation Agreement. Section 4.a. - Rights and Obligations of CalOptima: Oversight (CalOptima oversight of delegated functions) \n•\tDelegation Agreement. Section 6. - Reporting (delegates’ ongoing reporting expectations to CalOptima) \n•\tDelegation Agreement. Schedules A-D (describes the Delegated Activity, LOB, Delegate Responsibility, CalOptima Responsibility, Reporting, Performance Evaluation, and Remediation for each delegated responsibility, by delegated functional area) ","Assists with Network Adequacy and Member Access","CalOptima has a robust delegation oversight program that includes a detailed annual audit program and ongoing monitoring process to oversee performance of delegated functions on an ongoing basis. CalOptima has a dedicated team of staff in its Delegation Oversight (DO) department responsible for conducting the annual audits of delegated activities and monitoring of Corrective Action Plans (CAPs) stemming from the annual audits. The annual audit process includes an audit of any downstream subcontractor arrangements, if applicable. The DO department maintains a calendar of scheduled audits for the year to ensure audits are conducted annually and completed timely. In addition to the work performed by the DO department, the Subject Matter Experts (SMEs) in CalOptima’s internal divisions related to functions that are delegated also perform ongoing monitoring of delegated activities by reviewing performance metrics and reports submitted the delegates on an ongoing basis. Oversight activities and findings are reported through the Delegation Oversight Committee, which reports up to the Compliance Committee.  ","CalOptima conducts pre-delegation readiness assessments of subcontractors to determine the subcontractor’s ability and capacity to implement and perform delegated activities prior to delegating such activities. The entity must demonstrate its ability and capacity to perform the delegated functions by meeting or exceeding all requirements in the CalOptima Service Agreement and CalOptima Delegation Oversight policies. If unable to meet a standard, the potential subcontractor may be placed on a Corrective Action Plan (CAP) prior to assuming delegated duties. Once a successful pre-delegation readiness assessment has been completed and responsibilities have been delegated to the subcontractor via a signed delegation agreement, CalOptima maintains ongoing oversight of delegated activities via ongoing monitoring and the annual audit process. The pre-delegation readiness assessment and annual audit includes a review of any downstream subcontractor agreements, if applicable. ","All subcontracted delegated entities must agree to the provisions of the CalOptima Delegation Agreement outlined in Attachment H of the agreement between CalOptima and the delegate. Under the Delegation Agreement, the delegate agrees to perform the delegated services in accordance with the responsibilities outlined in Attachment H for CalOptima and its Members assigned to Delegate.\nUnder the agreement the delegate must agree (either itself or through a CalOptima-approved Subcontractor or downstream entity) to provide the delegated services set forth in Schedules A, B, C, and D, of the agreement as applicable, (“Delegated Services”) in accordance with the terms of this Attachment H and Standards and Requirements. Under the agreement the term “Standards and Requirements” means currently applicable NCQA accreditation standards; DHCS, DMHC, CMS requirements; state and federal statutes, regulations, and sub-regulatory requirements; and CalOptima Policies and contractual requirements, including the State Contract.\n\nApplicable Citations: \n•\tDelegation Agreement. Attachment H in its entirety. \n•\tDelegation Agreement. Section 2.c. – Subdelegation (notice and approval requirements for subdelegation)\n•\tDelegation Agreement. Section 4.a. - Rights and Obligations of CalOptima: Oversight (CalOptima oversight of delegated functions) \n•\tDelegation Agreement. Section 6. - Reporting (delegates’ ongoing reporting expectations to CalOptima) \n•\tDelegation Agreement. Schedules A-D (describes the Delegated Activity, LOB, Delegate Responsibility, CalOptima Responsibility, Reporting, Performance Evaluation, and Remediation for each delegated responsibly, by delegated functional area) ","The Subcontractors have access to CalOptima's Policies and Procedures on CalOptima.org website; it's available 24 hours a day/7 days a week. CalOptima distributes weekly communications that includes Policy and Procedure updates that impact our Subcontractors and Downstream Subcontractors.","Capitation arrangement PMPM","N/A","See attached zipped file, HMO Contract Template subfolder, documents titled:\n 1. Medi-Cal HMO Contract (KL rev. 03.17.22) (00221231xD58B3) - this is the provider contract template that refers to the delegation agreement.\n 2. HMO HN Amendment with Delegation Agreement - this amendment includes the applicable delegation agreement for this subcontractor. "]
["CalOptima Health ","S2","AMVI Care ","Partially Delegated Subcontractor","Orange","Michelle Amador, VP, Compliance\n\n ","EmaiL: XXXX\nTelephone: XXXX","Anesthesiology, Cardiology, Dental Services - Oral Surgery, Dermatology, Endocrinology, ENT/Otolaryngology, Family Medicine/Primary Care, General Surgery, Hematology, HIV/AIDS/Infectious Disease, Hospice, Nephrology, Nuclear Medicine, Oncology, Ophthalmology, Orthopedic Surgery, Pediatrics, Physical Medicine and Rehabilitation, Podiatry, Obstetrics-Gynecology, Pulmonology, Radiology","Non-Emergency Transportation, Claims Processing, Care Coordination, Provider Credentialing, Eligibility Confirmation, Utilization Management, Prior Authorizations","N/A","600 City Parkway West","Suite 800","Orange",92868,3.0811000000000002E-2,"N/A","Network Adequacy and Member Access","N/A","In accordance with CalOptima’s Delegation Agreement and Delegation Oversight Health Network and FDR Annual Audits, Subcontractors and/or Downstream Subcontractors are not permitted to sub-delegate any functions unless the Subcontractor and/or Downstream Subcontractor requests prior permission and receives approval by CalOptima, the Health Network, and/or the FDR. Ultimately, all sub-delegated functions require prior approval by CalOptima.\n\nCalOptima maintains oversight over delegated functions to Subcontractors and Downstream Subcontractors via a variety of methods including but not limited to annual audits, corrective action plans, ongoing monitoring, external audits, and accreditation review, and reporting review.  \n\nApplicable Citations: \n•\tDelegation Agreement. Section 2.c. – Subdelegation (notice and approval requirements for subdelegation)\n•\tDelegation Agreement. Section 4.a. - Rights and Obligations of CalOptima: Oversight (CalOptima oversight of delegated functions) \n•\tDelegation Agreement. Section 6. - Reporting (delegates’ ongoing reporting expectations to CalOptima) \n•\tDelegation Agreement. Schedules A-D (describes the Delegated Activity, LOB, Delegate Responsibility, CalOptima Responsibility, Reporting, Performance Evaluation, and Remediation for each delegated responsibility, by delegated functional area) ","Assists with Network Adequacy and Member Access","CalOptima has a robust delegation oversight program that includes a detailed annual audit program and ongoing monitoring process to oversee performance of delegated functions on an ongoing basis. CalOptima has a dedicated team of staff in its Delegation Oversight (DO) department responsible for conducting the annual audits of delegated activities and monitoring of Corrective Action Plans (CAPs) stemming from the annual audits. The annual audit process includes an audit of any downstream subcontractor arrangements, if applicable. The DO department maintains a calendar of scheduled audits for the year to ensure audits are conducted annually and completed timely. In addition to the work performed by the DO department, the Subject Matter Experts (SMEs) in CalOptima’s internal divisions related to functions that are delegated also perform ongoing monitoring of delegated activities by reviewing performance metrics and reports submitted the delegates on an ongoing basis. Oversight activities and findings are reported through the Delegation Oversight Committee, which reports up to the Compliance Committee.  ","CalOptima conducts pre-delegation readiness assessments of subcontractors to determine the subcontractor’s ability and capacity to implement and perform delegated activities prior to delegating such activities. The entity must demonstrate its ability and capacity to perform the delegated functions by meeting or exceeding all requirements in the CalOptima Service Agreement and CalOptima Delegation Oversight policies. If unable to meet a standard, the potential subcontractor may be placed on a Corrective Action Plan (CAP) prior to assuming delegated duties. Once a successful pre-delegation readiness assessment has been completed and responsibilities have been delegated to the subcontractor via a signed delegation agreement, CalOptima maintains ongoing oversight of delegated activities via ongoing monitoring and the annual audit process. The pre-delegation readiness assessment and annual audit includes a review of any downstream subcontractor agreements, if applicable. ","All subcontracted delegated entities must agree to the provisions of the CalOptima Delegation Agreement outlined in Attachment H of the agreement between CalOptima and the delegate. Under the Delegation Agreement, the delegate agrees to perform the delegated services in accordance with the responsibilities outlined in Attachment H for CalOptima and its Members assigned to Delegate.\nUnder the agreement the delegate must agree (either itself or through a CalOptima-approved Subcontractor or downstream entity) to provide the delegated services set forth in Schedules A, B, C, and D, of the agreement as applicable, (“Delegated Services”) in accordance with the terms of this Attachment H and Standards and Requirements. Under the agreement the term “Standards and Requirements” means currently applicable NCQA accreditation standards; DHCS, DMHC, CMS requirements; state and federal statutes, regulations, and sub-regulatory requirements; and CalOptima Policies and contractual requirements, including the State Contract.\n\nApplicable Citations: \n•\tDelegation Agreement. Attachment H in its entirety. \n•\tDelegation Agreement. Section 2.c. – Subdelegation (notice and approval requirements for subdelegation)\n•\tDelegation Agreement. Section 4.a. - Rights and Obligations of CalOptima: Oversight (CalOptima oversight of delegated functions) \n•\tDelegation Agreement. Section 6. - Reporting (delegates’ ongoing reporting expectations to CalOptima) \n•\tDelegation Agreement. Schedules A-D (describes the Delegated Activity, LOB, Delegate Responsibility, CalOptima Responsibility, Reporting, Performance Evaluation, and Remediation for each delegated responsibly, by delegated functional area) ","The Subcontractors have access to CalOptima's Policies and Procedures on CalOptima.org website; it's available 24 hours a day/7 days a week. CalOptima distributes weekly communications that includes Policy and Procedure updates that impact our Subcontractors and Downstream Subcontractors.\n","Capitation arrangement PMPM","N/A","See attached zipped file, PHC Contract Template subfolder, documents titled:\n1. Medi-Cal PHC PHY Contract (KL rev. 03.17.22) (00221244xD58B3) - this is the provider contract template that refers to the delegation agreement.\n2. PHC-Physician (PHC-P) HN Amendment with Delegation Agreement - this amendment includes the applicable delegation agreement for this subcontractor."]
["CalOptima Health ","S3","CHOC Physicians Network","Partially Delegated Subcontractor","Orange","Lynn Grieves, Chief Compliance Officer","EmaiL: XXXX\nTelephone: XXXX","Anesthesiology, Cardiology, Dental Services - Oral Surgery, Dermatology, Endocrinology, ENT/Otolaryngology, Family Medicine/Primary Care, General Surgery, Hematology, HIV/AIDS/Infectious Disease, Hospice, Nephrology, Nuclear Medicine, Oncology, Ophthalmology, Orthopedic Surgery, Pediatrics, Physical Medicine and Rehabilitation, Podiatry, Obstetrics-Gynecology, Pulmonology, Radiology","Non-Emergency Transportation, Claims Processing, Care Coordination, Provider Credentialing, Eligibility Confirmation, Utilization Management, Prior Authorizations","N/A","1120 West La Veta Ave","Suite 450","Orange",92868,0.161691,"N/A","Network Adequacy and Member Access","N/A","In accordance with CalOptima’s Delegation Agreement and Delegation Oversight Health Network and FDR Annual Audits, Subcontractors and/or Downstream Subcontractors are not permitted to sub-delegate any functions unless the Subcontractor and/or Downstream Subcontractor requests prior permission and receives approval by CalOptima, the Health Network, and/or the FDR. Ultimately, all sub-delegated functions require prior approval by CalOptima.\n\nCalOptima maintains oversight over delegated functions to Subcontractors and Downstream Subcontractors via a variety of methods including but not limited to annual audits, corrective action plans, ongoing monitoring, external audits, and accreditation review, and reporting review.  \n\nApplicable Citations: \n•\tDelegation Agreement. Section 2.c. – Subdelegation (notice and approval requirements for subdelegation)\n•\tDelegation Agreement. Section 4.a. - Rights and Obligations of CalOptima: Oversight (CalOptima oversight of delegated functions) \n•\tDelegation Agreement. Section 6. - Reporting (delegates’ ongoing reporting expectations to CalOptima) \n•\tDelegation Agreement. Schedules A-D (describes the Delegated Activity, LOB, Delegate Responsibility, CalOptima Responsibility, Reporting, Performance Evaluation, and Remediation for each delegated responsibility, by delegated functional area) ","Assists with Network Adequacy and Member Access","CalOptima has a robust delegation oversight program that includes a detailed annual audit program and ongoing monitoring process to oversee performance of delegated functions on an ongoing basis. CalOptima has a dedicated team of staff in its Delegation Oversight (DO) department responsible for conducting the annual audits of delegated activities and monitoring of Corrective Action Plans (CAPs) stemming from the annual audits. The annual audit process includes an audit of any downstream subcontractor arrangements, if applicable. The DO department maintains a calendar of scheduled audits for the year to ensure audits are conducted annually and completed timely. In addition to the work performed by the DO department, the Subject Matter Experts (SMEs) in CalOptima’s internal divisions related to functions that are delegated also perform ongoing monitoring of delegated activities by reviewing performance metrics and reports submitted the delegates on an ongoing basis. Oversight activities and findings are reported through the Delegation Oversight Committee, which reports up to the Compliance Committee.  ","CalOptima conducts pre-delegation readiness assessments of subcontractors to determine the subcontractor’s ability and capacity to implement and perform delegated activities prior to delegating such activities. The entity must demonstrate its ability and capacity to perform the delegated functions by meeting or exceeding all requirements in the CalOptima Service Agreement and CalOptima Delegation Oversight policies. If unable to meet a standard, the potential subcontractor may be placed on a Corrective Action Plan (CAP) prior to assuming delegated duties. Once a successful pre-delegation readiness assessment has been completed and responsibilities have been delegated to the subcontractor via a signed delegation agreement, CalOptima maintains ongoing oversight of delegated activities via ongoing monitoring and the annual audit process. The pre-delegation readiness assessment and annual audit includes a review of any downstream subcontractor agreements, if applicable. ","All subcontracted delegated entities must agree to the provisions of the CalOptima Delegation Agreement outlined in Attachment H of the agreement between CalOptima and the delegate. Under the Delegation Agreement, the delegate agrees to perform the delegated services in accordance with the responsibilities outlined in Attachment H for CalOptima and its Members assigned to Delegate.\nUnder the agreement the delegate must agree (either itself or through a CalOptima-approved Subcontractor or downstream entity) to provide the delegated services set forth in Schedules A, B, C, and D, of the agreement as applicable, (“Delegated Services”) in accordance with the terms of this Attachment H and Standards and Requirements. Under the agreement the term “Standards and Requirements” means currently applicable NCQA accreditation standards; DHCS, DMHC, CMS requirements; state and federal statutes, regulations, and sub-regulatory requirements; and CalOptima Policies and contractual requirements, including the State Contract.\n\nApplicable Citations: \n•\tDelegation Agreement. Attachment H in its entirety. \n•\tDelegation Agreement. Section 2.c. – Subdelegation (notice and approval requirements for subdelegation)\n•\tDelegation Agreement. Section 4.a. - Rights and Obligations of CalOptima: Oversight (CalOptima oversight of delegated functions) \n•\tDelegation Agreement. Section 6. - Reporting (delegates’ ongoing reporting expectations to CalOptima) \n•\tDelegation Agreement. Schedules A-D (describes the Delegated Activity, LOB, Delegate Responsibility, CalOptima Responsibility, Reporting, Performance Evaluation, and Remediation for each delegated responsibly, by delegated functional area) ","The Subcontractors have access to CalOptima's Policies and Procedures on CalOptima.org website; it's available 24 hours a day/7 days a week. CalOptima distributes weekly communications that includes Policy and Procedure updates that impact our Subcontractors and Downstream Subcontractors.\n","Capitation arrangement PMPM","N/A","See attached zipped file, PHC Contract Template subfolder, documents titled:\n1. Medi-Cal PHC PHY Contract (KL rev. 03.17.22) (00221244xD58B3) - this is the provider contract template that refers to the delegation agreement.\n2. PHC-Physician (PHC-P) HN Amendment with Delegation Agreement - this amendment includes the applicable delegation agreement for this subcontractor."]
