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AZ | CA | CO | CT | FL | FLBH | GA | HIBH | IL | IN | IA | IABH | KS | KY | ME | MD | MA
MABH | MI | MN | MT | NE | NH | NJ | NM | NY | ND | OH | OK | PA | SC | TN | TX | UT | VA | WV

"25. INSURANCE
A certificate of insurance naming the State of Arizona and AHCCCSA as the 'additional insured' must be submitted to AHCCCSA within 10 days of notification of contract award and prior to commencement of any services under this contract. This insurance shall be provided by carriers rated as 'A+' or higher by the A.M. Best Rating Service. The following types and levels of insurance coverage are required for this contract:
a. Commercial General Liability: ...
b. Commercial Automobile Liability: ...
c. Workers Compensation: ...
d. Professional Liability (if applicable): …" Arizona Contract, page 61.

"6.2 ADMINISTRATION/STAFFING
6.2.1 Contract Performance
Contractor will maintain the organization and staffing, for implementing and operating the Contract. Contractor will ensure the following:

A. The organization has an accountable governing body…

C. If the Contractor is a subsidiary organization, the attestation of the parent organization that his Contract will be a high priority to the parent organization, and that the parent organization is committed to supplying any necessary resources to assure full performance of the Contract." California Contract, page 80.

"VI. FINANCIAL STANDARDS AND REPORTING
B. Insurance Requirements
During the performance period of this Contract, and any extension(s) hereof, Contractor agrees that it will keep in force an insurance policy or policies, issued by a company authorized to do business in Colorado, in the minimum amounts specified below...
1. Standard Worker's Compensation and Employers' Liability, as required by State statute including occupational disease, covering all employees on or off the work site, acting within the course and scope of their employment

2. General, Personal Injury, and Automobile Liability, (including bodily injury, personal injury and property damage) minimum coverage...

5. If the contractor is a 'public entity' within the meaning of the Colorado Governmental Immunity Act, CRS 24-10-101, et seq., as amended ('Act'), the Contractor shall at all times during the term of this contract maintain such liability insurance, by commercial policy or self-insurance, as is necessary to meet its liabilities under the Act...

7. Provider Insurance:
a. Physicians participating in the Contractor’s Provider Network shall be independently insured for malpractice, in an amount equal to a minimum of $0.5 million per incident and $1.5 million in aggregate per year.
b. Facilities participating in the Contractor’s Provider Network shall be insured for malpractice, in an amount equal to a minimum of $0.5 million per incident and $3.0 million in aggregate per year.
c. Provisions (a) and (b) of this section above shall not apply to physicians and facilities in the Contractor’s network which:
i. are public entities or employees pursuant to the Colorado Governmental Immunity Act...
ii. maintain any other security acceptable to the Colorado Commissioner of Insurance, which may include approved plans of self-insurance...

C. The Contractor shall meet the solvency standards set forth at 10 CCR 2050-10, § 8.205.31." Colorado Contract, pages 25-27.

"L. Conflict of Interest...
During the performance period of this Contract the Contractor shall not enter any third party relationship that gives the appearance of creating a conflict of interest. Upon learning of an existing appearance of a conflict of interest situation, the Contractor shall submit to the Department a full disclosure statement setting forth the details that create the appearance of a conflict of interest. Failure to promptly submit a disclosure statement required by this paragraph shall constitute grounds for the State's termination, for cause, of its Contract with the Contractor." Colorado Contract, page 31.

"3.30 Marketing Requirements
a. The MCO shall not distribute, directly or indirectly through any employee, agent or independent contractor, marketing materials that contain false or misleading information.
b. The MCO shall distribute any marketing materials to the entire service area of the MCO...
c. The MCO shall not seek to enroll a Member with the MCO in conjunction with the sale of any other type of insurance.
d. The MCO shall not, directly or indirectly through any employee, agent or independent contractor, engage in any 'cold call' telephone or door-to-door marketing of Members.
e… The MCO shall submit to the DEPARTMENT for prior written approval a marketing plan and all marketing materials…" Connecticut Contract, page 41.

"Appendix H: DSS Marketing Guidelines
DSS Marketing Guidelines
Revised, October 1998...
A. Prohibited Marketing Activities
The following are prohibited marketing activities...
* Asserting of implying that a recipient will lose or not qualify for HUSKY benefits unless he/she enrolls in the organization's plan...
* Discriminating (in marketing or in the course of the enrollment process) against any eligible individual on the basis of health status or need for future health care services.
* Making inaccurate, misleading or exaggerated statements (e.g. about the nature of the eligibility or enrollment process, the positive attributes of the MCO, or about the disadvantages of competing MCOs).
* Door-to-door marketing or enrollment activities to prospective enrollees.
* Failing to submit for approval marketing materials or marketing approaches when such approval is required by DSS (see Section B below)...
* Conducting any form of individual or group solicitation activity other than those expressly permitted under Section B of this document, unless prior approval is obtained from DSS..." Connecticut Contract, Appendix H, pages 1-5.

"12. Marketing Activities. The plan shall be responsible for developing and implementing a written plan designed to solicit enrollment form Medicaid eligible persons and to control the actions of its marketing staff...
a. Market Area...The plan shall not solicit application for enrollment for residents of a service area which is not authorized by the contract.

b. Marketing Practices. The plan is not authorized to make any presentations or engage in any recruitment activities that are not approved, in writing, by the agency.

Violations of any of the policies listed below shall subject the plan to rescission of its authorization to market in all or specific locations, or through any or all methods, as determined by the agency...
(1) The plan is prohibited from engaging in any of the following practices or activities: ...
(a) practices that are discriminatory
(b) activities that could mislead or confuse recipients, or misrepresent the organization, its marketing representatives, or the agency...
(c) Overly aggressive solicitation...
(d) …offers of material or financial gain, other than the health benefits expressed in this contract, provided as an incentive to enroll or remain enrolled
(e) Direct or indirect cold call marketing for solicitation of Medicaid recipients, either by door-to-door, telephone or other, in accordance with Section 4707 of the 1997 Balanced Budget Act, and Section 409.912(18), F.S. ...
(f) Offers of accidental death, dismemberment, disability or life insurance.
(h) ...false or misleading claims that the state or county recommends that a Medicaid recipient enroll with the plan.
(i) ... claims that a Medicaid recipient will lose benefits under the Medicaid program or any other health or welfare benefits to which the recipient is legally entitled, if the recipient does not enroll with the plan.
(j) ... false or misleading claims that the entity is recommended or endorsed by any state or county agency, or by any other organization which has not certified its endorsement in writing to the plan.
(k) ...false or misleading claims that marketing representatives are employees or representatives of the state or county, or of anyone other than the entity or the organization by whom they are reimbursed.
(l) Offers of material or financial gain to any persons soliciting, referring or otherwise facilitating recipient enrollment except for authorized licensed marketing representatives...
(m) Giving away promotional items in excess of a $1.00 retail value to attract attention...
(n) ...marketing Medicaid recipients in state offices unless approved in writing and supervised by the agency and, after choice counseling contract implementation, supervised by its choice counseling contractor, and approved by the affected state agency when solicitation occurs in the office of another state agency...
(o) Marketing face-to-face to assigned members unless the member contacts the plan and requests a marketing interview...
(p) Providing any gift, commission, or any form of compensation to the choice counseling contractor..." Florida Contract, pages 28-30.

