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Medica Administrative Manual Home > Special Contracting Requirements > Subcontracting

Subcontracting

How to Initiate Subcontracts: Administrative Requirements (Contracting/Subcontracting)

Process

Providers cannot subcontract for health services without the prior written approval of Medica. A provider that is subcontracted must be a participating provider unless Medica approves in writing a subcontract with a nonparticipating provider.

To establish primary care provider subcontracting:

  • Contact contract manager for current list of subcontract provisions.
  • Unless otherwise indicated in the Media Participation Agreement, capitated clinics or care systems may enter into and maintain subcontracts with, or on behalf of, all clinic providers who are not clinic employees. Medica must approve in writing all forms of clinic subcontracts prior to use by a clinic. A clinic must provide Medica with a satisfactory rationale for subcontracting health services. Medica's approval of the form of clinic subcontracts will not be unreasonably withheld or delayed.

Provisions

Clauses (1) through (7) are referred to as "Required Subcontract Provisions." Medica will provide a list of all Required Subcontract Provisions.

All subcontracts must:

  • Require providers to comply with the terms and conditions of the Medica agreement.
  • Comply with all applicable laws and regulations and all National Committee for Quality Assurance accreditation standards regarding subcontract arrangements, as identified in writing by Medica.
  • Acknowledge Medica as a third-party beneficiary.
  • Reference Medica’s approval authority (though Medica is not required to be a signatory).
  • Acknowledge a provider’s responsibility to comply with the duties of health maintenance organizations and all applicable state and federal requirements.
  • Require at least 125 days’ prior written notice to Medica of any at-will termination of subcontract.
  • Include all other rights, obligations and provisions required by Medica that Medica identifies in writing to the clinic.

All subcontracts entered into after Medica’s written notice of such modifications must include the then current Required Subcontract Provisions. If requested by Medica-within 90 days after receiving from Medica written notice of modifications-the clinic/care system shall amend all subcontracts in effect prior to such written notice from Medica to comply with the then current Required Subcontract Provisions.

Please note: Medica may modify the Required Subcontract Provisions by providing the clinic/care system written notification.


Participation in Review Programs

Medica expects its participating providers and any subcontracted providers to deliver cost-effective, quality care. Providers are required to cooperate fully with Medica's quality assessment and improvement activities, audits and reviews as stated in the Medica Participation Agreement.

Date: 6/20/2019 6:30:59 AM Version: 4.0.30319.42000 Machine Name: PWIVE-CMSWEB01