["CalOptima Health ","S4","Family Choice Health Services","Partially Delegated Subcontractor","Orange","Phuc V. Nguyen, M.D., Chief Compliance Officer","EmaiL: XXXX\nTelephone: XXXX","Anesthesiology, Cardiology, Dental Services - Oral Surgery, Dermatology, Endocrinology, ENT/Otolaryngology, Family Medicine/Primary Care, General Surgery, Hematology, HIV/AIDS/Infectious Disease, Hospice, Nephrology, Nuclear Medicine, Oncology, Ophthalmology, Orthopedic Surgery, Pediatrics, Physical Medicine and Rehabilitation, Podiatry, Obstetrics-Gynecology, Pulmonology, Radiology","Non-Emergency Transportation, Claims Processing, Care Coordination, Provider Credentialing, Eligibility Confirmation, Utilization Management, Prior Authorizations","N/A","7631 Wyoming St","Suite 202","Westminster",92683,5.2159999999999998E-2,"N/A","Network Adequacy and Member Access","N/A","In accordance with CalOptima’s Delegation Agreement and Delegation Oversight Health Network and FDR Annual Audits, Subcontractors and/or Downstream Subcontractors are not permitted to sub-delegate any functions unless the Subcontractor and/or Downstream Subcontractor requests prior permission and receives approval by CalOptima, the Health Network, and/or the FDR. Ultimately, all sub-delegated functions require prior approval by CalOptima.\n\nCalOptima maintains oversight over delegated functions to Subcontractors and Downstream Subcontractors via a variety of methods including but not limited to annual audits, corrective action plans, ongoing monitoring, external audits, and accreditation review, and reporting review.  \n\nApplicable Citations: \n•\tDelegation Agreement. Section 2.c. – Subdelegation (notice and approval requirements for subdelegation)\n•\tDelegation Agreement. Section 4.a. - Rights and Obligations of CalOptima: Oversight (CalOptima oversight of delegated functions) \n•\tDelegation Agreement. Section 6. - Reporting (delegates’ ongoing reporting expectations to CalOptima) \n•\tDelegation Agreement. Schedules A-D (describes the Delegated Activity, LOB, Delegate Responsibility, CalOptima Responsibility, Reporting, Performance Evaluation, and Remediation for each delegated responsibility, by delegated functional area) ","Assists with Network Adequacy and Member Access","CalOptima has a robust delegation oversight program that includes a detailed annual audit program and ongoing monitoring process to oversee performance of delegated functions on an ongoing basis. CalOptima has a dedicated team of staff in its Delegation Oversight (DO) department responsible for conducting the annual audits of delegated activities and monitoring of Corrective Action Plans (CAPs) stemming from the annual audits. The annual audit process includes an audit of any downstream subcontractor arrangements, if applicable. The DO department maintains a calendar of scheduled audits for the year to ensure audits are conducted annually and completed timely. In addition to the work performed by the DO department, the Subject Matter Experts (SMEs) in CalOptima’s internal divisions related to functions that are delegated also perform ongoing monitoring of delegated activities by reviewing performance metrics and reports submitted the delegates on an ongoing basis. Oversight activities and findings are reported through the Delegation Oversight Committee, which reports up to the Compliance Committee.  ","CalOptima conducts pre-delegation readiness assessments of subcontractors to determine the subcontractor’s ability and capacity to implement and perform delegated activities prior to delegating such activities. The entity must demonstrate its ability and capacity to perform the delegated functions by meeting or exceeding all requirements in the CalOptima Service Agreement and CalOptima Delegation Oversight policies. If unable to meet a standard, the potential subcontractor may be placed on a Corrective Action Plan (CAP) prior to assuming delegated duties. Once a successful pre-delegation readiness assessment has been completed and responsibilities have been delegated to the subcontractor via a signed delegation agreement, CalOptima maintains ongoing oversight of delegated activities via ongoing monitoring and the annual audit process. The pre-delegation readiness assessment and annual audit includes a review of any downstream subcontractor agreements, if applicable. ","All subcontracted delegated entities must agree to the provisions of the CalOptima Delegation Agreement outlined in Attachment H of the agreement between CalOptima and the delegate. Under the Delegation Agreement, the delegate agrees to perform the delegated services in accordance with the responsibilities outlined in Attachment H for CalOptima and its Members assigned to Delegate.\nUnder the agreement the delegate must agree (either itself or through a CalOptima-approved Subcontractor or downstream entity) to provide the delegated services set forth in Schedules A, B, C, and D, of the agreement as applicable, (“Delegated Services”) in accordance with the terms of this Attachment H and Standards and Requirements. Under the agreement the term “Standards and Requirements” means currently applicable NCQA accreditation standards; DHCS, DMHC, CMS requirements; state and federal statutes, regulations, and sub-regulatory requirements; and CalOptima Policies and contractual requirements, including the State Contract.\n\nApplicable Citations: \n•\tDelegation Agreement. Attachment H in its entirety. \n•\tDelegation Agreement. Section 2.c. – Subdelegation (notice and approval requirements for subdelegation)\n•\tDelegation Agreement. Section 4.a. - Rights and Obligations of CalOptima: Oversight (CalOptima oversight of delegated functions) \n•\tDelegation Agreement. Section 6. - Reporting (delegates’ ongoing reporting expectations to CalOptima) \n•\tDelegation Agreement. Schedules A-D (describes the Delegated Activity, LOB, Delegate Responsibility, CalOptima Responsibility, Reporting, Performance Evaluation, and Remediation for each delegated responsibly, by delegated functional area) ","The Subcontractors have access to CalOptima's Policies and Procedures on CalOptima.org website; it's available 24 hours a day/7 days a week. CalOptima distributes weekly communications that includes Policy and Procedure updates that impact our Subcontractors and Downstream Subcontractors.\n","Capitation arrangement PMPM","N/A","See attached zipped file, HMO Contract Template subfolder, documents titled:\n 1. Medi-Cal HMO Contract (KL rev. 03.17.22) (00221231xD58B3) - this is the provider contract template that refers to the delegation agreement.\n 2. HMO HN Amendment with Delegation Agreement - this amendment includes the applicable delegation agreement for this subcontractor. "]
["CalOptima Health ","S5","Heritage Provider Network, Inc. ","Partially Delegated Subcontractor","Orange","Jeff Baron, Chief Compliance Officer","EmaiL: XXXX\nTelephone: XXXX","Anesthesiology, Cardiology, Dental Services - Oral Surgery, Dermatology, Endocrinology, ENT/Otolaryngology, Family Medicine/Primary Care, General Surgery, Hematology, HIV/AIDS/Infectious Disease, Hospice, Nephrology, Nuclear Medicine, Oncology, Ophthalmology, Orthopedic Surgery, Pediatrics, Physical Medicine and Rehabilitation, Podiatry, Obstetrics-Gynecology, Pulmonology, Radiology","Non-Emergency Transportation, Claims Processing, Care Coordination, Provider Credentialing, Eligibility Confirmation, Utilization Management, Prior Authorizations","N/A","8510 Balboa Blvd","Suite 285","Northridge",91325,1.3903E-2,"N/A","Network Adequacy and Member Access","N/A","In accordance with CalOptima’s Delegation Agreement and Delegation Oversight Health Network and FDR Annual Audits, Subcontractors and/or Downstream Subcontractors are not permitted to sub-delegate any functions unless the Subcontractor and/or Downstream Subcontractor requests prior permission and receives approval by CalOptima, the Health Network, and/or the FDR. Ultimately, all sub-delegated functions require prior approval by CalOptima.\n\nCalOptima maintains oversight over delegated functions to Subcontractors and Downstream Subcontractors via a variety of methods including but not limited to annual audits, corrective action plans, ongoing monitoring, external audits, and accreditation review, and reporting review.  \n\nApplicable Citations: \n•\tDelegation Agreement. Section 2.c. – Subdelegation (notice and approval requirements for subdelegation)\n•\tDelegation Agreement. Section 4.a. - Rights and Obligations of CalOptima: Oversight (CalOptima oversight of delegated functions) \n•\tDelegation Agreement. Section 6. - Reporting (delegates’ ongoing reporting expectations to CalOptima) \n•\tDelegation Agreement. Schedules A-D (describes the Delegated Activity, LOB, Delegate Responsibility, CalOptima Responsibility, Reporting, Performance Evaluation, and Remediation for each delegated responsibility, by delegated functional area) ","Assists with Network Adequacy and Member Access","CalOptima has a robust delegation oversight program that includes a detailed annual audit program and ongoing monitoring process to oversee performance of delegated functions on an ongoing basis. CalOptima has a dedicated team of staff in its Delegation Oversight (DO) department responsible for conducting the annual audits of delegated activities and monitoring of Corrective Action Plans (CAPs) stemming from the annual audits. The annual audit process includes an audit of any downstream subcontractor arrangements, if applicable. The DO department maintains a calendar of scheduled audits for the year to ensure audits are conducted annually and completed timely. In addition to the work performed by the DO department, the Subject Matter Experts (SMEs) in CalOptima’s internal divisions related to functions that are delegated also perform ongoing monitoring of delegated activities by reviewing performance metrics and reports submitted the delegates on an ongoing basis. Oversight activities and findings are reported through the Delegation Oversight Committee, which reports up to the Compliance Committee.  ","CalOptima conducts pre-delegation readiness assessments of subcontractors to determine the subcontractor’s ability and capacity to implement and perform delegated activities prior to delegating such activities. The entity must demonstrate its ability and capacity to perform the delegated functions by meeting or exceeding all requirements in the CalOptima Service Agreement and CalOptima Delegation Oversight policies. If unable to meet a standard, the potential subcontractor may be placed on a Corrective Action Plan (CAP) prior to assuming delegated duties. Once a successful pre-delegation readiness assessment has been completed and responsibilities have been delegated to the subcontractor via a signed delegation agreement, CalOptima maintains ongoing oversight of delegated activities via ongoing monitoring and the annual audit process. The pre-delegation readiness assessment and annual audit includes a review of any downstream subcontractor agreements, if applicable. ","All subcontracted delegated entities must agree to the provisions of the CalOptima Delegation Agreement outlined in Attachment H of the agreement between CalOptima and the delegate. Under the Delegation Agreement, the delegate agrees to perform the delegated services in accordance with the responsibilities outlined in Attachment H for CalOptima and its Members assigned to Delegate.\nUnder the agreement the delegate must agree (either itself or through a CalOptima-approved Subcontractor or downstream entity) to provide the delegated services set forth in Schedules A, B, C, and D, of the agreement as applicable, (“Delegated Services”) in accordance with the terms of this Attachment H and Standards and Requirements. Under the agreement the term “Standards and Requirements” means currently applicable NCQA accreditation standards; DHCS, DMHC, CMS requirements; state and federal statutes, regulations, and sub-regulatory requirements; and CalOptima Policies and contractual requirements, including the State Contract.\n\nApplicable Citations: \n•\tDelegation Agreement. Attachment H in its entirety. \n•\tDelegation Agreement. Section 2.c. – Subdelegation (notice and approval requirements for subdelegation)\n•\tDelegation Agreement. Section 4.a. - Rights and Obligations of CalOptima: Oversight (CalOptima oversight of delegated functions) \n•\tDelegation Agreement. Section 6. - Reporting (delegates’ ongoing reporting expectations to CalOptima) \n•\tDelegation Agreement. Schedules A-D (describes the Delegated Activity, LOB, Delegate Responsibility, CalOptima Responsibility, Reporting, Performance Evaluation, and Remediation for each delegated responsibly, by delegated functional area) ","The Subcontractors have access to CalOptima's Policies and Procedures on CalOptima.org website; it's available 24 hours a day/7 days a week. CalOptima distributes weekly communications that includes Policy and Procedure updates that impact our Subcontractors and Downstream Subcontractors.\n","Capitation arrangement PMPM","N/A","See attached zipped file, HMO Contract Template subfolder, documents titled:\n 1. Medi-Cal HMO Contract (KL rev. 03.17.22) (00221231xD58B3) - this is the provider contract template that refers to the delegation agreement.\n 2. HMO HN Amendment with Delegation Agreement - this amendment includes the applicable delegation agreement for this subcontractor. "]
["CalOptima Health ","S6","Noble Mid Orange County","Partially Delegated Subcontractor","Orange","Michelle Ford, Chief Compliance Officer","EmaiL: XXXX\nTelephone: XXXX","Anesthesiology, Cardiology, Dental Services - Oral Surgery, Dermatology, Endocrinology, ENT/Otolaryngology, Family Medicine/Primary Care, General Surgery, Hematology, HIV/AIDS/Infectious Disease, Hospice, Nephrology, Nuclear Medicine, Oncology, Ophthalmology, Orthopedic Surgery, Pediatrics, Physical Medicine and Rehabilitation, Podiatry, Obstetrics-Gynecology, Pulmonology, Radiology","Claims Processing, Care Coordination, Provider Credentialing, Eligibility Confirmation, Utilization Management, Prior Authorizations","N/A","5785 Corporate Ave",null,"Cypress",90630,2.7955000000000001E-2,"N/A","Network Adequacy and Member Access","N/A","In accordance with CalOptima’s Delegation Agreement and Delegation Oversight Health Network and FDR Annual Audits, Subcontractors and/or Downstream Subcontractors are not permitted to sub-delegate any functions unless the Subcontractor and/or Downstream Subcontractor requests prior permission and receives approval by CalOptima, the Health Network, and/or the FDR. Ultimately, all sub-delegated functions require prior approval by CalOptima.\n\nCalOptima maintains oversight over delegated functions to Subcontractors and Downstream Subcontractors via a variety of methods including but not limited to annual audits, corrective action plans, ongoing monitoring, external audits, and accreditation review, and reporting review.  \n\nApplicable Citations: \n•\tDelegation Agreement. Section 2.c. – Subdelegation (notice and approval requirements for subdelegation)\n•\tDelegation Agreement. Section 4.a. - Rights and Obligations of CalOptima: Oversight (CalOptima oversight of delegated functions) \n•\tDelegation Agreement. Section 6. - Reporting (delegates’ ongoing reporting expectations to CalOptima) \n•\tDelegation Agreement. Schedules A-D (describes the Delegated Activity, LOB, Delegate Responsibility, CalOptima Responsibility, Reporting, Performance Evaluation, and Remediation for each delegated responsibility, by delegated functional area) ","Assists with Network Adequacy and Member Access","CalOptima has a robust delegation oversight program that includes a detailed annual audit program and ongoing monitoring process to oversee performance of delegated functions on an ongoing basis. CalOptima has a dedicated team of staff in its Delegation Oversight (DO) department responsible for conducting the annual audits of delegated activities and monitoring of Corrective Action Plans (CAPs) stemming from the annual audits. The annual audit process includes an audit of any downstream subcontractor arrangements, if applicable. The DO department maintains a calendar of scheduled audits for the year to ensure audits are conducted annually and completed timely. In addition to the work performed by the DO department, the Subject Matter Experts (SMEs) in CalOptima’s internal divisions related to functions that are delegated also perform ongoing monitoring of delegated activities by reviewing performance metrics and reports submitted the delegates on an ongoing basis. Oversight activities and findings are reported through the Delegation Oversight Committee, which reports up to the Compliance Committee.  ","CalOptima conducts pre-delegation readiness assessments of subcontractors to determine the subcontractor’s ability and capacity to implement and perform delegated activities prior to delegating such activities. The entity must demonstrate its ability and capacity to perform the delegated functions by meeting or exceeding all requirements in the CalOptima Service Agreement and CalOptima Delegation Oversight policies. If unable to meet a standard, the potential subcontractor may be placed on a Corrective Action Plan (CAP) prior to assuming delegated duties. Once a successful pre-delegation readiness assessment has been completed and responsibilities have been delegated to the subcontractor via a signed delegation agreement, CalOptima maintains ongoing oversight of delegated activities via ongoing monitoring and the annual audit process. The pre-delegation readiness assessment and annual audit includes a review of any downstream subcontractor agreements, if applicable. ","All subcontracted delegated entities must agree to the provisions of the CalOptima Delegation Agreement outlined in Attachment H of the agreement between CalOptima and the delegate. Under the Delegation Agreement, the delegate agrees to perform the delegated services in accordance with the responsibilities outlined in Attachment H for CalOptima and its Members assigned to Delegate.\nUnder the agreement the delegate must agree (either itself or through a CalOptima-approved Subcontractor or downstream entity) to provide the delegated services set forth in Schedules A, B, C, and D, of the agreement as applicable, (“Delegated Services”) in accordance with the terms of this Attachment H and Standards and Requirements. Under the agreement the term “Standards and Requirements” means currently applicable NCQA accreditation standards; DHCS, DMHC, CMS requirements; state and federal statutes, regulations, and sub-regulatory requirements; and CalOptima Policies and contractual requirements, including the State Contract.\n\nApplicable Citations: \n•\tDelegation Agreement. Attachment H in its entirety. \n•\tDelegation Agreement. Section 2.c. – Subdelegation (notice and approval requirements for subdelegation)\n•\tDelegation Agreement. Section 4.a. - Rights and Obligations of CalOptima: Oversight (CalOptima oversight of delegated functions) \n•\tDelegation Agreement. Section 6. - Reporting (delegates’ ongoing reporting expectations to CalOptima) \n•\tDelegation Agreement. Schedules A-D (describes the Delegated Activity, LOB, Delegate Responsibility, CalOptima Responsibility, Reporting, Performance Evaluation, and Remediation for each delegated responsibly, by delegated functional area) ","The Subcontractors have access to CalOptima's Policies and Procedures on CalOptima.org website; it's available 24 hours a day/7 days a week. CalOptima distributes weekly communications that includes Policy and Procedure updates that impact our Subcontractors and Downstream Subcontractors.\n","Capitation arrangement PMPM","N/A","See attached zipped file, Shared Risk Contract Template subfolder, documents titled:\n1. Medi-Cal Physician Shared Risk Group Contract (KL rev. 03.17.22) (00221241xD58B3)_am6.3.2022 - this is the provider contract template that refers to the delegation agreement.\n2. SRG HN Amendment with Delegation Agreement - this amendment includes the applicable delegation agreement for this subcontractor."]
["CalOptima Health ","S7","Optum","Partially Delegated Subcontractor","Orange","Shirste Gessler, Chief Compliance Officer","EmaiL: XXXX\nTelephone: XXXX","Anesthesiology, Cardiology, Dental Services - Oral Surgery, Dermatology, Endocrinology, ENT/Otolaryngology, Family Medicine/Primary Care, General Surgery, Hematology, HIV/AIDS/Infectious Disease, Hospice, Nephrology, Nuclear Medicine, Oncology, Ophthalmology, Orthopedic Surgery, Pediatrics, Physical Medicine and Rehabilitation, Podiatry, Obstetrics-Gynecology, Pulmonology, Radiology","Non-Emergency Transportation, Claims Processing, Care Coordination, Provider Credentialing, Eligibility Confirmation, Utilization Management, Prior Authorizations","N/A","11 Technology Drive",null,"Irvine",92618,0.20261299999999999,"N/A","Network Adequacy and Member Access","Effective 1.1.24, Talbert Medical Group. P.C. and ARTA Western California, Inc. merged with Monarch Health Plan, Inc. and operate under the name, Optum.","In accordance with CalOptima’s Delegation Agreement and Delegation Oversight Health Network and FDR Annual Audits, Subcontractors and/or Downstream Subcontractors are not permitted to sub-delegate any functions unless the Subcontractor and/or Downstream Subcontractor requests prior permission and receives approval by CalOptima, the Health Network, and/or the FDR. Ultimately, all sub-delegated functions require prior approval by CalOptima.\n\nCalOptima maintains oversight over delegated functions to Subcontractors and Downstream Subcontractors via a variety of methods including but not limited to annual audits, corrective action plans, ongoing monitoring, external audits, and accreditation review, and reporting review.  \n\nApplicable Citations: \n•\tDelegation Agreement. Section 2.c. – Subdelegation (notice and approval requirements for subdelegation)\n•\tDelegation Agreement. Section 4.a. - Rights and Obligations of CalOptima: Oversight (CalOptima oversight of delegated functions) \n•\tDelegation Agreement. Section 6. - Reporting (delegates’ ongoing reporting expectations to CalOptima) \n•\tDelegation Agreement. Schedules A-D (describes the Delegated Activity, LOB, Delegate Responsibility, CalOptima Responsibility, Reporting, Performance Evaluation, and Remediation for each delegated responsibility, by delegated functional area) ","Assists with Network Adequacy and Member Access","CalOptima has a robust delegation oversight program that includes a detailed annual audit program and ongoing monitoring process to oversee performance of delegated functions on an ongoing basis. CalOptima has a dedicated team of staff in its Delegation Oversight (DO) department responsible for conducting the annual audits of delegated activities and monitoring of Corrective Action Plans (CAPs) stemming from the annual audits. The annual audit process includes an audit of any downstream subcontractor arrangements, if applicable. The DO department maintains a calendar of scheduled audits for the year to ensure audits are conducted annually and completed timely. In addition to the work performed by the DO department, the Subject Matter Experts (SMEs) in CalOptima’s internal divisions related to functions that are delegated also perform ongoing monitoring of delegated activities by reviewing performance metrics and reports submitted the delegates on an ongoing basis. Oversight activities and findings are reported through the Delegation Oversight Committee, which reports up to the Compliance Committee.  ","CalOptima conducts pre-delegation readiness assessments of subcontractors to determine the subcontractor’s ability and capacity to implement and perform delegated activities prior to delegating such activities. The entity must demonstrate its ability and capacity to perform the delegated functions by meeting or exceeding all requirements in the CalOptima Service Agreement and CalOptima Delegation Oversight policies. If unable to meet a standard, the potential subcontractor may be placed on a Corrective Action Plan (CAP) prior to assuming delegated duties. Once a successful pre-delegation readiness assessment has been completed and responsibilities have been delegated to the subcontractor via a signed delegation agreement, CalOptima maintains ongoing oversight of delegated activities via ongoing monitoring and the annual audit process. The pre-delegation readiness assessment and annual audit includes a review of any downstream subcontractor agreements, if applicable. ","All subcontracted delegated entities must agree to the provisions of the CalOptima Delegation Agreement outlined in Attachment H of the agreement between CalOptima and the delegate. Under the Delegation Agreement, the delegate agrees to perform the delegated services in accordance with the responsibilities outlined in Attachment H for CalOptima and its Members assigned to Delegate.\nUnder the agreement the delegate must agree (either itself or through a CalOptima-approved Subcontractor or downstream entity) to provide the delegated services set forth in Schedules A, B, C, and D, of the agreement as applicable, (“Delegated Services”) in accordance with the terms of this Attachment H and Standards and Requirements. Under the agreement the term “Standards and Requirements” means currently applicable NCQA accreditation standards; DHCS, DMHC, CMS requirements; state and federal statutes, regulations, and sub-regulatory requirements; and CalOptima Policies and contractual requirements, including the State Contract.\n\nApplicable Citations: \n•\tDelegation Agreement. Attachment H in its entirety. \n•\tDelegation Agreement. Section 2.c. – Subdelegation (notice and approval requirements for subdelegation)\n•\tDelegation Agreement. Section 4.a. - Rights and Obligations of CalOptima: Oversight (CalOptima oversight of delegated functions) \n•\tDelegation Agreement. Section 6. - Reporting (delegates’ ongoing reporting expectations to CalOptima) \n•\tDelegation Agreement. Schedules A-D (describes the Delegated Activity, LOB, Delegate Responsibility, CalOptima Responsibility, Reporting, Performance Evaluation, and Remediation for each delegated responsibly, by delegated functional area) ","The Subcontractors have access to CalOptima's Policies and Procedures on CalOptima.org website; it's available 24 hours a day/7 days a week. CalOptima distributes weekly communications that includes Policy and Procedure updates that impact our Subcontractors and Downstream Subcontractors.\n","Capitation arrangement PMPM","N/A","See attached zipped file, HMO Contract Template subfolder, documents titled:\n 1. Medi-Cal HMO Contract (KL rev. 03.17.22) (00221231xD58B3) - this is the provider contract template that refers to the delegation agreement.\n 2. HMO HN Amendment with Delegation Agreement - this amendment includes the applicable delegation agreement for this subcontractor. "]