"13. Ownership and Management Disclosure. Federal and state laws require full disclosure of ownership, management and control of Medicaid HMOs.

a. Disclosure shall be made on forms prescribed by the agency for the areas of ownership and control interest (42 CFR 455.104 Form HCFA 1513), business transactions (42 DFR 455.105), public entity crimes (section 287.133(3)(a), Florida Statutes), and disbarment suspension (52 Fed. Reg., pages 20260-20369, and Section 4707 of the 1997 Balanced Budget Act.)... In addition, the plan shall submit to the agency full disclosure of ownership and control of Medicaid HMOs at least 60 days before any change in the plan's ownership or control occurs: ...

e. The plan shall submit to the agency, as soon as possible, any information on any officer, director, agent, managing employee, or owner of stock or beneficial interest in excess of five percent of the plan who has been found guilty of, regardless of adjudication, or who entered a plea of no lo contendere or guilty to, any of the offenses listed in Section 435.03F.S., or has a confirmed report of abuse, neglect or exploitation pursuant to part 1 of Chapter 415, F.S..." Florida Contract, pages 60-62.

FLMH

"3.20 Proposal Bond or Proposal Guarantee
Each proposal shall be accompanied by a Proposal Guarantee payable to the agency in the amount of $5,000…The unsuccessful proposers' Proposal Guarantee shall be returned upon execution of a legal contract. If the successful proposer fails to execute a contract within fifteen (15) consecutive calendar days after notification of award, the Proposal Guarantee shall be fortified to the agency…" Florida Mental Health RFP, pages 51-53.

"4.46 Fidelity Bonds
The contractor shall secure and maintain during the life of the resulting contract a blanket fidelity bond from a company doing business in the State of Florida on all personnel in their employment. The bond shall be issued in the amount of at least $250,000 per occurrence., Said bond shall protect the agency from any losses sustained through any fraudulent or dishonest act or acts committed by any employees of the contractor and subcontractors, if any. Proof of coverage must be submitted o the contracting officer within 60 calendar days after execution of the contract and prior to the delivery of mental health care.

4.47 Contractor's Insurance
The contractor shall not commence any work in connection with the contract until he/she has obtained all of the following types of insurance and such insurance has been approved by the agency, nor shall the contractor allow any subcontractor to commence work on a subcontract until all similar insurance required of the subcontractor has been so obtained and approved...

A. Worker's Compensation Insurance…

B. Contractor's Public Liability and Property Damage Insurance
The contractor shall take out and maintain during the life of this agreement COMPREHENSIVE GENERAL LIABILITY AND COMPREHENSIVE AUTOMOBILE LIABILITY INSURANCE as shall protect the contractor form claims for damage for personal injury, including accidental death...

C. Contractor's Fire Insurance...

D. Subcontractor's Public :Liability and Property Damage Insurance…" Florida Mental Health RFP, pages 73-74.

"SECTION 6
TECHNICAL PROPOSAL...
6.010 Transmittal Letter
The transmittal letter must be on an official business letterhead and will be signed by an individual authorized to legally bind the contractor. The transmittal letter must include the following attachments: …
- A statement indicating intent to sign the Drug Free Workplace Certificate;
- A statement by the contractor indicating that the principal officers (President, Vice President, Treasurer, Chairperson of the Board of Directors and other executive officers) nor any individuals with an ownership interest in the entity have been terminated previously from the Medicare program, Medicaid program or have been convicted of Medicare or Medicaid fraud..." Georgia RFP, pages 14-15.

"1.090 Insurance...
The Contractor shall at a minimum prior to the commencement of work, procure the insurance policies identified below at the Contractor's own cost and expense...
* Workers' Compensation Insurance, the policy (ies) to insure the statutory limits established by the General Assembly of the State of Georgia...
* Bodily Injury by Accident $500,000 each accident...
* Commercial General Liability Policy (ies) as follows:
Combined Single Limits: $1,000,000 per person/$3,000,000 per occurrence
The Commercial General Liability Policy must be on an 'occurrence' basis.
* Liability for property damage in the amount of $500,000 including content coverage for all records maintained pursuant to this Contract." Georgia RFP, Appendix E, pages 4-5.

HIBH

"60.910 Wages, Hours and Working Conditions of Employees Providing Services
Services to be performed by the offeror and its subcontractors or providers shall be performed by employees paid at wages or salaries not less than the wages paid to public officers and employees for similar work. Additionally, the offeror shall comply with all applicable laws of Federal and State government relative to workers compensation, unemployment compensation, payment of wages and safety…" Hawaii Behavioral Health RFP, page 70.

"62.200 Insurance
The offeror shall procure and maintain such policies of general liability, professional liability and other insurance as may be necessary to insure its officers, agents and employees against liability for claims or damages due to acts or omissions by the offeror, its officers, agents or employees in the performance of this contract...

The offeror shall also provide DHS with sufficient data to show that the offeror has bonded its key financial personnel for the trustworthiness, honesty and fidelity of the employee." Hawaii Behavioral Health RFP, page 77.

"Article V
Duties of Contractor...
(d) Marketing…
The Contractor agrees to be bound by the following requirements for Marketing: ...
(13) The Contractor shall not engage in any Marketing activities directed at enrolling Beneficiaries who are admitted to any inpatient facilities." Illinois HMO Contract, pages 18-29.

"2.8 PROPOSAL AND PERFORMANCE BONDS
Each offeror shall furnish a proposal bond in the amount of ten thousand dollars ($10,000.00) to guarantee the financial stability of the company, and to guarantee that the offeror is serious in its intent to sign a contract with the State. Proposal bonds will be returned after the contract has been fully executed with the selected vendor(s), or if it is necessary to cancel the procurement. Bonds must be submitted in the form of a cashier's check, certified check, or surety bond as part of the offerors' Business Proposal. If the surety bond is executed, the surety company must be authorized to do business in the State of Indiana as approved by the Indiana Department of Insurance. This surety will be payable to the State Department of Administration in the event that the offeror fails to enter into a contract with the State, if selected by the State to do so.

An offeror will forfeit the proposal bond if the offeror is selected and fails to sign a contract within seven days from receipt of a final contract document." Indiana RFP, pages 2-5.

"6.3.3 Fiscal Soundness
Each MCO must demonstrate fiscal soundness as evidenced by a separate, detailed description of the following: ...
* A fidelity bond or bonds, procured and maintained by the MCO, in an amount fixed by its policymaking body but not less than $100,000 per individual, covering each office and employee entrusted with the handling of its funds.
* Insurance policies or other arrangements, secured and maintained by the MCO or the legal entity and approved by HCFA to insure the MCO against losses arising from professional liability claims, fire, theft, fraud, embezzlement, and other casualty risks." Indiana RFP, page 6-7.

