Delegated Vendor Information

Thank you for your partnership with Health Partners Plans.

We are committed to fulfilling all Federal and State Compliance Program Requirements related our Medicare Advantage, Medicaid and CHIP products and is required to ensure our contracted partners, also referred to as delegated vendors, fulfill the compliance requirements related to the services they provide.

Please review all content on this webpage to ensure your organization understands and fulfills the Compliance Program Requirements.

 

General Compliance Program and Fraud, Waste and Abuse (FWA) Requirements

Health Partners Plans requires its Delegated Vendors to fulfill the General Compliance Program and FWA Requirements listed below which are monitored through our Delegated Vendor Compliance Attestation processes (see section 2 for Compliance Attestation submission requirements).

Additional details for these requirements are provided in the Delegated Vendor Compliance Guide.

General Compliance Program and FWA Requirements:

1. Code of Business Conduct (COBC)/Compliance Policies and Procedures Distribution (Applies to all HPP Delegated Vendors- Medicare First Tiers, Medicaid and CHIP Subcontractors)

Your organization is required to comply with and distribute the Health Partners Plans Code of Business Conduct and Compliance Program documents provided below or its own materially similar versions to all personnel assigned to perform our services within 90 days of contracting, annually thereafter and upon revision.

Health Partners Plans Code of Business Conduct (COBC) (PDF)

Health Partners Plans Compliance Program (PDF)

 

Medicare Downstream Entity Code of Business Conduct (COBC)/Compliance Policies and Procedures (Applies to Medicare only)

If your organization contracts with downstream entities to perform HPP Medicare Part C or D services, your organization must:

  • Provide HPP's COBC and Compliance Program documents or its own similar versions to its downstream entities within 90 days of hire or contracting, upon revision, and annually thereafter; or
  • Contractually require your downstream entities to have and distribute their own COBC and Compliance Policies and conduct a review of their COBC and Compliance Policies to ensure the content is sufficient.
  • Monitor and audit your downstream entities’ performance to ensure compliance with all applicable CMS requirements and the requirements discussed in this Compliance Guide, HPP’s Code of Business Conduct and Compliance Program document.

 

2. Compliance Attestation and Other Form Requirements

There are certain Compliance Attestations and Forms we require Delegated Vendors to submit to help us monitor their fulfillment of General Compliance and FWA requirements related to our Medicare, Medicaid and CHIP programs.

Please see the table below for the links to the required attestations and forms your organization must submit along with due date timeframes and requirement applicability based on Program and Delegated Vendor types.

 

Form Link Medicaid Subcontractors  CHIP Subcontractors Medicare First Tier Entities Due Date Timeframe 
Newly Contracted Delegated Vendor Compliance Attestation Required Required Required Within 90 days of contracting with HPP
Annual Delegated Vendor Compliance Attestation Required Required Required Within 30 days of HPP notification
Offshore Subcontractor Required Required Required

Within 15 days after Offshore contract signing

*Note: HPP approval for Offshore Subcontracting is required prior to your offshore contract signing. Please obtain approval from HPP prior to submitting this form.
Downstream Entity Not Applicable Not Applicable Required for HPP Medicare First Tier Entities that are not HPP Medicare Network Providers Only. Submit within 90 days of contracting with HPP and when your organization contracts with new downstreams post HPP contracting.
Provider Compliance Attestation Not Applicable Not Applicable Required for HPP Medicare Network Providers Only Within 30 days of HPP notification

 

3. Reporting Non-Compliance and FWA Issues

Please ensure all personnel assigned to perform Health Partners Plans services within your organization and its downstreams (when applicable) know the reporting mechanisms that are available to report non-compliance and FWA issues internally.

Your HPP assigned personnel should know:

  • Their managers and/or direct reports are available to apply their business experience and help with making the right decisions.
  • How to contact your organization's compliance department or general counsel.
  • How to use other reporting methods made available by your organization.

Your organization must also have processes to report non-compliance and FWA issues that impact HPP business to HPP.  