["CalOptima Health ","S8","Prospect Health Plan ","Partially Delegated Subcontractor","Orange","Michelle Amador, VP, Compliance\n\n","EmaiL: XXXX\nTelephone: XXXX\n","Anesthesiology, Cardiology, Dental Services - Oral Surgery, Dermatology, Endocrinology, ENT/Otolaryngology, Family Medicine/Primary Care, General Surgery, Hematology, HIV/AIDS/Infectious Disease, Hospice, Nephrology, Nuclear Medicine, Oncology, Ophthalmology, Orthopedic Surgery, Pediatrics, Physical Medicine and Rehabilitation, Podiatry, Obstetrics-Gynecology, Pulmonology, Radiology","Non-Emergency Transportation, Claims Processing, Care Coordination, Provider Credentialing, Eligibility Confirmation, Utilization Management, Prior Authorizations","N/A","600 City Parkway West","Suite 800","Orange",92868,5.0266999999999999E-2,"N/A","Network Adequacy and Member Access","N/A","In accordance with CalOptima’s Delegation Agreement and Delegation Oversight Health Network and FDR Annual Audits, Subcontractors and/or Downstream Subcontractors are not permitted to sub-delegate any functions unless the Subcontractor and/or Downstream Subcontractor requests prior permission and receives approval by CalOptima, the Health Network, and/or the FDR. Ultimately, all sub-delegated functions require prior approval by CalOptima.\n\nCalOptima maintains oversight over delegated functions to Subcontractors and Downstream Subcontractors via a variety of methods including but not limited to annual audits, corrective action plans, ongoing monitoring, external audits, and accreditation review, and reporting review.  \n\nApplicable Citations: \n•\tDelegation Agreement. Section 2.c. – Subdelegation (notice and approval requirements for subdelegation)\n•\tDelegation Agreement. Section 4.a. - Rights and Obligations of CalOptima: Oversight (CalOptima oversight of delegated functions) \n•\tDelegation Agreement. Section 6. - Reporting (delegates’ ongoing reporting expectations to CalOptima) \n•\tDelegation Agreement. Schedules A-D (describes the Delegated Activity, LOB, Delegate Responsibility, CalOptima Responsibility, Reporting, Performance Evaluation, and Remediation for each delegated responsibility, by delegated functional area) ","Assists with Network Adequacy and Member Access","CalOptima has a robust delegation oversight program that includes a detailed annual audit program and ongoing monitoring process to oversee performance of delegated functions on an ongoing basis. CalOptima has a dedicated team of staff in its Delegation Oversight (DO) department responsible for conducting the annual audits of delegated activities and monitoring of Corrective Action Plans (CAPs) stemming from the annual audits. The annual audit process includes an audit of any downstream subcontractor arrangements, if applicable. The DO department maintains a calendar of scheduled audits for the year to ensure audits are conducted annually and completed timely. In addition to the work performed by the DO department, the Subject Matter Experts (SMEs) in CalOptima’s internal divisions related to functions that are delegated also perform ongoing monitoring of delegated activities by reviewing performance metrics and reports submitted the delegates on an ongoing basis. Oversight activities and findings are reported through the Delegation Oversight Committee, which reports up to the Compliance Committee.  ","CalOptima conducts pre-delegation readiness assessments of subcontractors to determine the subcontractor’s ability and capacity to implement and perform delegated activities prior to delegating such activities. The entity must demonstrate its ability and capacity to perform the delegated functions by meeting or exceeding all requirements in the CalOptima Service Agreement and CalOptima Delegation Oversight policies. If unable to meet a standard, the potential subcontractor may be placed on a Corrective Action Plan (CAP) prior to assuming delegated duties. Once a successful pre-delegation readiness assessment has been completed and responsibilities have been delegated to the subcontractor via a signed delegation agreement, CalOptima maintains ongoing oversight of delegated activities via ongoing monitoring and the annual audit process. The pre-delegation readiness assessment and annual audit includes a review of any downstream subcontractor agreements, if applicable. ","All subcontracted delegated entities must agree to the provisions of the CalOptima Delegation Agreement outlined in Attachment H of the agreement between CalOptima and the delegate. Under the Delegation Agreement, the delegate agrees to perform the delegated services in accordance with the responsibilities outlined in Attachment H for CalOptima and its Members assigned to Delegate.\nUnder the agreement the delegate must agree (either itself or through a CalOptima-approved Subcontractor or downstream entity) to provide the delegated services set forth in Schedules A, B, C, and D, of the agreement as applicable, (“Delegated Services”) in accordance with the terms of this Attachment H and Standards and Requirements. Under the agreement the term “Standards and Requirements” means currently applicable NCQA accreditation standards; DHCS, DMHC, CMS requirements; state and federal statutes, regulations, and sub-regulatory requirements; and CalOptima Policies and contractual requirements, including the State Contract.\n\nApplicable Citations: \n•\tDelegation Agreement. Attachment H in its entirety. \n•\tDelegation Agreement. Section 2.c. – Subdelegation (notice and approval requirements for subdelegation)\n•\tDelegation Agreement. Section 4.a. - Rights and Obligations of CalOptima: Oversight (CalOptima oversight of delegated functions) \n•\tDelegation Agreement. Section 6. - Reporting (delegates’ ongoing reporting expectations to CalOptima) \n•\tDelegation Agreement. Schedules A-D (describes the Delegated Activity, LOB, Delegate Responsibility, CalOptima Responsibility, Reporting, Performance Evaluation, and Remediation for each delegated responsibly, by delegated functional area) ","The Subcontractors have access to CalOptima's Policies and Procedures on CalOptima.org website; it's available 24 hours a day/7 days a week. CalOptima distributes weekly communications that includes Policy and Procedure updates that impact our Subcontractors and Downstream Subcontractors.\n","Capitation arrangement PMPM","N/A","See attached zipped file, HMO Contract Template subfolder, documents titled:\n 1. Medi-Cal HMO Contract (KL rev. 03.17.22) (00221231xD58B3) - this is the provider contract template that refers to the delegation agreement.\n 2. HMO HN Amendment with Delegation Agreement - this amendment includes the applicable delegation agreement for this subcontractor. "]
["CalOptima Health ","S9","United Care Medical Group","Partially Delegated Subcontractor","Orange","Michelle Amador, VP, Compliance\n\n","EmaiL: XXXX\nTelephone: XXXX\n","Anesthesiology, Cardiology, Dental Services - Oral Surgery, Dermatology, Endocrinology, ENT/Otolaryngology, Family Medicine/Primary Care, General Surgery, Hematology, HIV/AIDS/Infectious Disease, Hospice, Nephrology, Nuclear Medicine, Oncology, Ophthalmology, Orthopedic Surgery, Pediatrics, Physical Medicine and Rehabilitation, Podiatry, Obstetrics-Gynecology, Pulmonology, Radiology","Non-Emergency Transportation, Claims Processing, Care Coordination, Provider Credentialing, Eligibility Confirmation, Utilization Management, Prior Authorizations","N/A","600 City Parkway West","Suite 800","Orange",92868,4.8614999999999998E-2,"N/A","Network Adequacy and Member Access","N/A","In accordance with CalOptima’s Delegation Agreement and Delegation Oversight Health Network and FDR Annual Audits, Subcontractors and/or Downstream Subcontractors are not permitted to sub-delegate any functions unless the Subcontractor and/or Downstream Subcontractor requests prior permission and receives approval by CalOptima, the Health Network, and/or the FDR. Ultimately, all sub-delegated functions require prior approval by CalOptima.\n\nCalOptima maintains oversight over delegated functions to Subcontractors and Downstream Subcontractors via a variety of methods including but not limited to annual audits, corrective action plans, ongoing monitoring, external audits, and accreditation review, and reporting review.  \n\nApplicable Citations: \n•\tDelegation Agreement. Section 2.c. – Subdelegation (notice and approval requirements for subdelegation)\n•\tDelegation Agreement. Section 4.a. - Rights and Obligations of CalOptima: Oversight (CalOptima oversight of delegated functions) \n•\tDelegation Agreement. Section 6. - Reporting (delegates’ ongoing reporting expectations to CalOptima) \n•\tDelegation Agreement. Schedules A-D (describes the Delegated Activity, LOB, Delegate Responsibility, CalOptima Responsibility, Reporting, Performance Evaluation, and Remediation for each delegated responsibility, by delegated functional area) ","Assists with Network Adequacy and Member Access","CalOptima has a robust delegation oversight program that includes a detailed annual audit program and ongoing monitoring process to oversee performance of delegated functions on an ongoing basis. CalOptima has a dedicated team of staff in its Delegation Oversight (DO) department responsible for conducting the annual audits of delegated activities and monitoring of Corrective Action Plans (CAPs) stemming from the annual audits. The annual audit process includes an audit of any downstream subcontractor arrangements, if applicable. The DO department maintains a calendar of scheduled audits for the year to ensure audits are conducted annually and completed timely. In addition to the work performed by the DO department, the Subject Matter Experts (SMEs) in CalOptima’s internal divisions related to functions that are delegated also perform ongoing monitoring of delegated activities by reviewing performance metrics and reports submitted the delegates on an ongoing basis. Oversight activities and findings are reported through the Delegation Oversight Committee, which reports up to the Compliance Committee.  ","CalOptima conducts pre-delegation readiness assessments of subcontractors to determine the subcontractor’s ability and capacity to implement and perform delegated activities prior to delegating such activities. The entity must demonstrate its ability and capacity to perform the delegated functions by meeting or exceeding all requirements in the CalOptima Service Agreement and CalOptima Delegation Oversight policies. If unable to meet a standard, the potential subcontractor may be placed on a Corrective Action Plan (CAP) prior to assuming delegated duties. Once a successful pre-delegation readiness assessment has been completed and responsibilities have been delegated to the subcontractor via a signed delegation agreement, CalOptima maintains ongoing oversight of delegated activities via ongoing monitoring and the annual audit process. The pre-delegation readiness assessment and annual audit includes a review of any downstream subcontractor agreements, if applicable. ","All subcontracted delegated entities must agree to the provisions of the CalOptima Delegation Agreement outlined in Attachment H of the agreement between CalOptima and the delegate. Under the Delegation Agreement, the delegate agrees to perform the delegated services in accordance with the responsibilities outlined in Attachment H for CalOptima and its Members assigned to Delegate.\nUnder the agreement the delegate must agree (either itself or through a CalOptima-approved Subcontractor or downstream entity) to provide the delegated services set forth in Schedules A, B, C, and D, of the agreement as applicable, (“Delegated Services”) in accordance with the terms of this Attachment H and Standards and Requirements. Under the agreement the term “Standards and Requirements” means currently applicable NCQA accreditation standards; DHCS, DMHC, CMS requirements; state and federal statutes, regulations, and sub-regulatory requirements; and CalOptima Policies and contractual requirements, including the State Contract.\n\nApplicable Citations: \n•\tDelegation Agreement. Attachment H in its entirety. \n•\tDelegation Agreement. Section 2.c. – Subdelegation (notice and approval requirements for subdelegation)\n•\tDelegation Agreement. Section 4.a. - Rights and Obligations of CalOptima: Oversight (CalOptima oversight of delegated functions) \n•\tDelegation Agreement. Section 6. - Reporting (delegates’ ongoing reporting expectations to CalOptima) \n•\tDelegation Agreement. Schedules A-D (describes the Delegated Activity, LOB, Delegate Responsibility, CalOptima Responsibility, Reporting, Performance Evaluation, and Remediation for each delegated responsibly, by delegated functional area) ","The Subcontractors have access to CalOptima's Policies and Procedures on CalOptima.org website; it's available 24 hours a day/7 days a week. CalOptima distributes weekly communications that includes Policy and Procedure updates that impact our Subcontractors and Downstream Subcontractors.\n","Capitation arrangement PMPM","N/A","See attached zipped file, Shared Risk Contract Template subfolder, documents titled:\n1. Medi-Cal Physician Shared Risk Group Contract (KL rev. 03.17.22) (00221241xD58B3)_am6.3.2022 - this is the provider contract template that refers to the delegation agreement.\n2. SRG HN Amendment with Delegation Agreement - this amendment includes the applicable delegation agreement for this subcontractor."]
["CalOptima Health ","S10","Vision Service Plan","Partially Delegated Subcontractor","Orange","Erin Neal, Chief Compliance Officer","EmaiL: XXXX\nTelephone: XXXX","Vision","Claims Processing, Provider Credentialing, Eligibility Confirmation, Prior Authorizations","N/A","3333 Quality Drive",null,"Rancho Cordova",95670,0,"N/A","Network Adequacy and Member Access","N/A","In accordance with CalOptima’s Delegation Agreement and Delegation Oversight Health Network and FDR Annual Audits, Subcontractors and/or Downstream Subcontractors are not permitted to sub-delegate any functions unless the Subcontractor and/or Downstream Subcontractor requests prior permission and receives approval by CalOptima, the Health Network, and/or the FDR. Ultimately, all sub-delegated functions require prior approval by CalOptima.\n\nCalOptima maintains oversight over delegated functions to Subcontractors and Downstream Subcontractors via a variety of methods including but not limited to annual audits, corrective action plans, ongoing monitoring, external audits, and accreditation review, and reporting review.  \n\nApplicable Citations: \n•\tDelegation Agreement. Section 2.c. – Subdelegation (notice and approval requirements for subdelegation)\n•\tDelegation Agreement. Section 4.a. - Rights and Obligations of CalOptima: Oversight (CalOptima oversight of delegated functions) \n•\tDelegation Agreement. Section 6. - Reporting (delegates’ ongoing reporting expectations to CalOptima) \n•\tDelegation Agreement. Schedules A-D (describes the Delegated Activity, LOB, Delegate Responsibility, CalOptima Responsibility, Reporting, Performance Evaluation, and Remediation for each delegated responsibility, by delegated functional area) ","Assists with Network Adequacy and Member Access","CalOptima has a robust delegation oversight program that includes a detailed annual audit program and ongoing monitoring process to oversee performance of delegated functions on an ongoing basis. CalOptima has a dedicated team of staff in its Delegation Oversight (DO) department responsible for conducting the annual audits of delegated activities and monitoring of Corrective Action Plans (CAPs) stemming from the annual audits. The annual audit process includes an audit of any downstream subcontractor arrangements, if applicable. The DO department maintains a calendar of scheduled audits for the year to ensure audits are conducted annually and completed timely. In addition to the work performed by the DO department, the Subject Matter Experts (SMEs) in CalOptima’s internal divisions related to functions that are delegated also perform ongoing monitoring of delegated activities by reviewing performance metrics and reports submitted the delegates on an ongoing basis. Oversight activities and findings are reported through the Delegation Oversight Committee, which reports up to the Compliance Committee.  ","CalOptima conducts pre-delegation readiness assessments of subcontractors to determine the subcontractor’s ability and capacity to implement and perform delegated activities prior to delegating such activities. The entity must demonstrate its ability and capacity to perform the delegated functions by meeting or exceeding all requirements in the CalOptima Service Agreement and CalOptima Delegation Oversight policies. If unable to meet a standard, the potential subcontractor may be placed on a Corrective Action Plan (CAP) prior to assuming delegated duties. Once a successful pre-delegation readiness assessment has been completed and responsibilities have been delegated to the subcontractor via a signed delegation agreement, CalOptima maintains ongoing oversight of delegated activities via ongoing monitoring and the annual audit process. The pre-delegation readiness assessment and annual audit includes a review of any downstream subcontractor agreements, if applicable. ","All subcontracted delegated entities must agree to the provisions of the CalOptima Delegation Agreement outlined in Attachment H of the agreement between CalOptima and the delegate. Under the Delegation Agreement, the delegate agrees to perform the delegated services in accordance with the responsibilities outlined in Attachment H for CalOptima and its Members assigned to Delegate.\nUnder the agreement the delegate must agree (either itself or through a CalOptima-approved Subcontractor or downstream entity) to provide the delegated services set forth in Schedules A, B, C, and D, of the agreement as applicable, (“Delegated Services”) in accordance with the terms of this Attachment H and Standards and Requirements. Under the agreement the term “Standards and Requirements” means currently applicable NCQA accreditation standards; DHCS, DMHC, CMS requirements; state and federal statutes, regulations, and sub-regulatory requirements; and CalOptima Policies and contractual requirements, including the State Contract.\n\nApplicable Citations: \n•\tDelegation Agreement. Attachment H in its entirety. \n•\tDelegation Agreement. Section 2.c. – Subdelegation (notice and approval requirements for subdelegation)\n•\tDelegation Agreement. Section 4.a. - Rights and Obligations of CalOptima: Oversight (CalOptima oversight of delegated functions) \n•\tDelegation Agreement. Section 6. - Reporting (delegates’ ongoing reporting expectations to CalOptima) \n•\tDelegation Agreement. Schedules A-D (describes the Delegated Activity, LOB, Delegate Responsibility, CalOptima Responsibility, Reporting, Performance Evaluation, and Remediation for each delegated responsibly, by delegated functional area) ","The Subcontractors have access to CalOptima's Policies and Procedures on CalOptima.org website; it's available 24 hours a day/7 days a week. CalOptima distributes weekly communications that includes Policy and Procedure updates that impact our Subcontractors and Downstream Subcontractors.","Capitation arrangement PMPM","N/A","See attached zipped file, Ancillary Contract Template subfolder, documents titled:\n1. Ancillary Contract (FFS Medical) (KL rev. 03.17.22) (00221218xD58B3) - this is the provider contract template utilized for this subcontractor.\n2. Final Health Network Delegation Agreement 2023Clean - this is health network delegation agreement approved during operational readiness submission. The delegation agreement has been revised in 2024.\n"]
["CalOptima Health ","S11","Telemed 2U","Partially Delegated Subcontractor","Orange","Amanda Carrola, Sr. Director of Enterprise Operations\n/Privacy Office","EmaiL: XXXX\nTelephone: XXXX","Psychiatry","Provider Credentialing","N/A","3400 Douglas Blvd","Suite 170","Roseville",95661,0,"N/A","Network Adequacy and Member Access","N/A","In accordance with CalOptima’s Delegation Agreement and Delegation Oversight Health Network and FDR Annual Audits, Subcontractors and/or Downstream Subcontractors are not permitted to sub-delegate any functions unless the Subcontractor and/or Downstream Subcontractor requests prior permission and receives approval by CalOptima, the Health Network, and/or the FDR. Ultimately, all sub-delegated functions require prior approval by CalOptima.\n\nCalOptima maintains oversight over delegated functions to Subcontractors and Downstream Subcontractors via a variety of methods including but not limited to annual audits, corrective action plans, ongoing monitoring, external audits, and accreditation review, and reporting review.  \n\nApplicable Citations: \n•\tDelegation Agreement. Section 2.c. – Subdelegation (notice and approval requirements for subdelegation)\n•\tDelegation Agreement. Section 4.a. - Rights and Obligations of CalOptima: Oversight (CalOptima oversight of delegated functions) \n•\tDelegation Agreement. Section 6. - Reporting (delegates’ ongoing reporting expectations to CalOptima) \n•\tDelegation Agreement. Schedules A-D (describes the Delegated Activity, LOB, Delegate Responsibility, CalOptima Responsibility, Reporting, Performance Evaluation, and Remediation for each delegated responsibility, by delegated functional area) ","Assists with Network Adequacy and Member Access","CalOptima has a robust delegation oversight program that includes a detailed annual audit program and ongoing monitoring process to oversee performance of delegated functions on an ongoing basis. CalOptima has a dedicated team of staff in its Delegation Oversight (DO) department responsible for conducting the annual audits of delegated activities and monitoring of Corrective Action Plans (CAPs) stemming from the annual audits. The annual audit process includes an audit of any downstream subcontractor arrangements, if applicable. The DO department maintains a calendar of scheduled audits for the year to ensure audits are conducted annually and completed timely. In addition to the work performed by the DO department, the Subject Matter Experts (SMEs) in CalOptima’s internal divisions related to functions that are delegated also perform ongoing monitoring of delegated activities by reviewing performance metrics and reports submitted the delegates on an ongoing basis. Oversight activities and findings are reported through the Delegation Oversight Committee, which reports up to the Compliance Committee.  ","CalOptima conducts pre-delegation readiness assessments of subcontractors to determine the subcontractor’s ability and capacity to implement and perform delegated activities prior to delegating such activities. The entity must demonstrate its ability and capacity to perform the delegated functions by meeting or exceeding all requirements in the CalOptima Service Agreement and CalOptima Delegation Oversight policies. If unable to meet a standard, the potential subcontractor may be placed on a Corrective Action Plan (CAP) prior to assuming delegated duties. Once a successful pre-delegation readiness assessment has been completed and responsibilities have been delegated to the subcontractor via a signed delegation agreement, CalOptima maintains ongoing oversight of delegated activities via ongoing monitoring and the annual audit process. The pre-delegation readiness assessment and annual audit includes a review of any downstream subcontractor agreements, if applicable. ","All subcontracted delegated entities must agree to the provisions of the CalOptima Delegation Agreement outlined in Attachment H of the agreement between CalOptima and the delegate. Under the Delegation Agreement, the delegate agrees to perform the delegated services in accordance with the responsibilities outlined in Attachment H for CalOptima and its Members assigned to Delegate.\nUnder the agreement the delegate must agree (either itself or through a CalOptima-approved Subcontractor or downstream entity) to provide the delegated services set forth in Schedules A, B, C, and D, of the agreement as applicable, (“Delegated Services”) in accordance with the terms of this Attachment H and Standards and Requirements. Under the agreement the term “Standards and Requirements” means currently applicable NCQA accreditation standards; DHCS, DMHC, CMS requirements; state and federal statutes, regulations, and sub-regulatory requirements; and CalOptima Policies and contractual requirements, including the State Contract.\n\nApplicable Citations: \n•\tDelegation Agreement. Attachment H in its entirety. \n•\tDelegation Agreement. Section 2.c. – Subdelegation (notice and approval requirements for subdelegation)\n•\tDelegation Agreement. Section 4.a. - Rights and Obligations of CalOptima: Oversight (CalOptima oversight of delegated functions) \n•\tDelegation Agreement. Section 6. - Reporting (delegates’ ongoing reporting expectations to CalOptima) \n•\tDelegation Agreement. Schedules A-D (describes the Delegated Activity, LOB, Delegate Responsibility, CalOptima Responsibility, Reporting, Performance Evaluation, and Remediation for each delegated responsibly, by delegated functional area) ","The Subcontractors have access to CalOptima's Policies and Procedures on CalOptima.org website; it's available 24 hours a day/7 days a week.","Fee Schedule and Implementation Fees","N/A","See attached zipped file, Prof FFS Contract Template subfolder, documents titled:\n1. Professional Contract (KL rev. 03.17.22) (00221211xD58B3) - this is the provider contract template utilized for this subcontractor.\n2. Final 2023 Delegated for Credentialing Agreement_Group_v2_5.11.23_CLEAN - this is credentialing only delegation agreement approved during operational readiness submission. The delegation agreement has been revised in 2024."]