"The HMO shall disclose to the Department the transactions identified below which are expected to exceed the lesser of $25,000 or 5% of the total operating expenses of the HMO and which occur during the term of this Contract:
- any sale, exchange or lease of property between the HMO and a party in interest.
- any lending of money or other extension of credit between the HMO and a party in interest, and
- any furnishing for consideration of goods, services (including management services) or facilities between the HMO and a party of interest. This does not include salaries paid to employees for services provided in the normal course of employment." Iowa Contract, page 16.

"12.2 Insurance
The HMO, and any subcontractors performing the services required under this Contract, shall maintain in effect, with insurance companies authorized to do business in the State of Iowa, at its own expense, insurance covering its work. The insurance shall, among other things, insure against any loss or damage resulting from or related to the HMO's and any subcontractor's performance of this Contract...

Unless otherwise requested by the Department, the HMO, and any subcontractors shall, at its sole cost, obtain the insurance coverage(s) set forth below, each naming the State of Iowa and the Department as additional insured or loss payees, as applicable:

Type of Insurance...Limit...Amount
General Liability…... $2 million
Automobile Liability, including any auto, hired autos and non owned autos…...$1 million
Excess Liability, with Third Party Liability Endorsement…... $2 million
Workers Compensation...As required by Iowa law
Professional Liability Insurance…...$500,000

All insurance policies required by this Contract shall provide coverage for all claims arising from activities occurring during the term of the policy, regardless of the date the claim is filed or expiration of the policy." Iowa Contract, pages 58-59.

IABH

"20.0 INSURANCE
The Contractor shall maintain in effect, with insurance companies of recognized responsibility, at its own expense, insurance of the following types and in the following amounts:

General liability...$1,000,000
Umbrella liability...$10,000,000
Workers compensation...As required by Iowa Law
Professional liability...$1,000,000...

The Contractor shall provide certificates of the required insurance to the Departments...

It shall be the responsibility of the Contractor to keep the respective insurance policies and coverage's current and in force during the life of the Agreement." Iowa Behavioral Health Contract, pages 10-11.

"20.1 FIDELITY BOND
The Contractor shall post a fidelity bond, in the amount of $15,000,000, to provide funds to the Departments in the event that the Departments suffer any liability, loss, damage, or expense as a result of any fraudulent or dishonest act or omission of the Contractor or any subcontractor or any officer, director, employee, or agent of the Contractor or any subcontractor or any parent or subsidiary corporation of the Contractor or any subcontractor related to the procurement of this contract or related to the performance of this contract. The bond shall be to provide funds to the Departments for any fraudulent or dishonest act or omission which occurs during the term of the bond regardless of the date the act or omission is discovered or a claim is made. The bond shall be in effect at all times during the term of the Agreement and for one year following conclusion of the Agreement." Iowa Behavioral Health Contract, page 11.

"B. INSURANCE
The HMO, its successors and assignees shall procure and maintain such insurance as is required by currently applicable federal and state law and regulation. Such insurance should include, but not be limited to, the following:
• liability insurance (general, errors of omissions and directors and officers coverage);
• fidelity bonding of persons entrusted with handling of funds;
• workers compensation;
• unemployment insurance...

C. FINANCIAL SOLVENCY...
The HMO must demonstrate fiscal soundness as evidenced by the following minimum standards:
• Fidelity bonds covering any director, officer, partner, or employee of the HMO who receives, collects, disburses or invests funds in connection with the activities of the HMO and is responsible for such funds in a fiduciary relationship to the HMO. Fidelity bonds must be issued by an insurance company licensed in the State of Kansas and must be for a minimum of $100,000...
• Insurance policies against bodily injury liability, burglary, robbery or theft, whether issued by a stock or mutual company, or other insurer…

For new entities that SRS contracts with, or entities SRS places on probation due to financial difficulties, proforma financial statements shall be required and shall include:
• Descriptions of financing arrangements for operational deficits and for developmental costs if operational one year or less;
• A copy of the most recent unaudited financial statements of the HMO; and
• Financial projections using an accrual accounting system with generally accepted accounting principles for a minimum of three years from the anticipated date of certification and on a monthly basis from the date of certification through one year...

F. DISCLOSURE OF INTERLOCKING RELATIONSHIPS
If the HMO is contracting with SRS to provide services to Medicaid beneficiaries on a capitated or risk basis and is not also a Federally qualified HMO… it must report to SRS… a description of transactions between the HMO and parties in interest…" Kansas General Service, pages 84-88.

"D. DEBARRED INDIVIDUALS Contract Section IXB is amended to add the following language:
MCO agrees it shall not have a director, officer, partner, or person with more that 5% of the entity's equity, or have an employment, consulting, or other agreement with such a person for the provision of items and services that are significant and material to MCO's contractual obligation with the State who has been debarred or suspended by the Federal government." Kansas Contract, Amendment One.

"6.4.2 Ownership...
The Partnership is required to provide full and complete information as to identity of each person or corporation with an ownership or control interest in The Partnership, or any Subcontractor in which The Partnership has a direct or indirect ownership interest of five percent or more...

The Partnership shall provide to the Department full and complete information as to the identity of any person or corporation with ownership or controlling interest in the Partnership , or any subcontractor, of five percent or more by filing a Form MA-1513 within 30 days of any person or corporation acquiring such five percent, whichever date is later." Kentucky RFA, page 17.

"XI. INSURANCE.
A. REQUIRED COVERAGE
Before delivering services under this Contract, the Contractor shall obtain, at its sole expense, from an insurance company duly authorized to do business in Maine, insurance in the minimum coverage levels described below:

1. Workers' Compensation...

2. Professional Liability Insurance. The Contractor shall obtain and maintain, for the duration of this Contract, professional liability insurance in the amount of at least one million dollars ($1,000,000) for each occurrence and three million dollars ($3,000,000) in the aggregate. The
Contractor shall also obtain, pay for, and keep in force for the duration of the contract errors and omissions insurance in the amount of one million dollars ($1,000,000).

3. Liability and Property Damage Insurance." Maine Contract, pages 57-58.

"THE MCO AGREES: …
P. To comply with all provisions of the Balanced Budgets Act of 1997 that apply to this Agreement, including the State Medicaid Director's Letters regarding managed care issued or to be issued in the future. The following letters attached hereto have been issued to date and incorporated by reference:
Section...Subject...Date Issued
4704(a)...Emergency Services...02/20/98
Emergency Services... 05/06/98
Post-Stabilization Care... 08/05/98...

R. Not to knowingly have as a director, officer, partner, or owner of more than five percent (5%) of the entity's equity, a person who is or has been:
1. debarred, suspended, or otherwise excluded from participating in procurement activities under the Federal Acquisition Regulation or from participating in nonprocurement activities under regulations issued pursuant to Executive Order No. 12549 or under guidelines from such an order; or
2. an affiliate of a person described in (1) above..." Maryland Contract, pages 1, 3-4.