Various mechanisms are in place for reporting concerns directly to HPP, such as:

  • File a report through https://www.jeffersonhealthplans.com/home/about-us/report-compliance/. Reports filed through this webpage will be handled by a third-party vendor on behalf of HPP. An option for anonymous reporting is provided on the webpage.
  • Call the Compliance Hotline - 1-866-477-4848. The hotline is answered by a third-party vendor on behalf of HPP, and is available 24/7. Although you may identify yourself within your report, you will also be afforded the right to remain anonymous. At the end of your report, you will be provided with an ID number that you may also use to call back and receive updates on any investigations.
  • Email compliance concerns to compliance@hpplans.com.
  • Email suspected or actual fraud, waste and abuse concerns to SIUtips@hpplans.com.
  • HIPAA Privacy and Security Complaints can be sent directly to the Privacy Office by emailing PrivacyOfficial@hpplans.com.

 

Additional Information

 

4. Offshore Subcontracting Reporting

If your organization or its downstream or related entities plan to delegate any Jefferson Health Plans Medicare-, Medicaid- or CHIP-related work to an offshore subcontractor, approval from an authorized representative must be obtained prior to delegation.

Our Offshore Subcontractor Attestation form must be submitted within 15 calendar days from the offshore contract signing.

 

5. Employee Screening Requirements

Your organization must ensure that its HPP assigned/contracted personnel, downstream entities and downstream entity personnel do not appear on any of the Federal and/or State exclusion lists shown on the table below. These screenings must be performed prior to hiring or contracting and monthly thereafter.

 

Exclusion Screening Requirements by Program

Exclusion List Medicare  Medicaid and CHIP 

OIG Excluded List-

Department of Health and Human Services (DHHS) Office of Inspector General (OIG) List of Excluded Individuals and Entities

 Pre-hire/contracting & Monthly Pre-hire/contracting & Monthly

SAM Excluded List-

General Service Administration System for Award Management (SAM)

 Pre-hire/contracting & Monthly Pre-hire/contracting & Monthly
XPA Medicheck (State Exclusion List- Required for Medicaid and CHIP personnel only.) Not Applicable Pre-hire/contracting & Monthly

 

6. Medicaid/CHIP FWA Education Requirements

HPP is required to provide our Medicaid and CHIP Delegated Vendors with our written FWA policies to educate them and their HPP Medicaid and CHIP personnel about Healthcare FWA laws including:

  • Federal and State laws regarding false claims, provider prohibited acts, civil or criminal penalties for false claims and statements, and whistleblower protections (including Section 6032 (A) of the Deficit Reduction Act (DRA), 42 U.S.C. § 1396a(a)(68), 62 P.S. §§ 1407 and 1408, and 43 P.S. §§ 1421-1428) and;
  • methods to detect, prevent and report FWA.

 

This information is provided in HPP’s Code of Business Conduct (COBC) and Compliance Program Documents, located in section 1 of this webpage.

To ensure your organization fulfills Medicaid and/or CHIP FWA Education requirements, it must take one or more of the following actions:

  • Comply with and distribute HPP’s Compliance Program Document and Code of Business Conduct documents to all personnel performing HPP Medicaid and/or CHIP services. To meet this requirement, distribution of paper copies is not required, however, your personnel must be made aware of these documents and their location; or
  • Receive and comply with HPP FWA policies contained in our Compliance Program Document and Code of Business Conduct documents and provide your own similar FWA policies and procedures (P&Ps) and/or training to your HPP Medicaid and/or CHIP assigned personnel. If your organization chooses this second option, your FWA P&Ps and/or training content must include detailed information about Healthcare FWA laws including Federal and State laws regarding false claims, provider prohibited acts, civil or criminal penalties for false claims and statements, and whistleblower protections (including Section 6032 (A) of the Deficit Reduction Act (DRA), 42 U.S.C. § 1396a(a)(68), 62 P.S. §§ 1407 and 1408, and 43 P.S. §§ 1421-1428) and methods to detect, prevent and report fraud, waste and abuse.

 

Additional Resources for FWA Education content: Medical Assistance Bulletin 99-07-13.

 

Inquiries

If you have questions regarding the Delegated Vendor information provided on this webpage, please feel free to contact your appropriate HPP representative or email MedicareFDR@hpplans.com.