["CalOptima Health","S12","Verisys Corporation","Administrative Subcontractor","Orange","Jennifer L. Gillespie, Compliance Officer","EmaiL: XXXX\nTelephone: XXXX",null,"Provider Credentialing","N/A","9960 Corporate Campus Drive","Suite 3000","Louisville, KY",40223,0,"N/A","Assist with credentialing verification","N/A"," Vendor Contract Section 11.1, cannot delegate without CalOptima approval.\n ","Verisys is an NCQA Certified Credentialing Verification Organization. We have contracted with Verisys to credential and recredentialing our CalOptima Health Community Network providers. Verisys conducts all verifications to meet DHCS and NCQA credentialing requirements and they have automation be able to process a large volume of files quickly. While Verisys conducts verifications, CalOptima Health retains the right to determine whether the provider is approved for credentialing and will enter the CalOptima Health provider network. ","CalOptima has a robust delegation oversight program that includes a detailed annual audit program and ongoing monitoring process to oversee performance of delegated functions on an ongoing basis. CalOptima has a dedicated team of staff in its Delegation Oversight (DO) department responsible for conducting the annual audits of delegated activities and monitoring of Corrective Action Plans (CAPs) stemming from the annual audits. The annual audit process includes an audit of any downstream subcontractor arrangements, if applicable. The DO department maintains a calendar of scheduled audits for the year to ensure audits are conducted annually and completed timely. In addition to the work performed by the DO department, the Subject Matter Experts (SMEs) in CalOptima’s internal divisions related to functions that are delegated also perform ongoing monitoring of delegated activities by reviewing performance metrics and reports submitted the delegates on an ongoing basis. Oversight activities and findings are reported through the Delegation Oversight Committee, which reports up to the Compliance Committee.  ","CalOptima conducts pre-delegation readiness assessments of subcontractors to determine the subcontractor’s ability and capacity to implement and perform delegated activities prior to delegating such activities. The entity must demonstrate its ability and capacity to perform the delegated functions by meeting or exceeding all requirements in the CalOptima Service Agreement and CalOptima Delegation Oversight policies. If unable to meet a standard, the potential subcontractor may be placed on a Corrective Action Plan (CAP) prior to assuming delegated duties. Once a successful pre-delegation readiness assessment has been completed and responsibilities have been delegated to the subcontractor via a signed delegation agreement, CalOptima maintains ongoing oversight of delegated activities via ongoing monitoring and the annual audit process. The pre-delegation readiness assessment and annual audit includes a review of any downstream subcontractor agreements, if applicable. "," Vendor Contract, Exhibit C, 2.2 and FDR Attestation. ","The Subcontractors have access to CalOptima's Policies and Procedures on CalOptima.org website; it's available 24 hours a day/7 days a week.","Monthly Monitoring Price per provider\nand Per Event pricing","N/A","N/A"]
["CalOptima Health","S13","Modivcare","Administrative Subcontractor","Orange","Jody Kepler, Compliance Officer","EmaiL: XXXX\nTelephone: XXXX",null,"Non-Emergency Transportation, Provider Credentialing","N/A","6900 Layton Ave","12th Floor","Denver, CO",80237,0,"N/A","Member Access to Transportation Services","N/A","In accordance with CalOptima’s Delegation Agreement and Delegation Oversight Health Network and FDR Annual Audits, Subcontractors and/or Downstream Subcontractors are not permitted to sub-delegate any functions unless the Subcontractor and/or Downstream Subcontractor requests prior permission and receives approval by CalOptima, the Health Network, and/or the FDR. Ultimately, all sub-delegated functions require prior approval by CalOptima.\n\nCalOptima maintains oversight over delegated functions to Subcontractors and Downstream Subcontractors via a variety of methods including but not limited to annual audits, corrective action plans, ongoing monitoring, external audits, and accreditation review, and reporting review.  \n\nApplicable Citations: \n•\tDelegation Agreement. Section 2.c. – Subdelegation (notice and approval requirements for subdelegation)\n•\tDelegation Agreement. Section 4.a. - Rights and Obligations of CalOptima: Oversight (CalOptima oversight of delegated functions) \n•\tDelegation Agreement. Section 6. - Reporting (delegates’ ongoing reporting expectations to CalOptima) \n•\tDelegation Agreement. Schedules A-D (describes the Delegated Activity, LOB, Delegate Responsibility, CalOptima Responsibility, Reporting, Performance Evaluation, and Remediation for each delegated responsibility, by delegated functional area) ","Assists with Network Adequacy and Member Access for Transportation Services","CalOptima has a robust delegation oversight program that includes a detailed annual audit program and ongoing monitoring process to oversee performance of delegated functions on an ongoing basis. CalOptima has a dedicated team of staff in its Delegation Oversight (DO) department responsible for conducting the annual audits of delegated activities and monitoring of Corrective Action Plans (CAPs) stemming from the annual audits. The annual audit process includes an audit of any downstream subcontractor arrangements, if applicable. The DO department maintains a calendar of scheduled audits for the year to ensure audits are conducted annually and completed timely. In addition to the work performed by the DO department, the Subject Matter Experts (SMEs) in CalOptima’s internal divisions related to functions that are delegated also perform ongoing monitoring of delegated activities by reviewing performance metrics and reports submitted the delegates on an ongoing basis. Oversight activities and findings are reported through the Delegation Oversight Committee, which reports up to the Compliance Committee.  ","CalOptima conducts pre-delegation readiness assessments of subcontractors to determine the subcontractor’s ability and capacity to implement and perform delegated activities prior to delegating such activities. The entity must demonstrate its ability and capacity to perform the delegated functions by meeting or exceeding all requirements in the CalOptima Service Agreement and CalOptima Delegation Oversight policies. If unable to meet a standard, the potential subcontractor may be placed on a Corrective Action Plan (CAP) prior to assuming delegated duties. Once a successful pre-delegation readiness assessment has been completed and responsibilities have been delegated to the subcontractor via a signed delegation agreement, CalOptima maintains ongoing oversight of delegated activities via ongoing monitoring and the annual audit process. The pre-delegation readiness assessment and annual audit includes a review of any downstream subcontractor agreements, if applicable. ","All subcontracted delegated entities must agree to the provisions of the CalOptima Delegation Agreement outlined in Attachment H of the agreement between CalOptima and the delegate. Under the Delegation Agreement, the delegate agrees to perform the delegated services in accordance with the responsibilities outlined in Attachment H for CalOptima and its Members assigned to Delegate.\nUnder the agreement the delegate must agree (either itself or through a CalOptima-approved Subcontractor or downstream entity) to provide the delegated services set forth in Schedules A, B, C, and D, of the agreement as applicable, (“Delegated Services”) in accordance with the terms of this Attachment H and Standards and Requirements. Under the agreement the term “Standards and Requirements” means currently applicable NCQA accreditation standards; DHCS, DMHC, CMS requirements; state and federal statutes, regulations, and sub-regulatory requirements; and CalOptima Policies and contractual requirements, including the State Contract.\n\nApplicable Citations: \n•\tDelegation Agreement. Attachment H in its entirety. \n•\tDelegation Agreement. Section 2.c. – Subdelegation (notice and approval requirements for subdelegation)\n•\tDelegation Agreement. Section 4.a. - Rights and Obligations of CalOptima: Oversight (CalOptima oversight of delegated functions) \n•\tDelegation Agreement. Section 6. - Reporting (delegates’ ongoing reporting expectations to CalOptima) \n•\tDelegation Agreement. Schedules A-D (describes the Delegated Activity, LOB, Delegate Responsibility, CalOptima Responsibility, Reporting, Performance Evaluation, and Remediation for each delegated responsibly, by delegated functional area) ","The Subcontractors have access to CalOptima's Policies and Procedures on CalOptima.org website; it's available 24 hours a day/7 days a week.","Transportation Cost + Administration Fee (per CPT code) and\nInvoice Cost + Administration Fee (for some services)\n","N/A","See attached zipped file, Ancillary Contract Template subfolder, documents titled:\n1. Ancillary Contract (FFS Medical) (KL rev. 03.17.22) (00221218xD58B3) - this is the provider contract template utilized for this subcontractor.\n2. Final 2023 Delegated for Credentialing Agreement_Group_v2_5.11.23_CLEAN - this is credentialing only delegation agreement approved during operational readiness submission. The delegation agreement has been revised in 2024."]
["CalOptima Health","S14","Change Healthcare Solutions, LLC","Administrative Subcontractor","Orange","Laura Range, Compliance Officer","EmaiL: XXXX\nTelephone: XXXX",null,"Claims Processing","N/A","424 Church St","Suite 1400","Nashville, TN",37219,0,"N/A","Provides data clearing house services","N/A\n","Original agreement section 7. This subcontractor does not subdelegate. The Contract does not allow for sub-delegation with CalOptima Health approval.","Change Healthcare (CHC) is an Electronic Data Interchange (EDI) vendor. CHC receives claims via EDI from providers on behalf of CalOptima Health.  CHC will run the claims through standard HIPAA validation and business edits, any that do not meet the requirements will be reject back to the provider.  All other claims will be batched and sent to CalOptima Health.\n\nNote: Please note that due to data breach, effective 02/21/2024 CalOptima Health is not receiving claims from Change Healthcare ( Optum) anymore. The connection has not been reestablished.","CalOptima has a robust delegation oversight program that includes a detailed annual audit program and ongoing monitoring process to oversee performance of delegated functions on an ongoing basis. CalOptima has a dedicated team of staff in its Delegation Oversight (DO) department responsible for conducting the annual audits of delegated activities and monitoring of Corrective Action Plans (CAPs) stemming from the annual audits. The annual audit process includes an audit of any downstream subcontractor arrangements, if applicable. The DO department maintains a calendar of scheduled audits for the year to ensure audits are conducted annually and completed timely. In addition to the work performed by the DO department, the Subject Matter Experts (SMEs) in CalOptima’s internal divisions related to functions that are delegated also perform ongoing monitoring of delegated activities by reviewing performance metrics and reports submitted the delegates on an ongoing basis. Oversight activities and findings are reported through the Delegation Oversight Committee, which reports up to the Compliance Committee.  ","CalOptima conducts pre-delegation readiness assessments of subcontractors to determine the subcontractor’s ability and capacity to implement and perform delegated activities prior to delegating such activities. The entity must demonstrate its ability and capacity to perform the delegated functions by meeting or exceeding all requirements in the CalOptima Service Agreement and CalOptima Delegation Oversight policies. If unable to meet a standard, the potential subcontractor may be placed on a Corrective Action Plan (CAP) prior to assuming delegated duties. Once a successful pre-delegation readiness assessment has been completed and responsibilities have been delegated to the subcontractor via a signed delegation agreement, CalOptima maintains ongoing oversight of delegated activities via ongoing monitoring and the annual audit process. The pre-delegation readiness assessment and annual audit includes a review of any downstream subcontractor agreements, if applicable. ","Vendor Contract, Section 2, Services and Specifications (a) ensures compliance with all contractual provisions.","The Subcontractors have access to CalOptima's Policies and Procedures on CalOptima.org website; it's available 24 hours a day/7 days a week.","Contractor is paid per service based on the services utilized that monthly","N/A","N/A"]
["CalOptima Health","S15","Cotiviti, Inc.","Administrative Subcontractor","Orange","Julie Correll, VP Compliance","EmaiL: XXXX\nTelephone: XXXX",null,"Claims Processing","N/A","10701 S River Front Pkwy","Unit 200","South Jordan, UT",84095,0,"N/A","Provides claims editing services","N/A","Vendor Contract, Section 6.1, vendor cannot sub-delegate without CalOptima approval.\n","Payment Policy Management (PPM) Service (a new platform effective 03/03/2023) offers two products: Prepayment Claims Editing and Clinical Validation Services that CalOptima uses for Professional and Facility claims.\n\nClaims Prepayment Editing Service: Identifies claims that are incorrectly coded utilizing DHCS and CMS medical policies guidance.\n\nClinical Validation Service: Provides clinical assessment of prepayment claims data. Cotiviti Internal Coders return claims error results in improper payment recommendations.","CalOptima has a robust delegation oversight program that includes a detailed annual audit program and ongoing monitoring process to oversee performance of delegated functions on an ongoing basis. CalOptima has a dedicated team of staff in its Delegation Oversight (DO) department responsible for conducting the annual audits of delegated activities and monitoring of Corrective Action Plans (CAPs) stemming from the annual audits. The annual audit process includes an audit of any downstream subcontractor arrangements, if applicable. The DO department maintains a calendar of scheduled audits for the year to ensure audits are conducted annually and completed timely. In addition to the work performed by the DO department, the Subject Matter Experts (SMEs) in CalOptima’s internal divisions related to functions that are delegated also perform ongoing monitoring of delegated activities by reviewing performance metrics and reports submitted the delegates on an ongoing basis. Oversight activities and findings are reported through the Delegation Oversight Committee, which reports up to the Compliance Committee.  ","CalOptima conducts pre-delegation readiness assessments of subcontractors to determine the subcontractor’s ability and capacity to implement and perform delegated activities prior to delegating such activities. The entity must demonstrate its ability and capacity to perform the delegated functions by meeting or exceeding all requirements in the CalOptima Service Agreement and CalOptima Delegation Oversight policies. If unable to meet a standard, the potential subcontractor may be placed on a Corrective Action Plan (CAP) prior to assuming delegated duties. Once a successful pre-delegation readiness assessment has been completed and responsibilities have been delegated to the subcontractor via a signed delegation agreement, CalOptima maintains ongoing oversight of delegated activities via ongoing monitoring and the annual audit process. The pre-delegation readiness assessment and annual audit includes a review of any downstream subcontractor agreements, if applicable. ","Vendor Contract, Section 26 and FDR attestation ensures compliance with all contractual provisions.","The Subcontractors have access to CalOptima's Policies and Procedures on CalOptima.org website; it's available 24 hours a day/7 days a week.","PMPM","N/A","N/A"]
["CalOptima Health","S16","Health Management Systems, Inc.  \n ","Administrative Subcontractor","Orange","Anne Terwilliger VP, Chief Compliance Officer","EmaiL: XXXX\nTelephone: XXXX",null,"Claims Processing","N/A","5615 High Point Dr",null,"Irving, TX",75038,0,"N/A","Assists with COB and overpayment services","N/A","Article II, Section D of Original Contract,  vendor cannot sub-delegate without CalOptima approval.\n","HMS (now Gainwell) performs Coordination of Services (COB) and Overpayment Recovery services for our Medi-Cal  LOB.\nCOB Services: \nVendor matches the paid claim data to eligibility database of third-party resources to identify any paid claims by CalOptima Health to providers that may be the responsibility of Commercial or Medicare payor.\nFor Overpayment Recovery Services:  HMS submits paid claim data directly for overpayment reimbursements. For Disallowance Medicare Payor: HMS submits overpayment recovery letters to our servicing Providers.","From Claims: Monthly meetings are held with the HMS. COB and Overpayment Recoveries monthly data is communicated during these sessions. \nDirect Bill data/files is received monthly for CalOptima Health’s validation. Disallowance data/files is received every other month for pre/post approval for letter generation.","CalOptima and HMS have monthly meeting communication and 2 bi-annual visits to review business progress  with Executive Leadership at the CalOptima Health Corporate Office.","Vendor Contract, Section 26 and FDR attestation ensures compliance with all contractual provisions.","The Subcontractors have access to CalOptima's Policies and Procedures on CalOptima.org website; it's available 24 hours a day/7 days a week.","Contingency fee","N/A","N/A"]
["CalOptima Health","S17","Office Ally ","Administrative Subcontractor","Orange","Chere Jensen, Compliance Manager","EmaiL: XXXX\nTelephone: XXXX",null,"Claims Processing","N/A","1300 SE Cardinal Court","Suite 190","Vancouver, WA ",98683,0,"N/A","Provides data clearing house services","N/A"," Vendor Contract, Section 6(a),  and Amendment 1, vendor cannot sub-delegate without CalOptima approval.\n\n","Office Ally is an Electronic Data Interchange (EDI) vendor. Office Ally receives claims via their portal as well as electronically from providers on behalf of CalOptima.  Office Ally will run the claims through standard HIPAA and business edits, any that do not meet the requirements will reject back to the provider.  All other claims will be batched and sent to CalOptima Health.","From  Claims:  CalOptima Health performs a comparison of the total claim count by claim type from the clearinghouse’s daily manifest against the total claim count by claim type from our EDI Dept. The total number of claims from both reports must match 100%.  In addition, at the end of each month, we match the total number of claims received for that month by claim type to their billed invoice.","Office Ally passes the 837 Institutional and Professional claim files. CalOptima performs daily, monthly and annual monitoring to ensure their quality of work. ","Vendor Contract, Section 2, Services and Specifications (a)  ensures compliance with all contractual provisions.","The Subcontractors have access to CalOptima's Policies and Procedures on CalOptima.org website; it's available 24 hours a day/7 days a week.","Per claim fee, Per Month rate or Per Hour rate depending upon scope of work (some are restricted to a 'not to exceed' dollar amount)","N/A","N/A"]
["CalOptima Health","S18","Optum Insight, Inc.","Administrative Subcontractor","Orange","Gina Cesaretti, CCO and Deputy General Counsel","EmaiL: XXXX\nTelephone: XXXX",null,"Claims Processing","N/A","11000 Optum Circle",null,"Eden Prairie, MN",55344,0,"N/A","Performs credit balance recovery","N/A","Vendor contract section 11.1. vendor cannot sub-delegate without CalOptima approval.\n\n","Optum Insight, Inc. provides credit balance recovery services for the Medi-Cal LOB. They identify potential credit balances of inpatient and outpatient hospital services only. A comprehensive review of provider Account Receivables and patient billing records and all related documentation to determine if a credit balance exists for any CalOptima Health member account.","Optum Insight provides monthly summary of all recovery activities. The summary includes specific data regarding trends identified as the root cause for overpayments, e.g., Other Health Care coverages, contractual issues or fee schedule issues.","CalOptima and HMS hold meetings or conference calls as needed to discuss credit balances identified, issues, or concerns.","Vendor Contract, Exhibit C, Section 2 ensures compliance with all contractual provisions.","The Subcontractors have access to CalOptima's Policies and Procedures on CalOptima.org website; it's available 24 hours a day/7 days a week.","Contingency on recovery","N/A","N/A"]
["CalOptima Health","S19","Varis, LLC","Administrative Subcontractor","Orange","Phyllis Cartwright, Compliance Officer","EmaiL: XXXX\nTelephone: XXXX",null,"Claims Processing","N/A","9245 Sierra College Blvd","Suite 100","Roseville. CA",95661,0,"N/A","Provides high dollar and forensic claims review","N/A","Vendor Contract, Section 6.1. , they cannot delegate without CalOptima approval.\n","CalOptima Health utilized two VARIS products for Post Pay Claim Audit Review.\n\nOverpayment Identification Services: This involves post payment claim audit review of Inpatient Diagnosis Related Grouping (DRG) and Outpatient Ambulatory Payment Classification (APC). Overpayment identification include errors identified in the billing, processing, or coding phases of payment.\n\nClinical Validation: This involves clinical review of claim cases to determine whether the patient truly possesses the conditions that were documented in the medical record. The documented diagnosis must be substantiated by the clinical criteria generally accepted by the medical community.","CalOptima has a robust delegation oversight program that includes a detailed annual audit program and ongoing monitoring process to oversee performance of delegated functions on an ongoing basis. CalOptima has a dedicated team of staff in its Delegation Oversight (DO) department responsible for conducting the annual audits of delegated activities and monitoring of Corrective Action Plans (CAPs) stemming from the annual audits. The annual audit process includes an audit of any downstream subcontractor arrangements, if applicable. The DO department maintains a calendar of scheduled audits for the year to ensure audits are conducted annually and completed timely. In addition to the work performed by the DO department, the Subject Matter Experts (SMEs) in CalOptima’s internal divisions related to functions that are delegated also perform ongoing monitoring of delegated activities by reviewing performance metrics and reports submitted the delegates on an ongoing basis. Oversight activities and findings are reported through the Delegation Oversight Committee, which reports up to the Compliance Committee.  ","CalOptima conducts pre-delegation readiness assessments of subcontractors to determine the subcontractor’s ability and capacity to implement and perform delegated activities prior to delegating such activities. The entity must demonstrate its ability and capacity to perform the delegated functions by meeting or exceeding all requirements in the CalOptima Service Agreement and CalOptima Delegation Oversight policies. If unable to meet a standard, the potential subcontractor may be placed on a Corrective Action Plan (CAP) prior to assuming delegated duties. Once a successful pre-delegation readiness assessment has been completed and responsibilities have been delegated to the subcontractor via a signed delegation agreement, CalOptima maintains ongoing oversight of delegated activities via ongoing monitoring and the annual audit process. The pre-delegation readiness assessment and annual audit includes a review of any downstream subcontractor agreements, if applicable. ","Vendor Contract, Section 26 and FDR Attestation ensures compliance with all contractual provisions.","The Subcontractors have access to CalOptima's Policies and Procedures on CalOptima.org website; it's available 24 hours a day/7 days a week.","Fee per case","N/A","N/A"]
["CalOptima Health","S20","Children's Hospital Los Angeles Medical Group, Inc.","Administrative Subcontractor","Orange","Andre Wood, Director of Provider Network Management ","EmaiL: XXXX\nTelephone: XXXX",null,"Provider Credentialing","N/A","4601 Sunset Blvd","Room 124","Los Angeles",90027,0,"N/A","Assists with provider credentialing","N/A","In accordance with CalOptima’s Delegation Agreement and Delegation Oversight Health Network and FDR Annual Audits, Subcontractors and/or Downstream Subcontractors are not permitted to sub-delegate any functions unless the Subcontractor and/or Downstream Subcontractor requests prior permission and receives approval by CalOptima, the Health Network, and/or the FDR. Ultimately, all sub-delegated functions require prior approval by CalOptima.\n\nCalOptima maintains oversight over delegated functions to Subcontractors and Downstream Subcontractors via a variety of methods including but not limited to annual audits, corrective action plans, ongoing monitoring, external audits, and accreditation review, and reporting review.  \n\nApplicable Citations: \n•\tDelegation Agreement. Section 2.c. – Subdelegation (notice and approval requirements for subdelegation)\n•\tDelegation Agreement. Section 4.a. - Rights and Obligations of CalOptima: Oversight (CalOptima oversight of delegated functions) \n•\tDelegation Agreement. Section 6. - Reporting (delegates’ ongoing reporting expectations to CalOptima) \n•\tDelegation Agreement. Schedule D (describes the Delegated Activity, LOB, Delegate Responsibility, CalOptima Responsibility, Reporting, Performance Evaluation, and Remediation for each delegated responsibility, by delegated functional area) ","Assists with provider credentialing","CalOptima has a robust delegation oversight program that includes a detailed annual audit program and ongoing monitoring process to oversee performance of delegated functions on an ongoing basis. CalOptima has a dedicated team of staff in its Delegation Oversight (DO) department responsible for conducting the annual audits of delegated activities and monitoring of Corrective Action Plans (CAPs) stemming from the annual audits. The annual audit process includes an audit of any downstream subcontractor arrangements, if applicable. The DO department maintains a calendar of scheduled audits for the year to ensure audits are conducted annually and completed timely. In addition to the work performed by the DO department, the Subject Matter Experts (SMEs) in CalOptima’s internal divisions related to functions that are delegated also perform ongoing monitoring of delegated activities by reviewing performance metrics and reports submitted the delegates on an ongoing basis. Oversight activities and findings are reported through the Delegation Oversight Committee, which reports up to the Compliance Committee.  ","CalOptima conducts pre-delegation readiness assessments of subcontractors to determine the subcontractor’s ability and capacity to implement and perform delegated activities prior to delegating such activities. The entity must demonstrate its ability and capacity to perform the delegated functions by meeting or exceeding all requirements in the CalOptima Service Agreement and CalOptima Delegation Oversight policies. If unable to meet a standard, the potential subcontractor may be placed on a Corrective Action Plan (CAP) prior to assuming delegated duties. Once a successful pre-delegation readiness assessment has been completed and responsibilities have been delegated to the subcontractor via a signed delegation agreement, CalOptima maintains ongoing oversight of delegated activities via ongoing monitoring and the annual audit process. The pre-delegation readiness assessment and annual audit includes a review of any downstream subcontractor agreements, if applicable. ","All subcontracted delegated entities must agree to the provisions of the CalOptima Delegation Agreement outlined in Attachment H of the agreement between CalOptima and the delegate. Under the Delegation Agreement, the delegate agrees to perform the delegated services in accordance with the responsibilities outlined in Attachment H for CalOptima and its Members assigned to Delegate.\nUnder the agreement the delegate must agree (either itself or through a CalOptima-approved Subcontractor or downstream entity) to provide the delegated services set forth in Schedules A, B, C, and D, of the agreement as applicable, (“Delegated Services”) in accordance with the terms of this Attachment H and Standards and Requirements. Under the agreement the term “Standards and Requirements” means currently applicable NCQA accreditation standards; DHCS, DMHC, CMS requirements; state and federal statutes, regulations, and sub-regulatory requirements; and CalOptima Policies and contractual requirements, including the State Contract.\n\nApplicable Citations: \n•\tDelegation Agreement. Attachment H in its entirety. \n•\tDelegation Agreement. Section 2.c. – Subdelegation (notice and approval requirements for subdelegation)\n•\tDelegation Agreement. Section 4.a. - Rights and Obligations of CalOptima: Oversight (CalOptima oversight of delegated functions) \n•\tDelegation Agreement. Section 6. - Reporting (delegates’ ongoing reporting expectations to CalOptima) \n•\tDelegation Agreement. Schedules A-D (describes the Delegated Activity, LOB, Delegate Responsibility, CalOptima Responsibility, Reporting, Performance Evaluation, and Remediation for each delegated responsibly, by delegated functional area) ","\nThe CalOptima Provider Newsletter, which is distributed monthly, includes a section that outlines changes made to CalOptima Health Policies and Procedures. Additionally, Provider Alerts are distributed with important information for the CalOptima Health provider community. Both are also available on CalOptima.org website, under the Provider section.","Fee For Service","N/A","See attached zipped file, Prof FFS Contract Template subfolder, documents titled:\n1. Professional Contract (KL rev. 03.17.22) (00221211xD58B3) - this is the provider contract template utilized for this subcontractor.\n2. Final 2023 Delegated for Credentialing Agreement_Group_v2_5.11.23_CLEAN - this is credentialing only delegation agreement approved during operational readiness submission. The delegation agreement has been revised in 2024."]