"10.06.64.04...
.04 Financial Solvency.
An applicant that is not a certified HMO shall include in its application the following information or descriptions:
A. A table labeled 'Insurance Coverage', specifying the applicant's coverage in insurance types including, but not limited to… medical malpractice, general liability, and fidelity bond, and detailing the:
(1) Carrier,
(2) Entity covered,
(3) Description of coverage including deductibles, coinsurance, and minimum and maximum benefits,
(4) Premium in effect,
(5) Any additional policies to cover new risks associated with anticipated MCO functions, and
(6) Any other pertinent arrangements;

B. Evidence of the applicant's insurance for general liability and medical malpractice in the minimum amounts of $1,000,000 per loss and $3,000,000 in the aggregate…" Maryland COMAR 10.09.64.04

"10.09.65.02...
F. Assurance Against Insolvency.
(1) An MCO shall be actuarially sound." Maryland COMAR 10.09.65.02.

"Section 2.8 Marketing Activity Requirements…
B. Permissible Marketing Activities
The Contractor may engage in only the following Marketing activities, in accordance with the requirements stated in Section 2.8.A.

1. The Contractor may participate in Marketing at community events only in accordance with this section...
2. The Contractor may conduct or participate in Marketing at Contractor sponsored community events only if:
a. The Contractor notifies the Division of scheduled events at least 20 days in advance of such event...
b. A reasonable number of Division staff and representatives from the HBM Program enrollment vendor are invited to attend...
c. The Contractor only distributes MassHealth Marketing materials that have been approved by the Division; and
d. All free samples and gifts offered by the Contractor are available to all Members who attend the community event regardless of their intent to enroll in the Contractor's Plan...

4. The Contractor shall participate in Health Benefit Fairs sponsored by the Division...

5. The Contractor may Market the Contractor's Plan to Members in accordance with Section 2.8.A. above by:
a. Posting written promotional materials at MCO Provider and other sites throughout the Contractor's Service Area...
b. Initiating mailings campaigns, where the Contractor distributes by mail, Marketing materials throughout the Contractor's Service Area to Members who are potential Enrollees.

6. The Contractor may market its MassHealth Plan to Members by television, radio, newspaper and other audio or visual advertising only in accordance with Section 2.8.A. above...

C. Prohibitions on Marketing and Enrollment Activities
The Contractor shall not:
1. Distribute any Marketing material containing false or misleading information.
2. Seek to influence a Member's enrollment in the Contractor's Plan in conjunction with the sale of any other insurance.
3. Directly or indirectly, conduct door-to-door, telephonic, or other "cold call" marketing of enrollment, including any telemarketing to potential Enrollees.
4. Engage in any Marketing activities which could mislead, confuse or defraud Members or Enrollees...
5. Conduct any Marketing activities at Provider sites, including but not limited to
physician offices, community health centers, ancillary service sites, hospitals, or outpatient departments...
6. Offer financial incentives of greater than $30.00 or any life insurance policies to Members or Enrollees of other MCO Plans...
7. Incorporate any costs associated with Marketing or Marketing incentives, special programs or benefits other than MCO Covered Services to Enrollees in the Contractor's MCO Experience Review and Revenue Experience Report...
8. Engage in Marketing activities which target Members on the basis of health status or future need for health care services, or which otherwise may discriminate against individuals eligible for health care services…" Massachusetts Contract, pages 52-55.

"SECTION 5. ADDITIONAL TERMS AND CONDITIONS
Section 5.1 Administration...
G. Disclosure Requirements
The Contractor shall disclose to the Division and to the U.S. Department of Health and Human Services, information on ownership and control, business transactions, and persons convicted of crimes in accordance with 42 CFR Part 455, Subpart B. In addition, the Contractor shall comply with all reporting and disclosure requirements of 42 USC 1396b(m)(4)(A) if the Contractor is not a federally-qualified health maintenance organization under the Public Health Service Act…" Massachusetts Contract, pages 120-121.

MABH

“14. Anti-Boycott Warranty. During the term of this Contract, neither contractor nor any ‘affiliated company’ as hereafter defined, shall participate in or cooperate with an international boycott, as defined in Section 999 (b) (3) and (4) of the Internal Revenue code of 1954, as amended by the Tax Reform Act of 1986, or engage in conduct declared to be unlawful by Sections 2 and 3 of chapter 151E, Massachusetts General Laws. As used herein, an ‘affiliated company’ shall be any business entity of which at least 51% of the ownership interests are directly or indirectly owned by the Contractor or by a person persons or business entities which directly or indirectly own at least 51% of the ownership interests of the Contractor.

15. Certification. By signing below the Contractor certifies under the pains and penalties of perjury that pursuant to M.G.L c.62c, s.49A, the contractor has filed all state tax returns, paid all taxes and complied with all laws of the Commonwealth relating to taxes; and that pursuant to M.G.L c.151 s.19A, the Contractor has compiled with all laws of the Commonwealth relating to contributions and payments in lieu of contributions to the Employment Security System; and pursuant to the provisions of M.G.L c.7A S.6, that the names of all person having a financial interest in the Contract appear below as follows: (This shall not include any person whose financial interest consists of the holding of one percent (1%) or less or the capital stock of a corporation contraction to provide the service herein. Attach additional sheets as necessary.): …

26. Insurance. Unless otherwise provided by law, the Contractor shall provide, maintain and require its subcontractors to provide and maintain all insurance for its employees, including disability, worker’s compensation and unemployment compensation, in accordance with the statutory requirements of any state where work is performed. The contractor shall provide adequate proof of the fulfillment of any of the requirements of this section to the Division within seven (7) days of its receipt of a written request…” Massachusetts MH/SAP Contract, pages 3-5.

“B. Business Requirements
1. The Contractor hereby represents and warrants that the following are true and accurate at all time during this contract:
a. the Contractor is organized primarily for the purpose of administering and coordination the delivery of health care services;
b. the Contractor, its general partners and its parents; subsidiary(ies), and other related organization(s) if any, do not own, operate, manage, contract or otherwise engage in any business with any entity which delivers or manages the delivery of Covered Services listed in Appendix C to this Contract to Enrollees under the Contract…

3. Interests and Related Organizations
a. The Contractor shall have no interest at any time during this Contract that conflicts with the performance of services required under this Contract…” Massachusetts MH/SAP Contract, Appendix A, page 71.

"II-M CONTRACTOR ORGANIZATIONAL STRUCTURE, ADMINISTRATIVE SERVICES, FINANCIAL REQUIREMENTS AND PROVIDER NETWORKS
Organizational Structure...
The Contractor will provide, upon request, a disclosure statement fully disclosing to DCH the nature and extent of any contracts or arrangements between the individuals responsible for the conduct of the Contractor's affairs (of their immediate families or any legal entity in which they or their families have a financial interest exceeding 5% of the stock or assets of the entity) and the Contractor or a provider of other person concerning any financial relationship with the Contractor... Michigan Contract, page 32.

"II-S MARKETING
With the approval of DCH, Contractors are allowed to promote their services to the general population in the community, provided that such promotion and distribution of materials is directed at the population of the entire approved service area.

