B. This disputes clause does not preclude consideration of law questions in connection with decisions provided for in paragraph A above: Provided, that nothing in this contract shall be construed as making final the decision of any administrative official, representative, or board on a question of law. C. Disputes concerning the interpretation or application of Regulations and General Instructions or administrative procedures in connection therewith shall not be subject to the provisions of this Article. In addition, this Article shall not apply to termination of this agreement under Article XXVII, Termination of Agreement. Article XXIII The Appendices A and B attached hereto are a part of this agreement. Article XXIV CONTINUANCE OF FUNCTIONS AND DUTIES UNDER PRIOR AGREEMENT It is understood and agreed that the continuance of performance after June 30, 1975, of any function or duty undertaken under the agreement between the Intermediary and the Secretary pursuant to sections 1816 and 1842 of the Act in effect prior to July 1, 1975, shall be deemed to be performed under and subject to the terms of this agreement. It is further understood and agreed that any subcontract entered into by the Intermediary with the approval of the Secretary the term of which extends beyond June 30, 1975, shall remain in full force and effect until the expiration date thereof except where such subcontract shall be terminated prior to the expiration date in accordance with the provisions thereof or where such subcontract shall require further approval by the Secretary in accordance with paragraph F of Article XV of this agreement. Article XXV This agreement shall begin on July 1, 1975, and end on September 30, 1976. It will automatically be renewed for successive periods of 1 year unless the Intermediary or the Secretary gives written notice of intention not to renew the agreement at least six months before the end of the current period. Article XXVI MODIFICATION OF AGREEMENT A. This agreement may be modified at any time by mutual consent of the parties thereto. B. If the Secretary finds that because of enactment of P. L. 92-603 or any other subsequent legislative changes, modification of this agreement is necessary to carry out the provisions of the Act, as amended, or to perform experiments and demonstration projects pursuant to legislative enactment, he may modify any of the functions, duties, parts thereof, or any other services to be performed by the Intermediary. Prior to any such modification, the Secretary shall afford the Intermediary an opportunity to consult and participate in planning for adjustments which might be necessary and thereafter provide the Intermediary written notice that the modification is to be made within 90 days after a date specified in the notice. C. The Intermediary may enter into arrangements as approved by the Secretary with a Professional Standards Review Organization for purposes of implementation of Title XI of the Act. To the extent that any function or duty of the Intermediary under this agreement is assumed by the Professional Standards Review Organization under the arrangements approved, the Secretary shall waive performance of such function or duty by the Intermediary and will notify the Intermediary in writing of such waiver. D. Within 10 days of receipt of the Secretary's notification provided in paragraph B of this Article, the Intermediary may terminate this agreement upon 90 days written notice to the Secretary, and shall not be required to implement any modification of this agreement provided for in such notification during such 90 day period. E. Any costs referred to in Article XXVII of this agreement, as being applicable if incurred at the termination of this agreement, shall be allowable if incurred in the effectuation of any of the aforementioned provisions. Article XXVII TERMINATION OF AGREEMENT A. This agreement may be terminated at any time by mutual consent of the parties thereto. B. The Intermediary may terminate this agreement at any time upon 180 days notice to the Secretary, to the public, and to its providers of services. C. If the Secretary finds, after 60 days notice and opportunity for hearing to the Intermediary, that: (1) The Intermediary has failed substantially to carry out this agreement, or (2) The Intermediary is carrying out this agreement in a manner inconsistent with the efficient and effective administration of Part A of Title XVIII of the Act, the Secretary may terminate this agreement at any time upon 120 days notice to the Intermediary, to its providers of services, and to the public. D. If this agreement is terminated by the Secretary and/or the Intermediary in any manner provided in this agreement (including non- renewals under Article XXV), any funds advanced to the Intermediary under this agreement which have not been expended or encumbered in accordance with the terms of this agreement prior to the date the agreement was terminated shall be returned to the Secretary and any funds, determined to be due the Secretary or the Intermediary, after the application of Article XIV shall be paid to such party. Prior to final payment under this agreement, the Intermediary shall execute and deliver an assignment to the Secretary, in such form as he may prescribe, of refunds, rebates, credits, or other amounts (including interest thereon) properly allocable to costs for which the Intermediary has been reimbursed under this agreement. In determining the amount due to either party, reimbursable costs shall be determined in accordance with paragraph B of Article XIII. E. Any costs referred to under this Article shall be allowable if incurred in the implementation of any of the aforementioned provisions. AGREEMENT NO. In Witness Whereof, the parties hereby execute this agreement this NOTE: Intermediary, if a corporation, should cause the following certificate to be executed under its corporate seal, provided that the same officer shall not execute both the agreement and the certificate. of said corporation; that said agreement was duly signed for and in behalf of said corporation by authority of its governing body, and is within the scope of corporate powers. (Signature) (CORPORATE SEAL) AGREEMENT The Blue Cross Association (hereinafter referred to as "Intermediary"), has entered into an agreement with the Secretary of Health, Education, and Welfare (hereinafter referred to as "Secretary") to serve as an Intermediary between the Secretary and providers of services under Parts A and B of Title XVIII of the Social Security Act. Article II of that agreement authorizes the Intermediary, with the approval of the Secretary, to enter into subcontracts with other organizations for the performance of some of its functions set forth in Article II of that agreement. Pursuant to the provisions of Article II of that agreement, the Intermediary and (hereinafter referred to as "Plan") agree to the following terms. INDEX TO PLAN SUBCONTRACT AGREEMENT Page No. II Functions and Duties to be Performed by the Plan.. III Functions and Duties to be Performed by the Intermediary. IV Payment for Covered Services..... V Advance of Funds and Transfer of Funds through Letter of Credit.. VI Transfer of Funds, Budgets, and Reimbursement of Administrative Expenses XII Confidential Nature and Limitation on Use of Information and Records... XIII Types of Costs Allowable for Administration of This Agreement XXI Inspection and Evaluation. XXV Modification of Agreement. XXVI Termination of Agreement .. XXVII Continuance of Functions and Duties Under Prior Agreement 17 |