["CalOptima Health","S21","CHOC Children's Specialist","Administrative Subcontractor","Orange","Zenicel Gonzales, Credentialing Manager","EmaiL: XXXX\nTelephone: XXXX",null,"Provider Credentialing","N/A","1201 W. La Veta Ave",null,"Orange",92868,0,"N/A","Assists with provider credentialing","N/A","In accordance with CalOptima’s Delegation Agreement and Delegation Oversight Health Network and FDR Annual Audits, Subcontractors and/or Downstream Subcontractors are not permitted to sub-delegate any functions unless the Subcontractor and/or Downstream Subcontractor requests prior permission and receives approval by CalOptima, the Health Network, and/or the FDR. Ultimately, all sub-delegated functions require prior approval by CalOptima.\n\nCalOptima maintains oversight over delegated functions to Subcontractors and Downstream Subcontractors via a variety of methods including but not limited to annual audits, corrective action plans, ongoing monitoring, external audits, and accreditation review, and reporting review.  \n\nApplicable Citations: \n•\tDelegation Agreement. Section 2.c. – Subdelegation (notice and approval requirements for subdelegation)\n•\tDelegation Agreement. Section 4.a. - Rights and Obligations of CalOptima: Oversight (CalOptima oversight of delegated functions) \n•\tDelegation Agreement. Section 6. - Reporting (delegates’ ongoing reporting expectations to CalOptima) \n•\tDelegation Agreement. Schedule D (describes the Delegated Activity, LOB, Delegate Responsibility, CalOptima Responsibility, Reporting, Performance Evaluation, and Remediation for each delegated responsibility, by delegated functional area) ","Assists with provider credentialing","CalOptima has a robust delegation oversight program that includes a detailed annual audit program and ongoing monitoring process to oversee performance of delegated functions on an ongoing basis. CalOptima has a dedicated team of staff in its Delegation Oversight (DO) department responsible for conducting the annual audits of delegated activities and monitoring of Corrective Action Plans (CAPs) stemming from the annual audits. The annual audit process includes an audit of any downstream subcontractor arrangements, if applicable. The DO department maintains a calendar of scheduled audits for the year to ensure audits are conducted annually and completed timely. In addition to the work performed by the DO department, the Subject Matter Experts (SMEs) in CalOptima’s internal divisions related to functions that are delegated also perform ongoing monitoring of delegated activities by reviewing performance metrics and reports submitted the delegates on an ongoing basis. Oversight activities and findings are reported through the Delegation Oversight Committee, which reports up to the Compliance Committee.  ","CalOptima conducts pre-delegation readiness assessments of subcontractors to determine the subcontractor’s ability and capacity to implement and perform delegated activities prior to delegating such activities. The entity must demonstrate its ability and capacity to perform the delegated functions by meeting or exceeding all requirements in the CalOptima Service Agreement and CalOptima Delegation Oversight policies. If unable to meet a standard, the potential subcontractor may be placed on a Corrective Action Plan (CAP) prior to assuming delegated duties. Once a successful pre-delegation readiness assessment has been completed and responsibilities have been delegated to the subcontractor via a signed delegation agreement, CalOptima maintains ongoing oversight of delegated activities via ongoing monitoring and the annual audit process. The pre-delegation readiness assessment and annual audit includes a review of any downstream subcontractor agreements, if applicable. ","All subcontracted delegated entities must agree to the provisions of the CalOptima Delegation Agreement outlined in Attachment H of the agreement between CalOptima and the delegate. Under the Delegation Agreement, the delegate agrees to perform the delegated services in accordance with the responsibilities outlined in Attachment H for CalOptima and its Members assigned to Delegate.\nUnder the agreement the delegate must agree (either itself or through a CalOptima-approved Subcontractor or downstream entity) to provide the delegated services set forth in Schedules A, B, C, and D, of the agreement as applicable, (“Delegated Services”) in accordance with the terms of this Attachment H and Standards and Requirements. Under the agreement the term “Standards and Requirements” means currently applicable NCQA accreditation standards; DHCS, DMHC, CMS requirements; state and federal statutes, regulations, and sub-regulatory requirements; and CalOptima Policies and contractual requirements, including the State Contract.\n\nApplicable Citations: \n•\tDelegation Agreement. Attachment H in its entirety. \n•\tDelegation Agreement. Section 2.c. – Subdelegation (notice and approval requirements for subdelegation)\n•\tDelegation Agreement. Section 4.a. - Rights and Obligations of CalOptima: Oversight (CalOptima oversight of delegated functions) \n•\tDelegation Agreement. Section 6. - Reporting (delegates’ ongoing reporting expectations to CalOptima) \n•\tDelegation Agreement. Schedules A-D (describes the Delegated Activity, LOB, Delegate Responsibility, CalOptima Responsibility, Reporting, Performance Evaluation, and Remediation for each delegated responsibly, by delegated functional area) ","The CalOptima Provider Newsletter, which is distributed monthly, includes a section that outlines changes made to CalOptima Health Policies and Procedures. Additionally, Provider Alerts are distributed with important information for the CalOptima Health provider community. Both are also available on CalOptima.org website, under the Provider section.","Fee For Service","N/A","See attached zipped file, Prof FFS Contract Template subfolder, documents titled:\n1. Professional Contract (KL rev. 03.17.22) (00221211xD58B3) - this is the provider contract template utilized for this subcontractor.\n2. Final 2023 Delegated for Credentialing Agreement_Group_v2_5.11.23_CLEAN - this is credentialing only delegation agreement approved during operational readiness submission. The delegation agreement has been revised in 2024."]
["CalOptima Health","S22","City of Hope Medical Foundation","Administrative Subcontractor","Orange","Heidi Carmean, Director of Credentialing\nCarol Sharou Cred Supervisor","EmaiL: XXXX\nTelephone: XXXX",null,"Provider Credentialing","N/A","1500 E. Duarte Rd",null,"Duarte",91010,0,"N/A","Assists with provider credentialing","N/A","In accordance with CalOptima’s Delegation Agreement and Delegation Oversight Health Network and FDR Annual Audits, Subcontractors and/or Downstream Subcontractors are not permitted to sub-delegate any functions unless the Subcontractor and/or Downstream Subcontractor requests prior permission and receives approval by CalOptima, the Health Network, and/or the FDR. Ultimately, all sub-delegated functions require prior approval by CalOptima.\n\nCalOptima maintains oversight over delegated functions to Subcontractors and Downstream Subcontractors via a variety of methods including but not limited to annual audits, corrective action plans, ongoing monitoring, external audits, and accreditation review, and reporting review.  \n\nApplicable Citations: \n•\tDelegation Agreement. Section 2.c. – Subdelegation (notice and approval requirements for subdelegation)\n•\tDelegation Agreement. Section 4.a. - Rights and Obligations of CalOptima: Oversight (CalOptima oversight of delegated functions) \n•\tDelegation Agreement. Section 6. - Reporting (delegates’ ongoing reporting expectations to CalOptima) \n•\tDelegation Agreement. Schedule D (describes the Delegated Activity, LOB, Delegate Responsibility, CalOptima Responsibility, Reporting, Performance Evaluation, and Remediation for each delegated responsibility, by delegated functional area) ","Assists with provider credentialing","CalOptima has a robust delegation oversight program that includes a detailed annual audit program and ongoing monitoring process to oversee performance of delegated functions on an ongoing basis. CalOptima has a dedicated team of staff in its Delegation Oversight (DO) department responsible for conducting the annual audits of delegated activities and monitoring of Corrective Action Plans (CAPs) stemming from the annual audits. The annual audit process includes an audit of any downstream subcontractor arrangements, if applicable. The DO department maintains a calendar of scheduled audits for the year to ensure audits are conducted annually and completed timely. In addition to the work performed by the DO department, the Subject Matter Experts (SMEs) in CalOptima’s internal divisions related to functions that are delegated also perform ongoing monitoring of delegated activities by reviewing performance metrics and reports submitted the delegates on an ongoing basis. Oversight activities and findings are reported through the Delegation Oversight Committee, which reports up to the Compliance Committee.  ","CalOptima conducts pre-delegation readiness assessments of subcontractors to determine the subcontractor’s ability and capacity to implement and perform delegated activities prior to delegating such activities. The entity must demonstrate its ability and capacity to perform the delegated functions by meeting or exceeding all requirements in the CalOptima Service Agreement and CalOptima Delegation Oversight policies. If unable to meet a standard, the potential subcontractor may be placed on a Corrective Action Plan (CAP) prior to assuming delegated duties. Once a successful pre-delegation readiness assessment has been completed and responsibilities have been delegated to the subcontractor via a signed delegation agreement, CalOptima maintains ongoing oversight of delegated activities via ongoing monitoring and the annual audit process. The pre-delegation readiness assessment and annual audit includes a review of any downstream subcontractor agreements, if applicable. ","All subcontracted delegated entities must agree to the provisions of the CalOptima Delegation Agreement outlined in Attachment H of the agreement between CalOptima and the delegate. Under the Delegation Agreement, the delegate agrees to perform the delegated services in accordance with the responsibilities outlined in Attachment H for CalOptima and its Members assigned to Delegate.\nUnder the agreement the delegate must agree (either itself or through a CalOptima-approved Subcontractor or downstream entity) to provide the delegated services set forth in Schedules A, B, C, and D, of the agreement as applicable, (“Delegated Services”) in accordance with the terms of this Attachment H and Standards and Requirements. Under the agreement the term “Standards and Requirements” means currently applicable NCQA accreditation standards; DHCS, DMHC, CMS requirements; state and federal statutes, regulations, and sub-regulatory requirements; and CalOptima Policies and contractual requirements, including the State Contract.\n\nApplicable Citations: \n•\tDelegation Agreement. Attachment H in its entirety. \n•\tDelegation Agreement. Section 2.c. – Subdelegation (notice and approval requirements for subdelegation)\n•\tDelegation Agreement. Section 4.a. - Rights and Obligations of CalOptima: Oversight (CalOptima oversight of delegated functions) \n•\tDelegation Agreement. Section 6. - Reporting (delegates’ ongoing reporting expectations to CalOptima) \n•\tDelegation Agreement. Schedules A-D (describes the Delegated Activity, LOB, Delegate Responsibility, CalOptima Responsibility, Reporting, Performance Evaluation, and Remediation for each delegated responsibly, by delegated functional area) ","The CalOptima Provider Newsletter, which is distributed monthly, includes a section that outlines changes made to CalOptima Health Policies and Procedures. Additionally, Provider Alerts are distributed with important information for the CalOptima Health provider community. Both are also available on CalOptima.org website, under the Provider section.","Fee For Service","N/A","See attached zipped file, Prof FFS Contract Template subfolder, documents titled:\n1. Professional Contract (KL rev. 03.17.22) (00221211xD58B3) - this is the provider contract template utilized for this subcontractor.\n2. Final 2023 Delegated for Credentialing Agreement_Group_v2_5.11.23_CLEAN - this is credentialing only delegation agreement approved during operational readiness submission. The delegation agreement has been revised in 2024."]
["CalOptima Health","S23","Providence Medical Foundation","Administrative Subcontractor","Orange","Celina Yamaguchi, Credentialing Manager\nSue Boyadjian\n","EmaiL: XXXX\nTelephone: XXXX",null,"Provider Credentialing","N/A","200 W. Center St ","Promenade 3rd Floor","Anaheim",92805,0,"N/A","Assists with provider credentialing","N/A","In accordance with CalOptima’s Delegation Agreement and Delegation Oversight Health Network and FDR Annual Audits, Subcontractors and/or Downstream Subcontractors are not permitted to sub-delegate any functions unless the Subcontractor and/or Downstream Subcontractor requests prior permission and receives approval by CalOptima, the Health Network, and/or the FDR. Ultimately, all sub-delegated functions require prior approval by CalOptima.\n\nCalOptima maintains oversight over delegated functions to Subcontractors and Downstream Subcontractors via a variety of methods including but not limited to annual audits, corrective action plans, ongoing monitoring, external audits, and accreditation review, and reporting review.  \n\nApplicable Citations: \n•\tDelegation Agreement. Section 2.c. – Subdelegation (notice and approval requirements for subdelegation)\n•\tDelegation Agreement. Section 4.a. - Rights and Obligations of CalOptima: Oversight (CalOptima oversight of delegated functions) \n•\tDelegation Agreement. Section 6. - Reporting (delegates’ ongoing reporting expectations to CalOptima) \n•\tDelegation Agreement. Schedule D (describes the Delegated Activity, LOB, Delegate Responsibility, CalOptima Responsibility, Reporting, Performance Evaluation, and Remediation for each delegated responsibility, by delegated functional area) ","Assists with provider credentialing","CalOptima has a robust delegation oversight program that includes a detailed annual audit program and ongoing monitoring process to oversee performance of delegated functions on an ongoing basis. CalOptima has a dedicated team of staff in its Delegation Oversight (DO) department responsible for conducting the annual audits of delegated activities and monitoring of Corrective Action Plans (CAPs) stemming from the annual audits. The annual audit process includes an audit of any downstream subcontractor arrangements, if applicable. The DO department maintains a calendar of scheduled audits for the year to ensure audits are conducted annually and completed timely. In addition to the work performed by the DO department, the Subject Matter Experts (SMEs) in CalOptima’s internal divisions related to functions that are delegated also perform ongoing monitoring of delegated activities by reviewing performance metrics and reports submitted the delegates on an ongoing basis. Oversight activities and findings are reported through the Delegation Oversight Committee, which reports up to the Compliance Committee.  ","CalOptima conducts pre-delegation readiness assessments of subcontractors to determine the subcontractor’s ability and capacity to implement and perform delegated activities prior to delegating such activities. The entity must demonstrate its ability and capacity to perform the delegated functions by meeting or exceeding all requirements in the CalOptima Service Agreement and CalOptima Delegation Oversight policies. If unable to meet a standard, the potential subcontractor may be placed on a Corrective Action Plan (CAP) prior to assuming delegated duties. Once a successful pre-delegation readiness assessment has been completed and responsibilities have been delegated to the subcontractor via a signed delegation agreement, CalOptima maintains ongoing oversight of delegated activities via ongoing monitoring and the annual audit process. The pre-delegation readiness assessment and annual audit includes a review of any downstream subcontractor agreements, if applicable. ","All subcontracted delegated entities must agree to the provisions of the CalOptima Delegation Agreement outlined in Attachment H of the agreement between CalOptima and the delegate. Under the Delegation Agreement, the delegate agrees to perform the delegated services in accordance with the responsibilities outlined in Attachment H for CalOptima and its Members assigned to Delegate.\nUnder the agreement the delegate must agree (either itself or through a CalOptima-approved Subcontractor or downstream entity) to provide the delegated services set forth in Schedules A, B, C, and D, of the agreement as applicable, (“Delegated Services”) in accordance with the terms of this Attachment H and Standards and Requirements. Under the agreement the term “Standards and Requirements” means currently applicable NCQA accreditation standards; DHCS, DMHC, CMS requirements; state and federal statutes, regulations, and sub-regulatory requirements; and CalOptima Policies and contractual requirements, including the State Contract.\n\nApplicable Citations: \n•\tDelegation Agreement. Attachment H in its entirety. \n•\tDelegation Agreement. Section 2.c. – Subdelegation (notice and approval requirements for subdelegation)\n•\tDelegation Agreement. Section 4.a. - Rights and Obligations of CalOptima: Oversight (CalOptima oversight of delegated functions) \n•\tDelegation Agreement. Section 6. - Reporting (delegates’ ongoing reporting expectations to CalOptima) \n•\tDelegation Agreement. Schedules A-D (describes the Delegated Activity, LOB, Delegate Responsibility, CalOptima Responsibility, Reporting, Performance Evaluation, and Remediation for each delegated responsibly, by delegated functional area) ","The CalOptima Provider Newsletter, which is distributed monthly, includes a section that outlines changes made to CalOptima Health Policies and Procedures. Additionally, Provider Alerts are distributed with important information for the CalOptima Health provider community. Both are also available on CalOptima.org website, under the Provider section.","Fee For Service","N/A","See attached zipped file, Prof FFS Contract Template subfolder, documents titled:\n1. Professional Contract (KL rev. 03.17.22) (00221211xD58B3) - this is the provider contract template utilized for this subcontractor.\n2. Final 2023 Delegated for Credentialing Agreement_Group_v2_5.11.23_CLEAN - this is credentialing only delegation agreement approved during operational readiness submission. The delegation agreement has been revised in 2024."]