However, direct marketing to individual Beneficiaries is prohibited. The Contractor may not provide inducements through which compensation, reward, or supplementary benefits or services are offered to Beneficiaries to enroll or to remain enrolled with the Contractor… The following are examples of allowed and prohibited marketing locations and practices:

1. Allowed Marketing Locations/Practices directed at the general population:
*Newspaper articles
*Newspaper advertisements
*Magazine advertisements
*Signs
*Billboards
*Pamphlets
*Brochures
*Radio advertisements
*Television advertisements
*Non capitated plan sponsored events
*Public transportation (i.e. buses, taxicabs)
*Mailings to the general population.

2. Prohibited Marketing Locations/Practices which target individual Beneficiaries:
*Local FIA offices
*Provider offices
*Individual Contractor 'Health Fairs'
*Malls or commercial retail establishments
*Hospitals
*Check cashing establishments
*Door-to-door marketing
*Telemarketing
*Community centers and clinics
*Churches
*Direct mail targeting individual Medicaid Beneficiaries
*WIC clinics." Michigan Contract, pages 46-47.

"Section 3.2.1. Direct Marketing. Except through mailings asset forth below, the HEALTH PLAN, which includes any of its subcontractors, agents, independent contractors, employees and providers, is restricted from direct marketing and promotion to Recipients who are not enrolled in the HEALTH PLAN, including, but not limited to: telephone marketing, face-to-face marketing, promotion, cold-calling, or direct mail marketing. Such mailings shall not contain false or materially misleading information." Minnesota Contract, page 21.

"Section 9.2.13. The HEALTH PLAN shall not have a person described in Section 9.2.12. as a director, officer, partner, or person with beneficial ownership of more than 5 percent of the HEALTH PLAN's equity, nor have an employment, consulting, or other agreement with a person in Section 9.2.12. for the provision of items and services that are significant and material to the HEALTH PLAN's obligation under this Contract." Minnesota Contract, page 86.

"SECTION 12 GENERAL LIABILITY INSURANCE PROVISIONS
A. The CONTRACTOR must maintain, at its cost, primary insurance coverage against contractual liability, claims for injuries to persons, damages to property, or any other liabilities which may arise in the provision of services under the contract...

B. The CONTRACTOR must provide occurrence coverage commercial general liability inclusive of bodily injury, personal injury and property damage with combined single limits of $1,000,000 per claim and $2,000,000 aggregate per year, from an insurer with a Best's Rating of no less than A-.

C. The CONTRACTOR, where appropriate and feasible, must have the State of Montana named as additionally insured under the CONTRACTOR'S policy for liabilities arising out of the provision of services under the contract.

SECTION 13 PROFESSIONAL LIABILITY INSURANCE COVERAGE
A. The CONTRACTOR must maintain, at its cost, professional liability insurance coverage against claims for harm to persons which may arise from the professional services provided through the contract...

B. The CONTRACTOR, must provide occurrence coverage commercial professional liability insurance with combined single limits of $1,000,000 per claim and $2,000,000 aggregate per year, from an insurer with a Best's Rating of no less than A-.

C. The CONTRACTOR, where appropriate and feasible, must have the STATE OF MONTANA named as additionally insured under the CONTRACTOR'S policy for liabilities arising out of the activities performed by or on behalf of the CONTRACTOR…

SECTION 14 FINANCIAL RESPONSIBILITIES OF THE CONTRACTOR...

E. The CONTRACTOR must submit a completed HCFA Section 1318 Financial Disclosure Report and a HCFA Form 1513, Disclosure of Ownership and Control Interest Statement to the DEPARTMENT prior to the initial first time start of the contract." Montana Contract, pages 10-12.

"SECTION 33 PROHIBITING AFFILIATIONS WITH INDIVIDUALS DEBARRED BY FEDERAL AGENCIES

A. The CONTRACTOR may not knowingly:

1. have a person described in subsection B as a director, officer, partner, or person with beneficial ownership of more than 5 percent of the entity's equity, or

2. have an employment, consulting, or other agreement with a person described in subsection B for the provision of items and services that are significant and material to the CONTRACTOR's obligations under its contract with the DEPARTMENT.

B. A person is described in this subsection if such a person:
1. is debarred, suspended, or otherwise excluded from participating in procurement activities under the Federal Acquisition Regulations or from participating in procurement activities under regulations issued pursuant to Executive Order 12549 or under guidelines implementing such order; or

2. is an affiliate of a person described in subsection B.1." Montana Contract, page 24.

"8.24 Assurances Before Termination: If any document or deliverable required pursuant to the contract does not fulfill the requirements of the contract, the plan shall deliver assurances of additional plan resources, if necessary, at no additional cost to the contract, in order to complete the deliverable, and to ensure that other schedules shall not be adversely affected.

8.25 Insolvency: The Department shall obtain from each plan proof of financial solvency, including proof of adequate protection against insolvency...

The Department’s solvency protection requirements for the plan shall provide for protection in both the pre-insolvency and post-insolvency periods. The Department of Insurance is the designated agency for regulating plan solvency, and as such, shall coordinate all activities with the Department…" Nebraska Contract, page 22.

"13.23.1 CLIA Requirements: The laboratories utilized by the plan shall comply with the Clinical Laboratory Improvement Act (CLIA)…

13.37 HIPPA Requirements: The plans shall comply with the Maternity and Mental Health Requirements in the Health Insurance and Portability Act (HIPPA) of 1996 in that the maternity length of stay and mental health parity requirements in HIPPA requires that coverage for a hospital stay following a normal vaginal delivery may generally not be limited to less than forty-eight hours (48) for both the mother and newborn child, and that the health coverage for a hospital stay in connection with childbirth following a cesarean section may generally not be limited to less than ninety-six (96) hours for both the mother and newborn child." Nebraska Contract, pages 86-87.

"Article II
Functions and Duties of Contractor...

2.19 INSURANCE-----To obtain and maintain in force, at its sole expense and require any Subcontractor or Assignee to obtain and maintain in force the following insurance:

Statutory Workmen's Compensation and Employees Liability Insurance for all employees engaged in the performance of the Covered Services; and

Comprehensive general liability insurance against all claims of bodily injuries, death or property damage in amounts not less than $1,000,000 per occurrence and $3,000,000 in the aggregate.

These insurance policies shall be the standard form employed in the State of New Hampshire, issued by underwriters acceptable to the State, and authorized to do business in the State of New Hampshire. Contractor agrees to inform the State of any cancellations or modifications of its insurance policies ten (10) days prior to the effective date of such modification or cancellation." New Hampshire General Service Agreement, page 11.

"Article XIV
Financial Solvency and Related Areas...

14.3 OWNERSHIP AND CONTROLLING INTEREST --- Contractor shall provide the identity of each person with an ownership interest in the Contractor (5% or greater ownership interest) in accordance with 42 CFR 455.101." New Hampshire General Service Agreement, page 41.

"ARTICLE 11
MARKETING...
Direct marketing by the contractor will be limited and only allowed in locations other than the County Welfare Agencies...
11.3 All marketing plans, procedures, presentations, and materials must be accurate and may not mislead, confuse, or defraud either the enrollee, providers or DMAHS...

11.4 With the exception allowed under 11.14, neither the contractor nor its marketing representatives may put into effect a plan under which compensation, reward, gift, or opportunity are offered to eligible enrollees as an inducement to enroll in the contractor's plan other than to offer the health care benefits from the contractor pursuant to this contract...

11.5 The contractor must ensure that marketing representatives are appropriately trained and capable of performing marketing activities in accordance with terms of this contract... and the marketing standards described in Appendix O...

11.7 Under no conditions may a contractor use DMAHS's client/enrollee data base to identify and market its plan to Medicaid eligibles...

11.8 The contractor shall be required to submit to DMAHS for prior written approval a complete marketing plan which adheres to DMAHS's policies and procedures. Written or audio-visual marketing materials, public information releases to be distributed to or prepared for the purpose of informing Medicaid recipients and subsequent revisions thereto and promotional items must be approved by DMAHS prior to their use...

11.10 The contractor must distribute all approved marketing materials throughout all enrollment areas for which it's contracted to provide services...

11.13 Door-to-door canvassing, telephone, telemarketing, or 'cold call' marketing of enrollment activities, by the contractor itself or an agent or independent contractor thereof, are not permitted.
A. EXCEPTION: Contractors are permitted to use telemarketing and direct mailings for marketing purposes to potential enrollees in NJ KidCare - Plans B, C, and D.

11.14 The contractor may offer promotional give-aways that shall not exceed a combined total of $10 to any one individual for marketing purposes." New Jersey Contract, pages 63-67.

"ARTICLE 16
MONITORING AND EVALUATION...
16.4 The contractor shall report ownership and related information to DMAHS at the time of initial contracting with the Department, yearly thereafter, and upon request, to the Secretary of DHHS and the Inspector General of the United States, in accordance with 42 U.S.C. 1320a-3 and 1396b(m)(4)(Sections 1124 and 1903(m)(4) of the Social Security Act) and including any individuals in the contractor's organization that have a five percent (5%) or more controlling ownership or controlling interest in the contractor's organization…" New Jersey Contract, pages 84-86.

"ARTICLE 20
PROVIDER CONTRACTS...
20.7 All provider contracts must obligate the provider to comply with the following items...
E. Financial disclosure clause in accordance with 42 CFR 434, 1903(m) of the Social Security Act…" New Jersey Contract, pages 110-113.

"ARTICLE 21
CONTRACTS AND SUBCONTRACTS
21.1 The contractor shall annually report ownership and related information to DMAHS and, upon request, to the Secretary of HHS and the Inspector General of the United States, in accordance with 42 U.S.C. 1320a-3a and 1396(m)(4)[Sections 1124and 1903(m)(4) of the Social Security Act...

21.5 The contractor must submit full and complete information as to the name and address of each person or corporation with a 5% or more ownership or controlling interest in the contractor's plan, or any subcontractor in which the contractor ahs a 5% or more ownership interest (Section 1903(m)(2)(A) of the Social Security Act...
A. The contractor shall comply with this disclosure requirement through submission of the HCFA -1513 Form whether federally qualified or not.
21.6 If the contractor is not federally qualified, it must disclose to DMAHS information on types of transactions with a 'party in interest' as defined in Section 1318(b) of the Public Health Service Act.
A. All contractor business transactions must be reported. This requirement is not limited to transactions related only to serving the Medicaid enrollees and applies at least to the following transactions:
    1. Any sale, exchange, or leasing of property between the contractor and a 'party in interest';
    2. Any furnishing for consideration of good, services or facilities between the contractor and a 'party in interest'...
    3. Any lending of money or other extension of credit between the contractor and a 'party of interest'.
    4. Transactions or series of transactions during any one fiscal year that are expected to exceed the lesser of $25,000 or five (5) percent of the total operating expenses of the contractor.

B. The information that must be disclosed regarding transaction listed in this Article, Section 21.6A between the contractor and a 'party in interest' includes:
    1. The name of the 'party in interest' for each transaction;
    2. A description of each transaction and the quantity or units involved;
    3. The accrued dollar value of each transaction during the fiscal year; and
    4. The justification of the reasonableness of each transaction.

21.8 The contractor shall not knowingly have a director, officer, partner, or person with beneficial ownership of more than five per cent (5%) of the contractor's equity who has been debarred or suspended from any federal agency...

21.11 The contractor shall submit lists of names, addresses, ownership/control information of participating providers, subcontractors, and individuals or entities…" New Jersey Contract, pages 118-121.

"STANDARDS FOR MARKETING REPRESENTATIVES
A. General Requirements
   1. Only a trained marketing representative of the Contractor's plan who meets the DHS, DOH, and DBI requirements is permitted to market and to enroll prospective Medicaid enrollees...
   2. In those counties where enrollment is voluntary, marketing representatives may not state or imply that enrollment may be made mandatory in the future in an attempt to coerce enrollment.
   3. Door-to-door canvassing is not permitted.
   4. Telemarketing is not permitted...
   8. Marketing representatives may not encourage clients to disenroll from another contractor's plan or assist an enrollee or another plan in completing a disenrollment form from the other plan...

B. Prior Approval of Marketing Materials, Plans, and Activities
1. All marketing materials which will be used by marketing agents for every type of marketing presentation must be prior approved by DMAHS as stated in Article 11 of the Contract...

D. Enrollment Inducements
   1. Marketing representatives and other Contractor's staff are prohibited from offering or giving cash or any other form of compensation to the Medicaid recipient as an inducement or reward for enrolling in the Contractor's plan.
   2. Promotional items, gifts, 'give-aways' for marketing purposes are permitted. However, the combined total of such gifts or gift package may not exceed an amount of $10 to any one individual or family. Such items:
   - must be offered to the general public for marketing purposes whether or not an individual chooses to enroll in the Contractor's plan.
   - may only be given at the time of marketing presentations and may not be a continuous, periodic activity for the same individual, e.g., monthly or quarterly give-aways, as an inducement to remain enrolled.
    - may not be in the form of cash…" New Jersey Contract, pages 225-227.

"2.F.9 The CONTRACT OR. its successors and assignees shall procure and maintain such insurance as is required by currently applicable federal and state law and regulation. Such insurance should include. but not be limited to, the following:
(1) liability insurance for loss. damage, or injury (including death) of third parties arising from acts and omissions on the part of the MCO, its agents and employees:
(2) workers compensation:
(3) unemployment insurance: ..." New Mexico Contract, page 61.

"18. CONTRACTOR REPORTING REQUIREMENTS...
18.6 Ownership and Related Information Disclosure
The Contractor shall report ownership and related information to SDOH and the LDSS, and upon request to the Secretary of Department of Health and Human Services and the Inspector General of Health and Human Services, in accordance with 42 U.S.C. Section 1320a-3 and 1396b(m)(4) (Sections 1124 and 1903(m)(4) of the Federal Social Security Act)...

18.11 Conflict of Interest Disclosure
Contractor shall report to SDOH, in a format specified by SDOH, documentation, including but not limited to the identity of and financial statements of, person(s) or corporation(s) with an ownership or contract interest in the managed care plan, or with any subcontract(s) in which the managed care plan has a 5% or more ownership interest, consistent with requirements of SSA 1903 (m)(2)(a)(viii) and 42 CFR 455.100 455.104." New York Contract, pages 18-1-18-7.