["CalOptima Health","S24"," University of California, Irvine Health Physicians & Surgeons, Department\nof Pediatrics","Administrative Subcontractor","Orange","Sylvia Copen, Mgr Provider Enrollment\nAlyssa Reuther, Dir Medical Staff Admin","EmaiL: XXXX\nTelephone: XXXX",null,"Provider Credentialing","N/A","101 The City Drive Blvd",null,"Orange",92868,0,"N/A","Assists with provider credentialing","N/A","In accordance with CalOptima’s Delegation Agreement and Delegation Oversight Health Network and FDR Annual Audits, Subcontractors and/or Downstream Subcontractors are not permitted to sub-delegate any functions unless the Subcontractor and/or Downstream Subcontractor requests prior permission and receives approval by CalOptima, the Health Network, and/or the FDR. Ultimately, all sub-delegated functions require prior approval by CalOptima.\n\nCalOptima maintains oversight over delegated functions to Subcontractors and Downstream Subcontractors via a variety of methods including but not limited to annual audits, corrective action plans, ongoing monitoring, external audits, and accreditation review, and reporting review.  \n\nApplicable Citations: \n•\tDelegation Agreement. Section 2.c. – Subdelegation (notice and approval requirements for subdelegation)\n•\tDelegation Agreement. Section 4.a. - Rights and Obligations of CalOptima: Oversight (CalOptima oversight of delegated functions) \n•\tDelegation Agreement. Section 6. - Reporting (delegates’ ongoing reporting expectations to CalOptima) \n•\tDelegation Agreement. Schedule D (describes the Delegated Activity, LOB, Delegate Responsibility, CalOptima Responsibility, Reporting, Performance Evaluation, and Remediation for each delegated responsibility, by delegated functional area) ","Assists with provider credentialing","CalOptima has a robust delegation oversight program that includes a detailed annual audit program and ongoing monitoring process to oversee performance of delegated functions on an ongoing basis. CalOptima has a dedicated team of staff in its Delegation Oversight (DO) department responsible for conducting the annual audits of delegated activities and monitoring of Corrective Action Plans (CAPs) stemming from the annual audits. The annual audit process includes an audit of any downstream subcontractor arrangements, if applicable. The DO department maintains a calendar of scheduled audits for the year to ensure audits are conducted annually and completed timely. In addition to the work performed by the DO department, the Subject Matter Experts (SMEs) in CalOptima’s internal divisions related to functions that are delegated also perform ongoing monitoring of delegated activities by reviewing performance metrics and reports submitted the delegates on an ongoing basis. Oversight activities and findings are reported through the Delegation Oversight Committee, which reports up to the Compliance Committee.  ","CalOptima conducts pre-delegation readiness assessments of subcontractors to determine the subcontractor’s ability and capacity to implement and perform delegated activities prior to delegating such activities. The entity must demonstrate its ability and capacity to perform the delegated functions by meeting or exceeding all requirements in the CalOptima Service Agreement and CalOptima Delegation Oversight policies. If unable to meet a standard, the potential subcontractor may be placed on a Corrective Action Plan (CAP) prior to assuming delegated duties. Once a successful pre-delegation readiness assessment has been completed and responsibilities have been delegated to the subcontractor via a signed delegation agreement, CalOptima maintains ongoing oversight of delegated activities via ongoing monitoring and the annual audit process. The pre-delegation readiness assessment and annual audit includes a review of any downstream subcontractor agreements, if applicable. ","All subcontracted delegated entities must agree to the provisions of the CalOptima Delegation Agreement outlined in Attachment H of the agreement between CalOptima and the delegate. Under the Delegation Agreement, the delegate agrees to perform the delegated services in accordance with the responsibilities outlined in Attachment H for CalOptima and its Members assigned to Delegate.\nUnder the agreement the delegate must agree (either itself or through a CalOptima-approved Subcontractor or downstream entity) to provide the delegated services set forth in Schedules A, B, C, and D, of the agreement as applicable, (“Delegated Services”) in accordance with the terms of this Attachment H and Standards and Requirements. Under the agreement the term “Standards and Requirements” means currently applicable NCQA accreditation standards; DHCS, DMHC, CMS requirements; state and federal statutes, regulations, and sub-regulatory requirements; and CalOptima Policies and contractual requirements, including the State Contract.\n\nApplicable Citations: \n•\tDelegation Agreement. Attachment H in its entirety. \n•\tDelegation Agreement. Section 2.c. – Subdelegation (notice and approval requirements for subdelegation)\n•\tDelegation Agreement. Section 4.a. - Rights and Obligations of CalOptima: Oversight (CalOptima oversight of delegated functions) \n•\tDelegation Agreement. Section 6. - Reporting (delegates’ ongoing reporting expectations to CalOptima) \n•\tDelegation Agreement. Schedules A-D (describes the Delegated Activity, LOB, Delegate Responsibility, CalOptima Responsibility, Reporting, Performance Evaluation, and Remediation for each delegated responsibly, by delegated functional area) ","The CalOptima Provider Newsletter, which is distributed monthly, includes a section that outlines changes made to CalOptima Health Policies and Procedures. Additionally, Provider Alerts are distributed with important information for the CalOptima Health provider community. Both are also available on CalOptima.org website, under the Provider section.","Fee For Service","N/A","See attached zipped file, Prof FFS Contract Template subfolder, documents titled:\n1. Professional Contract (KL rev. 03.17.22) (00221211xD58B3) - this is the provider contract template utilized for this subcontractor.\n2. Final 2023 Delegated for Credentialing Agreement_Group_v2_5.11.23_CLEAN - this is credentialing only delegation agreement approved during operational readiness submission. The delegation agreement has been revised in 2024."]
["CalOptima Health","S25","UC San Diego Medical Group","Administrative Subcontractor","Orange","Sonia Paunovic, CPCS, Credentialing Manager ","EmaiL: XXXX\nTelephone: XXXX",null,"Provider Credentialing","N/A","200 W. Arbor Drive","MC 8821","San Diego",92103,0,"N/A","Assists with provider credentialing","N/A","In accordance with CalOptima’s Delegation Agreement and Delegation Oversight Health Network and FDR Annual Audits, Subcontractors and/or Downstream Subcontractors are not permitted to sub-delegate any functions unless the Subcontractor and/or Downstream Subcontractor requests prior permission and receives approval by CalOptima, the Health Network, and/or the FDR. Ultimately, all sub-delegated functions require prior approval by CalOptima.\n\nCalOptima maintains oversight over delegated functions to Subcontractors and Downstream Subcontractors via a variety of methods including but not limited to annual audits, corrective action plans, ongoing monitoring, external audits, and accreditation review, and reporting review.  \n\nApplicable Citations: \n•\tDelegation Agreement. Section 2.c. – Subdelegation (notice and approval requirements for subdelegation)\n•\tDelegation Agreement. Section 4.a. - Rights and Obligations of CalOptima: Oversight (CalOptima oversight of delegated functions) \n•\tDelegation Agreement. Section 6. - Reporting (delegates’ ongoing reporting expectations to CalOptima) \n•\tDelegation Agreement. Schedule D (describes the Delegated Activity, LOB, Delegate Responsibility, CalOptima Responsibility, Reporting, Performance Evaluation, and Remediation for each delegated responsibility, by delegated functional area) ","Assists with provider credentialing","CalOptima has a robust delegation oversight program that includes a detailed annual audit program and ongoing monitoring process to oversee performance of delegated functions on an ongoing basis. CalOptima has a dedicated team of staff in its Delegation Oversight (DO) department responsible for conducting the annual audits of delegated activities and monitoring of Corrective Action Plans (CAPs) stemming from the annual audits. The annual audit process includes an audit of any downstream subcontractor arrangements, if applicable. The DO department maintains a calendar of scheduled audits for the year to ensure audits are conducted annually and completed timely. In addition to the work performed by the DO department, the Subject Matter Experts (SMEs) in CalOptima’s internal divisions related to functions that are delegated also perform ongoing monitoring of delegated activities by reviewing performance metrics and reports submitted the delegates on an ongoing basis. Oversight activities and findings are reported through the Delegation Oversight Committee, which reports up to the Compliance Committee.  ","CalOptima conducts pre-delegation readiness assessments of subcontractors to determine the subcontractor’s ability and capacity to implement and perform delegated activities prior to delegating such activities. The entity must demonstrate its ability and capacity to perform the delegated functions by meeting or exceeding all requirements in the CalOptima Service Agreement and CalOptima Delegation Oversight policies. If unable to meet a standard, the potential subcontractor may be placed on a Corrective Action Plan (CAP) prior to assuming delegated duties. Once a successful pre-delegation readiness assessment has been completed and responsibilities have been delegated to the subcontractor via a signed delegation agreement, CalOptima maintains ongoing oversight of delegated activities via ongoing monitoring and the annual audit process. The pre-delegation readiness assessment and annual audit includes a review of any downstream subcontractor agreements, if applicable. ","All subcontracted delegated entities must agree to the provisions of the CalOptima Delegation Agreement outlined in Attachment H of the agreement between CalOptima and the delegate. Under the Delegation Agreement, the delegate agrees to perform the delegated services in accordance with the responsibilities outlined in Attachment H for CalOptima and its Members assigned to Delegate.\nUnder the agreement the delegate must agree (either itself or through a CalOptima-approved Subcontractor or downstream entity) to provide the delegated services set forth in Schedules A, B, C, and D, of the agreement as applicable, (“Delegated Services”) in accordance with the terms of this Attachment H and Standards and Requirements. Under the agreement the term “Standards and Requirements” means currently applicable NCQA accreditation standards; DHCS, DMHC, CMS requirements; state and federal statutes, regulations, and sub-regulatory requirements; and CalOptima Policies and contractual requirements, including the State Contract.\n\nApplicable Citations: \n•\tDelegation Agreement. Attachment H in its entirety. \n•\tDelegation Agreement. Section 2.c. – Subdelegation (notice and approval requirements for subdelegation)\n•\tDelegation Agreement. Section 4.a. - Rights and Obligations of CalOptima: Oversight (CalOptima oversight of delegated functions) \n•\tDelegation Agreement. Section 6. - Reporting (delegates’ ongoing reporting expectations to CalOptima) \n•\tDelegation Agreement. Schedules A-D (describes the Delegated Activity, LOB, Delegate Responsibility, CalOptima Responsibility, Reporting, Performance Evaluation, and Remediation for each delegated responsibly, by delegated functional area) ","The CalOptima Provider Newsletter, which is distributed monthly, includes a section that outlines changes made to CalOptima Health Policies and Procedures. Additionally, Provider Alerts are distributed with important information for the CalOptima Health provider community. Both are also available on CalOptima.org website, under the Provider section.","Fee For Service","N/A","See attached zipped file, Prof FFS Contract Template subfolder, documents titled:\n1. Professional Contract (KL rev. 03.17.22) (00221211xD58B3) - this is the provider contract template utilized for this subcontractor.\n2. Final 2023 Delegated for Credentialing Agreement_Group_v2_5.11.23_CLEAN - this is credentialing only delegation agreement approved during operational readiness submission. The delegation agreement has been revised in 2024."]

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["Subcontractor ID # ","Downstream Subcontractor ID #"," Downstream Subcontractor Name ","Applicable County(ies)","Downstream Subcontractor Key Personnel (Previously Compliance Officer)","Downstream Subcontractor Key Personnel Contact Information (Previously Compliance Contact Information)","Type of Downstream Subcontractor","Delegated Function(s)\n(Previously one field. Now split into three different columns)",null,null,"Address1","Address2","City","ZIP","% of Total Medi-Cal Managed Care Members Assigned","Proportion of Capitated Rates at Risk","Justification of Subcontractor Agreement or Downstream Subcontractor Agreement","Pre-Existing Relationships","Sub-Delegation","Impact on Contractor","Contractor’s Administrative Capacity to Oversee and Monitor Subcontractor and Downstream Subcontractor","Subcontractor’s and Downstream Subcontractor’s Administrative Capacity","Subcontractor’s and Downstream Subcontractors’ Compliance with Applicable Contractual Provisions","Contractor’s Oversight Policy and Procedures","Financial Arrangement","Other Information","Previously Approved Documents"]
["Assign each Subcontractor a different number using the format S#. Begin with S1 and proceed in numerical order (e.g. S2, S3, etc.)\n\nUse the same number assigned for each Subcontractor in Template A1, Column B. ","Assign a different number to each Downstream Subcontractor using the format DS#. Begin with DS1 and proceed numerically (DS2, DS3, etc.). Restart with DS1 for each separate Subcontractor. ","Name of the Downstream Subcontractor with whom the Subcontractor has a Downstream Subcontractor Agreement; or the name of the Downstream Subcontractor with whom the Subcontractor’s Downstream Subcontractor further delegates functions downstream","County in which Subcontractor is delegated services. ","Name for each of the Downstream Subcontractor’s key personnel who is responsible for ensuring compliance.","Contact information for each of the Downstream Subcontractor’s key personnel who is responsible for ensuring compliance (Email & Telephone Number).","Downstream Fully Delegated Subcontractor, Downstream Partially\nDelegated Subcontractor, Downstream Administrative Subcontractor","Clinical Functions\n\nThe clinical function(s) Contractor is delegating to Subcontractor. Please select all delegated functions. \n\nIf a Downstream Subcontractor is delegated different functions in different counties, please duplicate the Subcontractor entry but specify in each row which functions are delegated in each county.","Administrative Functions\n\nThe administrative function(s) Contractor is delegating to Subcontractor. Please select all delegated functions. \n\nIf a Downstream Subcontractor is delegated different functions in different counties, please duplicate the Subcontractor entry but specify in each row which functions are delegated in each county. ","Administrative - Other\n\nIf 'Other' was selected in Column I, please describe. ","The address of the location of the performance of the Downstream Subcontractor’s functions.",null,null,null,"Percentage of the total Medi-Cal Members assigned to the Downstream Subcontractor, if applicable.","Proportion of total capitated rates for which the Downstream Subcontractor, is at risk, if applicable.","Describe the purpose and the justification of the Subcontractor Agreement or Downstream Subcontractor Agreement.","Describe any pre-existing relationship, including any affiliation, parent entity, or prior existing contract between Contractor and Subcontractor, or Subcontractor and Downstream Subcontractor including the duration of such pre-existing relationship.","Indicate if Subcontractor or Downstream Subcontractor is permitted to sub-delegate any functions. If so, describe how Contractor will maintain oversight over delegated functions to Subcontractors and Downstream Subcontractors. Provide citations to provisions in the Subcontractor Agreement and Downstream Subcontractor Agreement to support Contractor’s assertions.","Describe the impact and benefit, if any, the Subcontractor Agreement or Downstream Subcontractor Agreement will have on Contractor’s operations, administrative capacity, and financial viability.","Describe Contractor’s administrative capacity to oversee and monitor Subcontractor and Downstream Subcontractor as applicable.","Describe Subcontractor’s and Downstream Subcontractor’s administrative capacity to perform each delegated function, including but not limited to Subcontractor’s and Downstream Subcontractor’s capacity to perform quality monitoring and community engagement, if applicable.","Detail how the Subcontractor Agreement and Downstream Subcontractor Agreement complies with, and ensures compliance, with all provisions of the Contract applicable to the delegated functions, including appropriate citations to the provisions in the Subcontractor Agreement and Downstream Subcontractor Agreement. Please complete Template C (Contract Requirements Grid) in Exhibit J to indicate which provisions are included in the Subcontractor Agreements and Downstream Subcontractor Agreements, as applicable for each Agreement.","Describe how Contractor will inform Subcontractor and Downstream Subcontractors of Contractor’s oversight policies and procedures.","Contractor must include description of any financial arrangements it has with Subcontractor and Downstream Subcontractor.","Include any other information that would assist DHCS in its review of Contractor’s delegated structure.","(Applicable to annual submissions only) If Contractor has previously submitted documentation to DHCS in connection with the Subcontractor Agreement or Downstream Subcontractor Agreement, either through the Request for Proposal (RFP) process or during the term of this Contract, Contractor must provide any such documentation.\n\nPlease submit any previously approved supplemental documentation with this completed Exhibit. Below, please indicate the title of the supplemental file along with a brief description of its contents. "]
["S1  ","DS1","AltaMed Health Services Corporation (AHSC)","Orange","Jerry Jackson","EmaiL: XXXX\nTelephone: XXXX","Downstream Administrative Subcontractor",null,"Other, Claims Processing, Provider Credentialing, Utilization Management","Provider Contracting","2040 Camfield Ave",null,"Los Angeles",90040,8.3000000000000004E-2,1,"By delegating tasks to AHSC, AHN can manage resources more effectively, focusing on core activities while AHSC handles specialized or supplementary tasks. By leveraging the expertise and resources of AHSC, the primary contractor can enhance overall project performance and deliver better results to CalOptima.","There was no preexisting relationship between AHN and AHSC in Orange County. ","Except as otherwise limited by the State Contract, the contract between AHSC and AHN and/or AHN policies, and subject to AHN’s prior written approval, AHSC may sub-delegate to an MSO,\nmedical group, and/or IPA administrative functions required of AHSC but shall not absolve AHN of oversight responsibilities. All sub-delegation must be approved by AHN.","Subcontracting to AHSC has lead to more efficient operations of delegated functions, reduced AHN administrative burdens, and improved financial viability through the division of financial responsibilities eff 01/01/2020. ","CalOptima has a robust delegation oversight program that includes a detailed annual audit program and ongoing monitoring process to oversee performance of delegated functions on an ongoing basis. CalOptima has a dedicated team of staff in its Delegation Oversight (DO) department responsible for conducting the annual audits of delegated activities and monitoring of Corrective Action Plans (CAPs) stemming from the annual audits. The annual audit process includes an audit of any downstream subcontractor arrangements, if applicable. The DO department maintains a calendar of scheduled audits for the year to ensure audits are conducted annually and completed timely. In addition to the work performed by the DO department, the Subject Matter Experts (SMEs) in CalOptima’s internal divisions related to functions that are delegated also perform ongoing monitoring of delegated activities by reviewing performance metrics and reports submitted the delegates on an ongoing basis. Oversight activities and findings are reported through the Delegation Oversight Committee, which reports up to the Compliance Committee.  ","AHN has organizational and administrative capacity to provide services to its members though an engaged board of directors, a dedicated management team, and a comprehensive administrative services agreement.  Further, medical management is provided through our contracted medical networks to ensure that medical decisions are rendered by qualified medical providers.\n\nThe Plan's medical services team reports to the Chief Medical Officer who ensures all members receive the appropriate medically required services unhindered by financial/administrative decisions and rendered only by qualified, licensed medical staff.  The CMO is also precluded from making any such administrative/financial decisions as evidenced by the Plan's conflict of interest policy filed with the Department.","Per AHN- AHSC 2017 contract Article VI Books and Records\nAHN and DMHC have the right to inspect all books and records of AHSC related to this agreement, and AHSC shall maintain and retain all books and records for six 6 years after the date such books and records are created or for a longer period as  required by applicable law. ","The AHN Compliance Department centralizes all communications and all Delegation Oversight activities. The AHN Compliance Department serves as the point of contact for both internal and external issues related to compliance with the applicable statutory and regulatory requirements, accreditation standards, contractual obligations, and AHN policy requirements.","AHN - AHSC signed a Division of Financial Responsibility eff. 01/01/2020 under which AHSC agreed to provide the provision of professional services as well entered into a shared risk pool with AHN for specified services. AHN and AHSC entered into an administrative agreement eff. 01/01/2017 whereby AHN provides AHSC a management fee of 2% of the gross revenue of AHN as reflected in the 2017 contract Article IV Compensation.","The agreement between CalOptima and AHN became effective 11/1/2024. AHSC is an existing AHN delegate which has the administrative capacity to carry out the duties.","N/A"]
["S3  ","DS1","CHOC Physicians Network ","Orange","Michael Weiss","EmaiL: XXXX\nTelephone: XXXX","Downstream Partially Delegated Subcontractor","Cardiology, Family Medicine/Primary Care, Endocrinology, General Surgery, Hematology, HIV/AIDS/Infectious Disease, Anesthesiology, Dermatology, ENT/Otolaryngology, Hospice, Nephrology, Nuclear Medicine, Obstetrics-Gynecology, Oncology, Ophthalmology, Pediatrics, Orthopedic Surgery, Physical Medicine and Rehabilitation, Podiatry, Psychiatry, Radiology, Vision","Other","Credentialing/Recredentialing","1120 W. La Veta Avenue ","Suite 450","Orange  ",92868,0.16200000000000001,1,"All professional (physician and advance practice clinician) services"," Arrangement in effect since 1995 with establishment of delegated health network model","No sub delegation permitted","Arrangement ensures efficient, effective, and coordinated delivery of clinical services","CalOptima has a robust delegation oversight program that includes a detailed annual audit program and ongoing monitoring process to oversee performance of delegated functions on an ongoing basis. CalOptima has a dedicated team of staff in its Delegation Oversight (DO) department responsible for conducting the annual audits of delegated activities and monitoring of Corrective Action Plans (CAPs) stemming from the annual audits. The annual audit process includes an audit of any downstream subcontractor arrangements, if applicable. The DO department maintains a calendar of scheduled audits for the year to ensure audits are conducted annually and completed timely. In addition to the work performed by the DO department, the Subject Matter Experts (SMEs) in CalOptima’s internal divisions related to functions that are delegated also perform ongoing monitoring of delegated activities by reviewing performance metrics and reports submitted the delegates on an ongoing basis. Oversight activities and findings are reported through the Delegation Oversight Committee, which reports up to the Compliance Committee.  ","Oversight of network retained at parent Delegate (CHA)"," Contractual Agreements specify and require continued compliance with all required duties.","Ongoing monitoring and participation in annual DOAA Audit","Capitation and Fee Schedule Agreements","N/A","N/A"]