"11. MARKETING
11.1 Marketing Plan
The Contractor shall have a Marketing Plan, that has been prior-approved by the SDOH and/or LDSS, that describes the Marketing activities the Contractor will undertake within the local district during the term of this Agreement.

The Marketing Plan and all marketing activities must be consistent with the Marketing Guidelines which are set forth in Appendix D...

The Marketing Plan shall be kept on file in the offices of the Contractor, LDSS, and the SDOH...

11.2 Marketing Activities
Marketing activities by the Contractor shall conform to the approved Marketing Plan.

11.3 Prior Approval of Marketing Materials, Procedures, Subcontractors
The Contractor shall submit all subcontracts, procedures, and materials related to Marketing to Eligible Persons to the SDOH and/or LDSS for prior written approval…" New York Contract, page 11-1.

"11 INSURANCE
The Contractor shall secure, from an insurance company or government self-insurance pool authorized to do business in this state, professional liability insurance or other coverage in the amount of at least $1,000,000 per claim and at least $3,000,000 per year covering its officers, employees, and agents for services provided under this contract and naming the state of North Dakota, its officers, agents, and employees as an additional insured or covered party...

Contractor's insurance coverage shall be primary (i.e., pay first) as respects any insurance, self-insurance, or self-retention maintained by the state of North Dakota...

The insurance may be in policy or policies of insurance, primary and excess, including the so-called umbrella or catastrophe for, be placed with insurers rated "A" or better by the A.M. Best Company, Inc., and include:
A. Liability insurance (general, automobile, errors and omissions, and directors and officers coverage);
B. Fidelity bonding of persons entrusted with handling of funds;
C. Workers compensation coverage for the Contractor and the Contractor's employees as may be required by N.D.C.C. Title 65, and as it may subsequently be amended, modified, or altered; and
D. Unemployment insurance…

15 FEDERAL REQUIREMENTS AND ASSURANCES
A. The Contractor shall comply with those federal requirements and assurances for recipients of federal grants provided in OMB Standard Form 424B (4-88) which are applicable to the Contractor...
C. The Contractor may not knowingly have an individual who has been debarred, suspended, or otherwise excluded from participating in procurement activities in the following:
- as a director, officer, partner, or person with beneficial ownership of more than 5% of the Con-tractor's equity; or
- have an employment, consulting, or other agreement with such a person for the provision of items and services that are significant to the Contractor's contractual obligation with the state." North Dakota Contract, pages 8-11.

"A. MCP Responsibilities
2. Any MCP which has been terminated from the Medicaid and/or Medicare program or not renewed as a participating provider in the Medicaid program in the two years prior to the issuance of this RFP is ineligible to submit a proposal to ODHS in response to this RFP. If the termination or non-renewal from Medicaid is county-specific, ineligibility for proposal submission applies only to that county." Ohio RFP, page 8.

"2.15 Marketing
2.15.1 General…
Health Plans must comply with the Authority's Marketing Guidelines found at Appendix 5.6 to assure that the marketing plans, procedures and materials are accurate and do not mislead, confuse, or defraud the State or the members…" Oklahoma RFP, page 54.

"SoonerCare Plus Marketing Guidelines…
According to the Balanced Budget Act of 1997 (BBA) managed care entities may not distribute, directly or indirectly, marketing materials without prior state approval and these materials may not contain false or materially misleading information. Plan must not commit marketing fraud and must comply with federal requirements for provision of information, including accurate oral and written information sufficient for the beneficiary to make an informed decision whether or not to enroll. The BBA also allows States to impose sanctions if the managed care entity distributes any marketing materials that contain false or misleading information* [* Health Care Finance Administration (HCFA) February, 20 1998]...

Marketing materials include any material used by the health plan to contact a member...
All materials must be submitted to the Authority for review...

Direct or Indirect Telephonic or Other 'cold-call' Marketing Solicitation

Door-to-Door solicitation is strictly prohibited under the SoonerCare Plus program. It is considered an infraction of the marketing rules if an activity such as this occurs…" Oklahoma RFP, pages 152-154, 161.

"D. MEMBER ENROLLMENT AND DISENROLLMENT...
2. HMO Marketing
Due to the Department's use of Benefits Consultants, the HMO will be prohibited from engaging in direct marketing of their MA managed care program to eligible or potential MA recipients effective the date the department announces the HealthChoices bid awards. The HMO is also prohibited from subcontracting with an outside entity to engage in any direct marketing activities to eligible or potential MA recipients. The HMO may not engage in direct marketing which includes but is not limited to the following locations and activities:
• County Assistance Offices (CAOs)
• Provider offices
• Malls/Commercial or retail establishments
• Hospitals
• Check cashing establishments
• Door-to-door
• Telemarketing
• Community Centers
• Churches
• Direct Mail

The HMO may engage in marketing in the areas listed below. However, all written and oral marketing materials must be prior approved (in writing) by the Department...
• Newspaper articles
• Newspaper advertisements
• Magazine advertisements
• Signs
• Billboards
• Pamphlets
• Brochures
• Radio advertisements
• Television advertisements
• Sponsored events
• Public Transportation (i.e., Buses, Subways, Taxicabs)

The Department will consider permitting an HMO to sponsor community events (i.e., art contents, scholarships programs, school-based writing contests, etc.)...

All marketing plans, procedures, and materials must be accurate and may not mislead, confuse, or defraud either the recipient or the Department.

The HMO may not provide inducements through which compensation, reward, or supplementary benefits or services are offered to eligible persons to enroll or to remain enrolled in the HMO (e.g., money, supplemental benefits)…The HMO will not be permitted to provide incentives to recipients not yet enrolled in their HMO...

Exception: The HMO will be permitted to use health-related incentives prior to the six (6) month enrollment restriction if the health incentives are directly related to the prenatal care or EPSDT activities such as incentives for early prenatal are or child immunizations…" Pennsylvania RFP, pages 20-24.

"2.7 Fidelity Bonds
The Contractor shall secure and maintain during the life of this Contract a blanket fidelity bond from a company doing business in the State of South Carolina on all personnel in its employment...

2.12 Insurance
The Contractor shall maintain, throughout the performance of its obligations under this Contract, a policy or policies of Worker's Compensation insurance with such limits as may be required by law, and a policy or policies of general liability insurance insuring against liability for injury to, and death of, persons and damage to, and destruction of, property arising out of or based upon any act or omission of the Contractor or any of its subcontractors or their respective officers, directors, employees or agents.

2.15 Errors and Omissions Insurance
The Contractor shall obtain, pay for, and keep in force for the duration of the contract period Errors and Omissions insurance, in the amount of at least One Million Dollars ($1,000,000.00), per occurrence." South Carolina Contract, pages 7-10.

"2-3. Benefit/Service Requirements and Limitations...
f. Additional Services and Incentives...
The CONTRACTOR may utilize incentives for prospective enrollees when marketing the CONTRACTOR's plan as a means to entice the prospective enrollee to select one plan over the other. Each type of incentive offered must be specifically approved by TENNCARE prior to implementation. The use of cash incentives shall be specifically prohibited." Tennessee Contract, pages 7-18.