["S3 ","DS2","Children's Hospital of Orange County","Orange","Kimberly Cripe","EmaiL: XXXX\nTelephone: XXXX","Downstream Administrative Subcontractor",null,"Other","Provider Contracting","1201 W. La Veta Avenue  and \n27700 Medical Center Road",null,"Orange and \nMission Viejo","92868 and \n92691",0.16200000000000001,1,"All institutional services"," Arrangement in effect since 1995 with establishment of delegated health network model","No sub delegation permitted","Arrangement ensures efficient, effective, and coordinated delivery of clinical services","CalOptima has a robust delegation oversight program that includes a detailed annual audit program and ongoing monitoring process to oversee performance of delegated functions on an ongoing basis. CalOptima has a dedicated team of staff in its Delegation Oversight (DO) department responsible for conducting the annual audits of delegated activities and monitoring of Corrective Action Plans (CAPs) stemming from the annual audits. The annual audit process includes an audit of any downstream subcontractor arrangements, if applicable. The DO department maintains a calendar of scheduled audits for the year to ensure audits are conducted annually and completed timely. In addition to the work performed by the DO department, the Subject Matter Experts (SMEs) in CalOptima’s internal divisions related to functions that are delegated also perform ongoing monitoring of delegated activities by reviewing performance metrics and reports submitted the delegates on an ongoing basis. Oversight activities and findings are reported through the Delegation Oversight Committee, which reports up to the Compliance Committee.  ","Oversight of network retained at parent Delegate (CHA)"," Contractual Agreements specify and require continued compliance with all required duties.","Ongoing monitoring and participation in annual DOAA Audit","Capitation and Fee Schedule Agreements","N/A","N/A"]
["S3  "," DS3","Rady Children's Hospital of San Diego","San Diego","Nancy Evans","EmaiL: XXXX\nTelephone: XXXX","Downstream Administrative Subcontractor",null,"Claims Processing, Eligibility Confirmation, Prior Authorizations, Member Complaint and Grievance Resolution, Claims Processing, Eligibility Confirmation, Prior Authorizations, Member Complaint and Grievance Resolution, Utilization Management","N/A","5898 Copley Drive",null,"San Diego",92111,0.16200000000000001,1,"Partial Administrative services"," Arrangement in effect since 1995 with establishment of delegated health network model","No sub delegation permitted","Arrangement ensures efficient, effective, and coordinated delivery of administrative services","CalOptima has a robust delegation oversight program that includes a detailed annual audit program and ongoing monitoring process to oversee performance of delegated functions on an ongoing basis. CalOptima has a dedicated team of staff in its Delegation Oversight (DO) department responsible for conducting the annual audits of delegated activities and monitoring of Corrective Action Plans (CAPs) stemming from the annual audits. The annual audit process includes an audit of any downstream subcontractor arrangements, if applicable. The DO department maintains a calendar of scheduled audits for the year to ensure audits are conducted annually and completed timely. In addition to the work performed by the DO department, the Subject Matter Experts (SMEs) in CalOptima’s internal divisions related to functions that are delegated also perform ongoing monitoring of delegated activities by reviewing performance metrics and reports submitted the delegates on an ongoing basis. Oversight activities and findings are reported through the Delegation Oversight Committee, which reports up to the Compliance Committee.  ","Oversight of network retained at parent Delegate (CHA)"," Contractual Agreements specify and require continued compliance with all required duties.","Ongoing monitoring and participation in annual DOAA Audit","Cost plus contractual arrangement","N/A","N/A"]
["S4  ","DS1","Conifer Value-Based Care","Los Angeles","Rosa Chiacchierarelli\nDiane Penn","EmaiL: XXXX\nTelephone: XXXX","Downstream Partially Delegated Subcontractor","ENT/Otolaryngology, Dental Services - Oral Surgery, Hematology","Prior Authorizations, Member Complaint and Grievance Resolution, Eligibility Confirmation, Non-Emergency Transportation, Claims Processing, Care Coordination, Provider Credentialing, Utilization Management","N/A","15821 Ventura Blvd.","Suite 600","Encino",91436,5.1999999999999998E-2,0,"Health Network contracts with sub contractor to provide delegated services that require infrastructure, staffing requirements, training, technology that health network has determined is more efficient to purchase from a sub contractor that is able to scale and provide expertise in the delegated services","Health Network has been contacted with sub contractor since June 1, 2009","No sub delegation permitted","Scale is achieved by optimizing resource allocation, implementing efficient technology and systems, strategically hiring and training new talent as needed, establishing and monitoring key performance indicators, optimizing automation","CalOptima has a robust delegation oversight program that includes a detailed annual audit program and ongoing monitoring process to oversee performance of delegated functions on an ongoing basis. CalOptima has a dedicated team of staff in its Delegation Oversight (DO) department responsible for conducting the annual audits of delegated activities and monitoring of Corrective Action Plans (CAPs) stemming from the annual audits. The annual audit process includes an audit of any downstream subcontractor arrangements, if applicable. The DO department maintains a calendar of scheduled audits for the year to ensure audits are conducted annually and completed timely. In addition to the work performed by the DO department, the Subject Matter Experts (SMEs) in CalOptima’s internal divisions related to functions that are delegated also perform ongoing monitoring of delegated activities by reviewing performance metrics and reports submitted the delegates on an ongoing basis. Oversight activities and findings are reported through the Delegation Oversight Committee, which reports up to the Compliance Committee.  ","Downstream contractor has a dedicated team with extensive expertise in delivering delegated services, established processes for performance monitoring, technology infrastructure to manage workflows efficiently, leaders qualified and experienced in the services. ","Contracts are reviewed by legal and compliance experts to ensure provisions of the agreement meet the required standards.","Contractor communicates oversight policies and procedures to sub contractor through bi-weekly meetings with sub contractor.","Sub contractor is paid a percentage of revenue by contracted to provide delegated services.","N/A","N/A"]
["S6  ","DS1","Calibrated Healthcare","Orange","Jovita Montes De Oca","EmaiL: XXXX\nTelephone: XXXX","Downstream Administrative Subcontractor",null,"Other","Data lift from claims images for OCR and convent/generate ANSI 837 files to import into processing system","Empire Towers LCC\n3633 Inland Empire","# 301","Ontario",91764,2.8000000000000001E-2,"N/A","Data lift from claims images for OCR and convert/generate ANSI 837 files to import into processing system","N/A","N/A","Provides process for  health network to be compliant with EDI requirements in the generation of ANSI 837 files","CalOptima has a robust delegation oversight program that includes a detailed annual audit program and ongoing monitoring process to oversee performance of delegated functions on an ongoing basis. CalOptima has a dedicated team of staff in its Delegation Oversight (DO) department responsible for conducting the annual audits of delegated activities and monitoring of Corrective Action Plans (CAPs) stemming from the annual audits. The annual audit process includes an audit of any downstream subcontractor arrangements, if applicable. The DO department maintains a calendar of scheduled audits for the year to ensure audits are conducted annually and completed timely. In addition to the work performed by the DO department, the Subject Matter Experts (SMEs) in CalOptima’s internal divisions related to functions that are delegated also perform ongoing monitoring of delegated activities by reviewing performance metrics and reports submitted the delegates on an ongoing basis. Oversight activities and findings are reported through the Delegation Oversight Committee, which reports up to the Compliance Committee.  ","Subcontractor has the capacity to accept the volume of paper claims at 100% that are submitted by providers and ability to perform quality monitoring","*subcontracting arrangement has policies and procedures in place to ensure that patient protected health information (PHI) and other personal information remains secure.\n*subcontracting arrangement prohibits subcontractor’s access to patient data not associated with the Sponsor’s contract with the subcontractor.\n*subcontracting arrangement has policies and procedures in place that allow for immediate termination of the subcontract upon discovery of a significant security breach.\n*subcontracting arrangement includes all required Medicare Parts C & D language (e.g., record retention requirements, compliance with all Medicare Parts C & D requirements, etc.)\n","1.\tAny significant security breach must be reported to Privacy Officer immediately.  A 1:1 meeting between Vendor and Privacy officer shall be scheduled.\n\na.\t Based upon that meeting, corrective action, if required, shall be identified and implemented. \n\nb.\tAll incidents and resolutions shall be reported to the Compliance Officer","Subcontractor is paid an agreed amount per claim","N/A","N/A"]
["S6  ","DS2","Office Ally","Orange","Kaylea Videro","EmaiL: XXXX\nTelephone: XXXX","Downstream Administrative Subcontractor",null,"Other","Health network's clearinghouse for provider electronic claim submission","1300 SE Cardinal Ct","#190","Vancouver, WA",98683,2.8000000000000001E-2,"N/A","Health network's clearinghouse for provider electronic claim submission","N/A","N/A","Provides the clearinghouse portal for providers to submit claims electronically","CalOptima has a robust delegation oversight program that includes a detailed annual audit program and ongoing monitoring process to oversee performance of delegated functions on an ongoing basis. CalOptima has a dedicated team of staff in its Delegation Oversight (DO) department responsible for conducting the annual audits of delegated activities and monitoring of Corrective Action Plans (CAPs) stemming from the annual audits. The annual audit process includes an audit of any downstream subcontractor arrangements, if applicable. The DO department maintains a calendar of scheduled audits for the year to ensure audits are conducted annually and completed timely. In addition to the work performed by the DO department, the Subject Matter Experts (SMEs) in CalOptima’s internal divisions related to functions that are delegated also perform ongoing monitoring of delegated activities by reviewing performance metrics and reports submitted the delegates on an ongoing basis. Oversight activities and findings are reported through the Delegation Oversight Committee, which reports up to the Compliance Committee.  ","Subcontractor has the capacity to accept the volume of electronic claims at 100% that are submitted by providers and ability to perform quality monitoring","*subcontracting arrangement has policies and procedures in place to ensure that patient protected health information (PHI) and other personal information remains secure.\n*subcontracting arrangement prohibits subcontractor’s access to patient data not associated with the Sponsor’s contract with the subcontractor.\n*subcontracting arrangement has policies and procedures in place that allow for immediate termination of the subcontract upon discovery of a significant security breach.\n*subcontracting arrangement includes all required Medicare Parts C & D language (e.g., record retention requirements, compliance with all Medicare Parts C & D requirements, etc.)","1.\tAny significant security breach must be reported to Privacy Officer immediately.  A 1:1 meeting between Vendor and Privacy officer shall be scheduled.\n\na.\t Based upon that meeting, corrective action, if required, shall be identified and implemented. \n\nb.\tAll incidents and resolutions shall be reported to the Compliance Officer","Subcontractor is paid an agreed amount per claim","N/A","N/A"]
["S7  ","DS1","Calibrated Healthcare","Orange","Jovita Montes De Oca ( CEO)","EmaiL: XXXX\nTelephone: XXXX","Downstream Administrative Subcontractor",null,"Claims processing, Eligibility Confirmation, Other","Benefit verification\nEDI Claim Inloads\nProvider Disputes / Adjustments\n","Atelier, Suite – 1, Level – 1| Worldmark 2| Aerocity\nCorporate Office - 3633 Inland Empire Blvd   ","Suite 301","New Delhi| India \nOntario California","110037\n91764",0.20300000000000001,"N/A","Cost effectiveness ","Monarch Health Care / Optum has been contracted with Calibrated Health Care since July of 2007.","Monthly review of Performance Quality Measurements to ensure quality metrics are met by individual staff and CHN. \nBiweekly Conference calls to discuss error trends, training needs, Inventory, quality scores etc. \nException error reports built into work queues to promote payment integrity for identified errors.\nMonthly Training. Focus training by specialty and review of Stand-up meetings.\nMonthly review of OIG screening. CHN will send by the 10th of the following month.\nAnnual review of Calibrated Health Network Policy and Procedures. \nAnnual review/ Approval of Calibrated Annual assessment tool with business operations management team. ","Cost effectiveness ","CalOptima has a robust delegation oversight program that includes a detailed annual audit program and ongoing monitoring process to oversee performance of delegated functions on an ongoing basis. CalOptima has a dedicated team of staff in its Delegation Oversight (DO) department responsible for conducting the annual audits of delegated activities and monitoring of Corrective Action Plans (CAPs) stemming from the annual audits. The annual audit process includes an audit of any downstream subcontractor arrangements, if applicable. The DO department maintains a calendar of scheduled audits for the year to ensure audits are conducted annually and completed timely. In addition to the work performed by the DO department, the Subject Matter Experts (SMEs) in CalOptima’s internal divisions related to functions that are delegated also perform ongoing monitoring of delegated activities by reviewing performance metrics and reports submitted the delegates on an ongoing basis. Oversight activities and findings are reported through the Delegation Oversight Committee, which reports up to the Compliance Committee.  ","Calibrated Health Care  is staffed based on membership for each line of business. If membership increases then Monarch - Optum would contract for additional staffing. ","Calibrated Health Care is not fully delegated. Monarch has oversight in all aspects of the service agreement. Quality and production reports are shared monthly to ensure both quality and production targets are met as outlined in service agreement.\nAnnual review of all  Calibrated Health Care Policies.\nAnnual Assessment  of the delegates performance, including both Compliance with applicable standards and the promotion of the organization's overall goals and objectives for the delegated functions.","Monarch HealthCare /Optum will share oversight polices and procedures during bi weekly conf calls or training sessions as needed. ","Calibrated is paid bi weekly for all billable staff. Invoice(s) are separated by each unit such as Claims, EDI, Benefits etc. Invoice will give breakdown by count of billable staff and bi weekly rates. ","N/A","N/A"]
["S10  ","DS1","Gemini Diversified Services","All states, all counties","Carol Kurtz               ","EmaiL: XXXX\nTelephone: XXXX","Downstream Administrative Subcontractor ",null,"Other","PSV/SVO","10055 Slater Avenue ","#214","Fountain Valley",92708,0,0,"Delegate the administrative functions and primary source verification portions of the credentialing process.","Contract effective 12/1/2019","No sub delegation permitted","Efficiencies and cost savings associated with credentialing verification.","CalOptima has a robust delegation oversight program that includes a detailed annual audit program and ongoing monitoring process to oversee performance of delegated functions on an ongoing basis. CalOptima has a dedicated team of staff in its Delegation Oversight (DO) department responsible for conducting the annual audits of delegated activities and monitoring of Corrective Action Plans (CAPs) stemming from the annual audits. The annual audit process includes an audit of any downstream subcontractor arrangements, if applicable. The DO department maintains a calendar of scheduled audits for the year to ensure audits are conducted annually and completed timely. In addition to the work performed by the DO department, the Subject Matter Experts (SMEs) in CalOptima’s internal divisions related to functions that are delegated also perform ongoing monitoring of delegated activities by reviewing performance metrics and reports submitted the delegates on an ongoing basis. Oversight activities and findings are reported through the Delegation Oversight Committee, which reports up to the Compliance Committee.  ","VSP has capacity and the resources needed to conduct appropriate oversight.  GDS has capacity needed to complete all delegated functions and provide oversight of its work.","Clearly stated in the contract and informed via notification of audit.","Clearly stated in the contract and informed via notification of audit.","Payment is made for services rendered.","N/A","N/A"]

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["Subcontractor or Downstream Subcontractor ID #","Subcontractor or Downstream Subcontractor Name","Exhibit A, Attachment III",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Exhibit E"]
[null,null,"1.0 Organization",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"2.0 Systems and Processes",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"3.0 Provider, Network Providers, Subcontractors, and Downstream Subcontractors",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"4.0 Member",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"5.0 Services - Scope and Delivery",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"6.0 Emergency Preparedness and Response",null,null,null,null,null,"7.0 Operations Deliverables and Requirements","1.0 Program Terms and Conditions"]
[null,null,"1.1 Plan Organization and Administration",null,null,null,null,null,null,null,null,null,null,"1.2 Financial Information",null,null,null,null,null,null,"1.3 Program Integrity and Compliance Program",null,null,null,null,null,null,"2.1 Management Information System",null,null,null,null,null,null,null,null,null,"2.2 Quality Improvement and Health Equity Transformation Program",null,null,null,null,null,null,null,null,null,null,null,null,"2.3 Utilization Management Program",null,null,null,"3.1 Network Provider Agreements, Subcontractor Agreements, Downstream Subcontractor Agreements, and Contractor's Oversight Duties",null,null,null,null,null,null,null,null,null,null,null,"3.2 Provider Relations",null,null,null,null,null,null,null,"3.3 Provider Compensation Arrangements",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"4.1 Marketing",null,"4.2 Enrollments and Disenrollments",null,"4.3 Population Health Management and Coordination of Care",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"4.4 Enhanced Care Management",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"4.5 Community Supports",null,null,null,null,null,null,null,null,null,null,null,null,null,"4.6 Member Grievance and Appeal System",null,null,null,null,null,null,null,null,"5.1 Member Services",null,null,null,null,"\n\n5.2 Network and Access to Care",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"5.3 Scope of Services",null,null,null,null,null,null,null,"5.4 Community Based Adult Services",null,null,null,null,"5.5 Mental Health and Substance Use Disorder Benefits",null,null,null,null,null,"5.6 MOUs with Local Government Agencies, County Programs, and Third Parties",null,null,"6.1 General Guidance","6.2 Business Continuity Emergency Plan","6.3 Member Emergency Preparedness Plan","6.4 California’s Standardized Emergency Management System","6.5 Reporting Requirements During an Emergency","6.6 DHCS Emergency Directives",null,"1.1 Governing Law","1.2 DHCS Guidance ","1.3 Contract Interpretation","1.4 Assignments, Mergers, Acquisitions","1.5 Independent Contractor","1.6 Amendment and Change Order Process","1.7 Delegation of Authority ","1.8 Authority of the State","1.9 Fulfillment of Obligations","1.10 Obtaining DHCS Approval","1.11 Certifications","1.12 Notices","1.13 Term","1.14 Service Area","1.15 Contract Extension","1.16 Termination","1.17 Phaseout Requirements","1.18 Indemnification","1.19 Sanctions","1.20 Liquidated Damages","1.21 Contractor’s Dispute Resolution Requirements","1.22 Inspection and Audit of Records and Facilities","1.23 Confidentiality of Information","1.24 Pilot Projects","1.25 Cost Avoidance and Post-Payment Recovery (PPR) of Other Health Coverage (OHC)","1.26 Third-Party Tort and Workers’ Compensation Liability","1.27 Litigation Support","1.28 Equal Opportunity Employer","1.29 Federal and State Nondiscrimination Requirements","1.30 Discrimination Prohibitions","1.31 Small Business Participation and Disabled Veteran Business Enterprises (DVBE) Reporting Requirements","1.32 Conflict of Interest Avoidance Requirements ","1.33 Guaranty Provision","1.34 Priority of Provisions","1.35 Additional Incorporated Provisions - Proposals","1.36 Miscellaneous Provisions"]
[null,null,"1.1.1 Legal Capacity","1.1.2 Key Personnel Disclosure Form","1.1.3 Conflict of Interest – Current and Former State Employees","1.1.4 Contract Performance","1.1.5 Medical Decisions","1.1.6 Medical Director","1.1.7 Chief Health Equity Officer ","1.1.8 Key Personnel Changes","1.1.9 Administrative Duties/Responsibilities","1.1.10 Member Representation","1.1.11 Diversity, Equity, and Inclusion Training","1.2.1 Financial Viability and Standards Compliance","1.2.2 Contractor’s Financial Reporting Obligations","1.2.3 Independent Financial Audit Reports","1.2.4 Cooperation with DHCS’ Financial Audits","1.2.5 Medical Loss Ratio (MLR) ","1.2.6 Contractor’s Obligations","1.2.7 Community Reinvestment Plan and Report","1.3.1 Compliance Program ","1.3.2 Fraud Prevention Program","1.3.3 Provider Screening, Enrolling, and Credentialing/Recredentialing","1.3.4 Contractor’s Obligations Regarding Suspended, Excluded, and Ineligible Providers and Ineligible Providers","1.3.5 Disclosures","1.3.6 Treatment of Overpayment Recoveries","1.3.7 Federal False Claims Act Compliance and Support","2.1.1 Management Information System Capability","2.1.2 Encounter Data Reporting","2.1.3 Participation in the State Drug Rebate Program","2.1.4 Network Provider Data Reporting","2.1.5 Program Data Reporting","2.1.6 Template Data Reporting ","2.1.7 MIS/Data Audits","2.1.8 MIS/Data Correspondence","2.1.9 Tracking and Submitting Alternative Format Selections","2.1.10 Interoperability Application Programming Information System\nRequirements","2.2.1 QIHETP Overview","2.2.2 Governing Board","2.2.3 QIHEC","2.2.4 Provider Participation","2.2.5 Subcontractor and Downstream Subcontractor QI Activities","2.2.6 QIHETP Policies and Procedures","2.2.7 Quality Improvement and Health Equity Annual Plan","2.2.8 NCQA Accreditation  ","2.2.9 External Quality Review (EQR) Requirements ","2.2.10 Quality Care for Children","2.2.11 Skilled Nursing Facilities - Long-Term Care","2.2.12 Disease Surveillance","2.2.13 Credentialing and Recredentialing","2.3.1 Prior Authorizations and Review Procedures","2.3.2 Timeframes for Medical Authorization","2.3.3 Review of Utilization Data","2.3.4 Delegating UM Activities","3.1.1 Overview of Contractor’s Duties and Obligations","3.1.2 DHCS Approval of Network Provider Agreements, Subcontractor Agreements, and Downstream Subcontractor Agreements","3.1.3 Contractor’s Duty to Disclose All Delegated Relationships and to Submit a “Delegation, Oversight, and Compliance Plan”","3.1.4 Contractor’s Duty to Ensure Subcontractor, Downstream Subcontractor, and Network Provider Compliance ","3.1.5 Requirements for Network Provider Agreements, Subcontractor Agreements, and Downstream Subcontractor Agreements","3.1.6 Financial Viability of Subcontractors, Downstream Subcontractors, and Network Providers ","3.1.7 Network Provider Agreements, Subcontractor Agreements, and Downstream Subcontractor Agreements with Federally Qualified Health Centers and Rural Health Clinics","3.1.8 Network Provider Agreements with Safety-Net Providers ","3.1.9 Network Provider Agreements, Subcontractor Agreements, and Downstream Subcontractor Agreements with Local Health Departments","3.1.10 Nondiscrimination in Provider Contracts","3.1.11 Public Records","3.1.12 Requirement to Post","3.2.1 Exclusivity","3.2.2 Provider Dispute Resolution Mechanism","3.2.3 Out-of-Network Provider Relations","3.2.4 Contractor’s Provider Manual","3.2.5 Network Provider Training","3.2.6 Emergency Department Protocols","3.2.7 Prohibited Punitive Action Against the Provider","3.2.8 Submittal of Inpatient Days Information","3.3.1 Compensation and Value Based Arrangements","3.3.2 Capitation Arrangements","3.3.3 Provider Financial Incentive Program Payments","3.3.4 Identification of Responsible Payor","3.3.5 Claims Processing","3.3.6 Prohibited Claims","3.3.7 Federally Qualified Health Center (FQHC), Rural Health Center (RHC), and Indian Health Service (IHS) Facilities","3.3.8 Non-Contracting Certified Nurse Midwife  (CNM), Certified Nurse Practitioner (CNP), and Licensed Midwife (LN)  Providers","3.3.9 Non-Contracting Family Planning Providers","3.3.10 Sexually Transmitted Disease (STD)","3.3.11 HIV Testing and Counseling","3.3.12 Immunizations","3.3.13 Community Based Adult Services (CBAS)","3.3.14 Major Organ Transplants","3.3.15 Long-Term Care Services","3.3.16 Emergency Services and Post-Stabilization Care Services","3.3.17 Provider-Preventable Conditions (PPCs)","3.3.18 Prohibition Against Payment to Excluded Providers","3.3.19 Compliance with Directed Payment Initiatives