"2-5. Marketing
The CONTRACTOR shall be responsible for developing and implementing a marketing plan designed to solicit enrollment from eligible persons. The CONTRACTOR shall receive written approval from TENNCARE for the marketing plan prior to implementation of any activities...The marketing plan will contain, at a minimum, a plan for the dissemination of materials to potential enrollees, and projections for future enrollment. Marketing materials must be approved prior to their use...TENNCARE reserves the right to notify the CONTRACTOR to discontinue or modify a particular part of the marketing plan or materials. The CONTRACTOR shall submit to TENNCARE, all draft marketing materials to include, including but not limited to: all brochures, posters, fact sheets, billboard ads, magazine and/or newspaper ads and other forms of commercial advertising...

All services listed in the marketing materials must be provided as described and the marketing materials and all accompanying materials must adhere to the following requirements: ...

b. Marketing
1. The CONTRACTOR or anyone acting on its behalf shall not submit enrollment applications or change ballots;
2. The CONTRACTOR shall not engage in marketing practices that mislead, confuse or defraud or that are unfair or deceptive practices or that otherwise violate federal or state consumer protection laws or regulations.
3. Overly aggressive solicitation, such as repeated telephoning or continued recruitment after an offer for enrollment is declined by an enrollee, or similar techniques shall not be tolerated.
4. Offers of material or financial gain as incentives to enroll shall not be allowed; however, increased or additional types of health benefits shall be acceptable.
8. The MCOs shall prohibit the use of independent agents or representatives for the purpose of in person or direct solicitation of persons for enrollment to the MCO. Direct or in person solicitation activities shall be conducted only by full-time or part-time salaried employees of the MCO. Employees may receive bonus payments for exemplary work...The MCO may contract with independent marketing firms, agents, representatives, etc...

c. Marketing Incentives
The CONTRACTOR may promote enrollment in the plan through the use of marketing incentives which TENNCARE determines are reasonable and fair. The CONTRACTOR must specify in its written marketing plan submitted prior to use, the incentives to be used. These incentives, if approved, may include but are not limited to:
1. the guarantee of a primary care provider;
2. greater variety of health care services and benefits than available under the basic TennCare program;
3. greater quantity of health care services than available under the basic TennCare program;
4. coordinated health care; and
5. other incentives proposed by the CONTRACTOR and approved by TENNCARE." Tennessee Contract, pages 32-34.

"2-19. Fidelity Bonds and Insolvency Protection
The CONTRACTOR shall secure and maintain during the life of this Agreement any fidelity bonds and/or insolvency protection required by the Tennessee Department of Commerce and Insurance. Proof of coverage must be submitted to TENNCARE as a deliverable item pursuant to Attachment III of this Agreement within sixty (60) calendar days after execution of this Agreement and prior to the delivery of health care, which ever comes first." Tennessee Contract, page 62.

"4.4 INSURANCE
4.4.1 HMO must maintain, or cause to be maintained, general liability insurance in the amounts of at least $1,000,000 per occurrence and $5,000,000 in the aggregate.

4.4.2 HMO must maintain or require professional liability insurance on each of the providers in its network in the amount of $100,000 per occurrence and $300,000 in the aggregate, or the limits required by the hospital at which the network provider has admitting privileges.

4.4.3 HMO must maintain an umbrella professional liability insurance policy for the greater of $3,000,000 or an amount (rounded to the next $100,000) which represents the number of STAR Members enrolled in HMO in the first month of the contract year multiplied by $150, not to exceed $10,000,000." Texas Contract, page 21.

"C. Marketing and Member Education
1. Approval of Marketing Materials
The Contractor's making plans, procedures and materials will accurate, and may not mislead, confuse, or defraud either Enrollees or the DEPARTMENT. All Medicaid marketing plans, procedures and materials will be reviewed and approved by the DEPARTMENT in consultation with the Medical Care Advisory Committee for Marketing Review before implemented or released by the CONTRACTOR...

a. No Door-to-Door, Telephonic, or 'Cold Call' Marketing
The Contractor cannot, either directly or indirectly, conduct door-to-door, telephonic or 'cold call' marketing of enrollment. These three marketing practices are prohibited whether conducted by the Health Plan itself ('directly') or by an agent or independent contractor ('indirectly')...
b. Distribution of Marketing Materials
Marketing materials must be distributed to the entire Service Area." Utah Contract, Attachment B, page 7.

"A. Federally Required Reports...
2. Disclosure of Ownership and Control Interest Statement
The CONTRACTOR will submit to the DEPARTMENT a copy of the 'Disclosure of Ownership and Control Interest Statement'...prior to the effective date of the Contract and by April 15 of each year thereafter..." Utah Contract, Attachment B, page 42.

"D. Disclosure of Ownership and Control Information
The CONTRACTOR agrees to meet the requirements of 42 CFR 455, Subpart B related to disclosure by the CONTRACTOR of ownership and control information." Utah Contract, Attachment B, page 35.

"K. INSURANCE...
The Contractor shall have the following insurance coverages at the time the Contract is awarded:
1. Professional Liability Insurance for the Contractor's Medical Director...
2. Workers' Compensation...
3. Employer's Liability...
4. Commercial General Liability...
5. Automobile Liability…" Virginia Contract, pages 119-120.

"3.28 Insurance
The Managed Care Plan, its successors and assignees shall procure and maintain such insurance as is required by currently applicable federal and state law and regulation. Such insurance should include, but not be limited to, the following:
* liability insurance for loss, damage, or injury (including death) of third parties arising from acts and omissions on the part of the Managed Care Plan, its agents and employees;
* fidelity bonding of persons entrusted with handling of funds;
* workers compensation; unemployment insurance; and
* other types of protection as specified in Section 3.29, Financial Responsibilities...

Disclosure of Ownership. The Managed Care Plan, as a 'disclosing entity', must supply the Department with full and complete information as to the identity of each person in the Managed Care Plan who has, directly or indirectly, a five percent or more controlling ownership or controlling interest in the Managed Care Plan...The Managed Care Plan is prohibited from having an employment, consulting, or any other agreement with a debarred or suspended person for the provision of items or services that are significant and material to the Managed Care Plan's contractual obligation with the State." West Virginia Contract, pages 27-28.

"5.13 Federal Requirements And Assurances
The Managed Care Plan shall comply with those federal requirements and assurances for recipients of federal grants provided in OMB Standard Form 4248 (4-88) which are applicable to the Managed Care Plan...

The Managed Care Plan shall provide for the compliance of any subcontractors with applicable federal requirements and assurances." West Virginia Contract, page 37.

"6.7 INSURANCE
The Contractor as an independent contractor is solely liable for the acts and omissions of its employees and agents. The successful Contractor shall maintain and furnish proof of coverage of liability insurance for loss, damage, or injury (including death) of third parties arising from acts and omissions on the part of the Contractor, its agents and employees.

Proof of insurance shall be provided by the Contractor at the time the contract is awarded." West Virginia RFA, page 64.