and Related Reimbursement Requirements","4.1.1 Training and Certification of Marketing Representatives","4.1.2 Marketing Plan","4.2.1 Enrollment ","4.2.2 Disenrollment","4.3.1 Population Health Management (PHM) Program Requirements","4.3.2 Population Needs Assessment (PNA)","4.3.3 Data Integration and Exchange","4.3.4 PHM Service","4.3.5 Population Risk Stratification Segmentation (RSS) and Risk Tiering","4.3.6 Screening and Assessments","4.3.7 Care Management Programs","4.3.8 Basic Population Health Management","4.3.9 Other Population Health Requirements for Children","4.3.10 Transitional Care Services","4.3.11 Targeted Case Management (TCM) Services","4.3.12 Mental Health Services","4.3.13 Alcohol and SUD Treatment Services","4.3.14 California Children’s Services (CCS)","4.3.15 Services for Persons with DD","4.3.16 School-Based Services","4.3.17 Dental","4.3.18 Direct Observed Therapy (COT) for Treatment of Tuberculosis (TB)","4.3.19 Women, Infants, and Children (WIC) Supplemental Nutrition Program","4.3.20 HCBS Waiver Programs","4.3.21 IHSS","4.3.22 Indian Health Services","4.3.23 Justice Involved Reentry Coordination","4.4.1 Contractor’s Responsibilities for Administration of ECM","4.4.2 Populations of Focus for ECM","4.4.3 ECM Providers","4.4.4 ECM Provider Capacity","4.4.5 Model of Care (MOC)","4.4.6 Member Identification for ECM","4.4.7 Authorizing Members for ECM","4.4.8 Assignment to an ECM Provider","4.4.9 Initiating Delivery of ECM","4.4.10 Discontinuation of ECM","4.4.11 Core Service Components of ECM","4.4.12 Data System Requirements and Data Sharing to Support ECM","4.4.13 Oversight of ECM Providers","4.4.14 Payment of ECM Providers","4.4.15 DHCS Oversight of ECM","4.4.16 ECM Quality and Performance Incentive Program","4.5.1 Contractor’s Responsibility for Administration of Community Supports","4.5.2 DHCS Pre-Approved Community Supports","4.5.3 Community Supports Providers","4.5.4 Community Supports Provider Capacity","4.5.5 Community Supports Model of Care (MOC)","4.5.6 Identifying Members for Community Supports","4.5.7 Authorizing Members for Community Supports and Communication of Authorization Status","4.5.8 Referring Members to Community Supports Providers for Community Supports","4.5.9  Data System Requirements and Data Sharing to Support Community Supports","4.5.10 Oversight of Community Supports Providers","4.5.11 Delegation of Community Supports Administration to Subcontractors and Downstream Subcontractors","4.5.12 Payment of Community Supports Providers","4.5.13 DHCS Oversight of Community Supports","4.5.14 Community Supports Quality and Performance Incentive Program","4.6.1 Grievance and Appeal Program Requirements","4.6.2 Grievance Process","4.6.3 Discrimination Grievances","4.6.4 Notice of Action","4.6.5 Appeal Process","4.6.6 Responsibilities in Expedited Appeals","4.6.7 State Fair Hearings and Independent Medical Reviews","4.6.8 Continuation of Services Until Appeal and State Fair Hearing Rights Are Exhausted","4.6.9 Grievance and Appeal Reporting and Data","5.1.1 Members Rights and Responsibilities","5.1.2 Member Services Staff","5.1.3 Member Information","5.1.4 Primary Care Service Provider Selection","5.1.5 Notices of Action for Denial, Deferral, or Modification of Prior Authorization Requests","5.2.1 Access to Network Providers and Covered Services ","5.2.2 Network Capacity","5.2.3 Network Composition","5.2.4 Network Ratios","5.2.5 Network Adequacy Standards","5.2.6 Access to Emergency Service Providers and Emergency Services","5.2.7 Out-of-Network Access","5.2.8 Specific Requirements for Access to Programs and Covered Services","5.2.9 Network and Access Changes to Covered Services","5.2.10 Access Rights","5.2.11 Cultural and Linguistic Programs and Committees","5.2.12 Continuity of Care for Seniors and Persons with Disabilities","5.2.13 Network Reports","5.2.14 Site Review","5.2.15 Street Medicine","5.3.1 Covered Services","5.3.2 Medically Necessary Services","5.3.3 Initial Health Appointment","5.3.4 Services for Members less than 21 Years of Age","5.3.5 Services for Adults","5.3.6 Pregnant and Postpartum Members","5.3.7 Services for All Members","5.3.8 Investigational Services","5.4.1 Covered Services","5.4.2 Coordination of Care","5.4.3 Required Reports for the CBAS Program","5.4.4 Community Participation","5.4.5 Community Based Adult Services Program Integrity","5.5.1 Mental Health Parity Requirements","5.5.2 Non-specialty Mental Health Services and Substance Use Disorder Services ","5.5.3 Non-specialty Mental Health Services Providers ","5.5.4 Emergency Mental Health and Substance Use Disorder Services ","5.5.5 Mental Health and Substance Use Disorder Services Disputes","5.5.6 No Wrong Door for Mental Health Services","5.6.1 MOU Purpose","5.6.2 MOU Requirements ","5.6.3 MOU Oversight and Compliance"]
["For Subcontractors, use the same # assigned in Template A1, Column B. \n\nFor Downstream Subcontractors, use a combination of the #s assigned in Template A2, Columns A and B (e.g. S1DS2).","Name of the Subcontractor or Downstream Subcontractor with whom Contractor has a Subcontractor Agreement, or with whom the Subcontractor has a Downstream Subcontractor agreement. ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Must not be delegated","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Must not be delegated","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Must not be delegated","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Must not be delegated","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Must not be delegated","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Must not be delegated","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  ","Select \"Yes\" or \"No\" for each delegated function.  "]
["S1","AltaMed Health Network Inc.","Yes","Yes","Yes","Yes","Yes","Yes","Must not be delegated","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Must not be delegated","Yes","Yes","Must not be delegated","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","No","Yes","Yes","Yes","No","No","No","No","No","No","No","No","No","No","No","Must not be delegated","No","No","No","No","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Must not be delegated","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","No","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","No","No","No","Yes","Yes","Yes","Yes","No","No","Yes","Yes","No","No","No","No","No","Yes","Yes","Yes","Yes","Yes","No","No","No","Yes","Yes","No","No","No","No","No","No","No","No","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","No","Yes","No","No","No","Yes","No","No","No","No","No","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","No","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","No","No","No","No","No","No","No","No","No","No","No","No","No","No","Yes","No","No","No","No","No","No","Yes","Yes","No","No","Yes","No","Must not be delegated","No","No","No","Yes","No","No","No","No","No","Yes","Yes","No","No","No","Yes","Yes","No","Yes","Yes","Yes","Yes","Yes","Yes","No","Yes","No","No","No","Yes"]
["S2","AMVI Care ","Yes","Yes","Yes","Yes","Yes","Yes","Must not be delegated","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Must not be delegated","Yes","Yes","Must not be delegated","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","No","Yes","Yes","Yes","No","No","No","No","No","No","No","No","No","No","No","Must not be delegated","No","No","No","No","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Must not be delegated","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","No","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","No","No","No","Yes","Yes","Yes","Yes","No","No","Yes","Yes","No","No","No","No","No","Yes","Yes","Yes","Yes","Yes","No","No","No","Yes","Yes","No","No","No","No","No","No","No","No","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","No","Yes","No","No","No","Yes","No","No","No","No","No","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","No","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","No","No","No","No","No","No","No","No","No","No","No","No","No","No","Yes","No","No","No","No","No","No","Yes","Yes","No","No","Yes","No","Must not be delegated","No","No","No","Yes","No","No","No","No","No","Yes","Yes","No","No","No","Yes","Yes","No","Yes","Yes","Yes","Yes","Yes","Yes","No","Yes","No","No","No","Yes"]
["S3","CHOC Physicians Network","Yes","Yes","Yes","Yes","Yes","Yes","Must not be delegated","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Must not be delegated","Yes","Yes","Must not be delegated","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","No","Yes","Yes","Yes","No","No","No","No","No","No","No","No","No","No","No","Must not be delegated","No","No","No","No","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Must not be delegated","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","No","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","No","No","No","Yes","Yes","Yes","Yes","No","No","Yes","Yes","No","No","No","No","No","Yes","Yes","Yes","Yes","Yes","No","No","No","Yes","Yes","No","No","No","No","No","No","No","No","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","No","Yes","No","No","No","Yes","No","No","No","No","No","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","No","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","No","No","No","No","No","No","No","No","No","No","No","No","No","No","Yes","No","No","No","No","No","No","Yes","Yes","No","No","Yes","No","Must not be delegated","No","No","No","Yes","No","No","No","No","No","Yes","Yes","No","No","No","Yes","Yes","No","Yes","Yes","Yes","Yes","Yes","Yes","No","Yes","No","No","No","Yes"]
["S4 ","Family Choice Health Services","Yes","Yes","Yes","Yes","Yes","Yes","Must not be delegated","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Must not be delegated","Yes","Yes","Must not be delegated","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","No","Yes","Yes","Yes","No","No","No","No","No","No","No","No","No","No","No","Must not be delegated","No","No","No","No","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Must not be delegated","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","No","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","No","No","No","Yes","Yes","Yes","Yes","No","No","Yes","Yes","No","No","No","No","No","Yes","Yes","Yes","Yes","Yes","No","No","No","Yes","Yes","No","No","No","No","No","No","No","No","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","No","Yes","No","No","No","Yes","No","No","No","No","No","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","No","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","No","No","No","No","No","No","No","No","No","No","No","No","No","No","Yes","No","No","No","No","No","No","Yes","Yes","No","No","Yes","No","Must not be delegated","No","No","No","Yes","No","No","No","No","No","Yes","Yes","No","No","No","Yes","Yes","No","Yes","Yes","Yes","Yes","Yes","Yes","No","Yes","No","No","No","Yes"]
["S5 ","Heritage Provider Network, Inc. ","Yes","Yes","Yes","Yes","Yes","Yes","Must not be delegated","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Must not be delegated","Yes","Yes","Must not be delegated","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","No","Yes","Yes","Yes","No","No","No","No","No","No","No","No","No","No","No","Must not be delegated","No","No","No","No","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Must not be delegated","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","No","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","No","No","No","Yes","Yes","Yes","Yes","No","No","Yes","Yes","No","No","No","No","No","Yes","Yes","Yes","Yes","Yes","No","No","No","Yes","Yes","No","No","No","No","No","No","No","No","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","No","Yes","No","No","No","Yes","No","No","No","No","No","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","No","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","No","No","No","No","No","No","No","No","No","No","No","No","No","No","Yes","No","No","No","No","No","No","Yes","Yes","No","No","Yes","No","Must not be delegated","No","No","No","Yes","No","No","No","No","No","Yes","Yes","No","No","No","Yes","Yes","No","Yes","Yes","Yes","Yes","Yes","Yes","No","Yes","No","No","No","Yes"]
["S6","Noble Mid Orange County","Yes","Yes","Yes","Yes","Yes","Yes","Must not be delegated","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Must not be delegated","Yes","Yes","Must not be delegated","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","No","Yes","Yes","Yes","No","No","No","No","No","No","No","No","No","No","No","Must not be delegated","No","No","No","No","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Must not be delegated","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","No","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","No","No","No","Yes","Yes","Yes","Yes","No","No","Yes","Yes","No","No","No","No","No","Yes","Yes","Yes","Yes","Yes","No","No","No","Yes","Yes","No","No","No","No","No","No","No","No","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","No","Yes","No","No","No","Yes","No","No","No","No","No","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","No","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","No","No","No","No","No","No","No","No","No","No","No","No","No","No","Yes","No","No","No","No","No","No","Yes","Yes","No","No","Yes","No","Must not be delegated","No","No","No","Yes","No","No","No","No","No","Yes","Yes","No","No","No","Yes","Yes","No","Yes","Yes","Yes","Yes","Yes","Yes","No","Yes","No","No","No","Yes"]
["S7 ","Optum","Yes","Yes","Yes","Yes","Yes","Yes","Must not be delegated","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Must not be delegated","Yes","Yes","Must not be delegated","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","No","Yes","Yes","Yes","No","No","No","No","No","No","No","No","No","No","No","Must not be delegated","No","No","No","No","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Must not be delegated","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","No","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","No","No","No","Yes","Yes","Yes","Yes","No","No","Yes","Yes","No","No","No","No","No","Yes","Yes","Yes","Yes","Yes","No","No","No","Yes","Yes","No","No","No","No","No","No","No","No","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","No","Yes","No","No","No","Yes","No","No","No","No","No","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","No","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","No","No","No","No","No","No","No","No","No","No","No","No","No","No","Yes","No","No","No","No","No","No","Yes","Yes","No","No","Yes","No","Must not be delegated","No","No","No","Yes","No","No","No","No","No","Yes","Yes","No","No","No","Yes","Yes","No","Yes","Yes","Yes","Yes","Yes","Yes","No","Yes","No","No","No","Yes"]
["S8","Prospect Health Plan ","Yes","Yes","Yes","Yes","Yes","Yes","Must not be delegated","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Must not be delegated","Yes","Yes","Must not be delegated","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","No","Yes","Yes","Yes","No","No","No","No","No","No","No","No","No","No","No","Must not be delegated","No","No","No","No","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Must not be delegated","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","No","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","No","No","No","Yes","Yes","Yes","Yes","No","No","Yes","Yes","No","No","No","No","No","Yes","Yes","Yes","Yes","Yes","No","No","No","Yes","Yes","No","No","No","No","No","No","No","No","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","No","Yes","No","No","No","Yes","No","No","No","No","No","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","No","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","No","No","No","No","No","No","No","No","No","No","No","No","No","No","Yes","No","No","No","No","No","No","Yes","Yes","No","No","Yes","No","Must not be delegated","No","No","No","Yes","No","No","No","No","No","Yes","Yes","No","No","No","Yes","Yes","No","Yes","Yes","Yes","Yes","Yes","Yes","No","Yes","No","No","No","Yes"]
["S9","United Care Medical Group","Yes","Yes","Yes","Yes","Yes","Yes","Must not be delegated","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Must not be delegated","Yes","Yes","Must not be delegated","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","No","Yes","Yes","Yes","No","No","No","No","No","No","No","No","No","No","No","Must not be delegated","No","No","No","No","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Must not be delegated","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","No","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","No","No","No","Yes","Yes","Yes","Yes","No","No","Yes","Yes","No","No","No","No","No","Yes","Yes","Yes","Yes","Yes","No","No","No","Yes","Yes","No","No","No","No","No","No","No","No","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","No","Yes","No","No","No","Yes","No","No","No","No","No","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","No","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","No","No","No","No","No","No","No","No","No","No","No","No","No","No","Yes","No","No","No","No","No","No","Yes","Yes","No","No","Yes","No","Must not be delegated","No","No","No","Yes","No","No","No","No","No","Yes","Yes","No","No","No","Yes","Yes","No","Yes","Yes","Yes","Yes","Yes","Yes","No","Yes","No","No","No","Yes"]
["S10 ","Vision Service Plan","Yes","Yes","Yes","Yes","Yes","Yes","Must not be delegated","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Must not be delegated","Yes","Yes","Must not be delegated","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","No","Yes","Yes","Yes","No","No","No","No","No","No","No","No","No","No","No","Must not be delegated","No","No","No","No","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Must not be delegated","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","No","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","No","No","No","Yes","Yes","Yes","Yes","No","No","Yes","Yes","No","No","No","No","No","Yes","Yes","Yes","Yes","Yes","No","No","No","Yes","Yes","No","No","No","No","No","No","No","No","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","No","Yes","No","No","No","Yes","No","No","No","No","No","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","No","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","No","No","No","No","No","No","No","No","No","No","No","No","No","No","Yes","No","No","No","No","No","No","Yes","Yes","No","No","Yes","No","Must not be delegated","No","No","No","Yes","No","No","No","No","No","Yes","Yes","No","No","No","Yes","Yes","No","Yes","Yes","Yes","Yes","Yes","Yes","No","Yes","No","No","No","Yes"]
["S1DS1","AltaMed Health Servics Corporation (AHSC)","No","No","No","No","No","No","Must not be delegated","No","No","No","No","No","No","No","No","Must not be delegated","No","No","Must not be delegated","No","Yes","No","No","No","No","No","No","No","No","No","No","No","No","No","No","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Must not be delegated","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","No","No","No","Must not be delegated","Yes","Yes","Yes","Yes","Yes","No","No","No","No","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","No","Yes","Yes","Yes","Yes","Yes","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","Must not be delegated","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No"]
["S3DS1","CHOC Physicians Network","Yes","Yes","Yes","Yes","Yes","Yes","Must not be delegated","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Must not be delegated","Yes","Yes","Must not be delegated","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Must not be delegated","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Must not be delegated","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","No","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","No","No","No","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","No","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Must not be delegated","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes"]
["S3DS2","Children's Hospital of Orange County","Yes","Yes","Yes","Yes","Yes","Yes","Must not be delegated","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Must not be delegated","Yes","Yes","Must not be delegated","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Must not be delegated","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Must not be delegated","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","No","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","No","No","No","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","No","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Must not be delegated","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes"]
["S3DS3","Rady Children's Hospital of San Diego","Yes","Yes","Yes","Yes","Yes","Yes","Must not be delegated","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Must not be delegated","Yes","Yes","Must not be delegated","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Must not be delegated","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Must not be delegated","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","No","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","No","No","No","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","No","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Must not be delegated","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes"]
["S4DS1","Conifer Value-Based Care","No","No","No","No","Yes","No","Must not be delegated","Yes","Yes","No","No","Yes","Yes","No","No","Must not be delegated","No","No","Must not be delegated","No","Yes","Yes","Yes","Yes","No","Yes","Yes","No","Yes","Yes","Yes","No","No","Yes","No","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Must not be delegated","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","No","No","Yes","Yes","Must not be delegated","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","No","Yes","Yes","Yes","Yes","No","No","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","No","Yes","Yes","Yes","Yes","Yes","No","No","No","No","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","No","No","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Yes","No","Yes","Yes","No","No","Yes","Yes","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","Yes","Yes","Yes","Yes","No","Yes","Yes","No","No","No","No","No","No","Must not be delegated","No","No","No","No","No","No","No","No","No","No","No","No","No","Yes","Yes","Yes","No","Yes","No","No","No","No","No","No","No","No","No","No","No"]
["S6DS1","Calibrated Healthcare","No","No","No","No","No","No","Must not be delegated","No","Yes","No","No","No","No","No","No","Must not be delegated","No","No","Must not be delegated","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","Must not be delegated","No","No","No","No","No","No","No","No","No","No","No","No","Must not be delegated","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","Must not be delegated","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No"]
["S6DS2","Office Ally","No","No","No","No","No","No","Must not be delegated","No","Yes","No","No","No","No","No","No","Must not be delegated","No ","No","Must not be delegated","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","Must not be delegated","No","No","No","No","No","No","No","No","No","No","No","No","Must not be delegated","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","Must not be delegated","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No"]
["S7DS1","Calibrated Healthcare","No","No","No","No","No","No","Must not be delegated","No","No","No","No","No","No","No","No","Must not be delegated","No","No","Must not be delegated","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","Yes","Yes","Yes","Yes","Yes","Yes","Yes","Must not be delegated","Yes","Yes","Yes","Yes","Yes","No","No","No","No","No","No","No","Must not be delegated","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","Must not be delegated","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No"]
["S10DS1","Gemini Diversified Services","No","No","No","No","No","No","Must not be delegated","No","No","No","No","No","No","No","No","Must not be delegated","No","No","Must not be delegated","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","Must not be delegated","No","No","No","No","No","No","No","No","No","No","No","No","Must not be delegated","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","Must not be delegated","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No"]
["S11","Telemed 2U","No","No","No","No","No","No","Must not be delegated","No","No","No","No","No","No","No","No","Must not be delegated","No","No","Must not be delegated","No","Yes","Yes","Yes","No","No","Yes","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","Must not be delegated","No","No","No","No","Yes","No","No","No","No","No","No","No","Must not be delegated","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","Yes","Yes","No","No","Yes","No","Must not be delegated","No","No","No","Yes","No","No","No","No","No","Yes","Yes","No","No","No","Yes","Yes","No","Yes","Yes","Yes","Yes","Yes","Yes","No","Yes","No","No","No","Yes"]
["S12","Verisys Corporation","No","No","No","No","No","No","Must not be delegated","No","No","No","No","No","No","No","No","Must not be delegated","No","No","Must not be delegated","No","Yes","Yes","Yes","No","No","Yes","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","Must not be delegated","No","No","No","No","Yes","No","No","No","No","No","No","No","Must not be delegated","Yes","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","No","Yes","Yes","No","No","Yes","No","Must not be delegated","No","No","No","Yes","No","No","No","No","No","No","No","No","No","No","Yes","Yes","No","No","No","No","Yes","Yes","No","No","Yes","No","No","No","No"]
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