Health plan — first-tier, downstream and related entity (FDR) agreement; Medicaid network provider agreement (42 CFR 422.503(b)(4)(vi); 42 CFR 438.610)

Exclusion record in place of attestation. At execution and monthly thereafter, Entity shall furnish, or Plan may obtain, a dated read of the HHS-OIG List of Excluded Individuals/Entities, the SAM.gov Exclusions public extract and the Medicaid exclusion or termination list of each state in which Entity furnishes items or services, for Entity's exact legal name and for each employee, governing-body member, contractor and downstream entity Entity engages for work under this agreement, each read carrying the date and time of the read, the source as printed, a SHA-256 of the read and a signature permitting verification without either party. A read showing a row under a name is a row to be examined by Plan, not a determination, and a source that did not answer shall be named as such and shall not be treated as a negative result. This record is in addition to, and does not replace, the attestations and compliance-program obligations required by 42 CFR 422.503(b)(4)(vi), 42 CFR 423.504(b)(4)(vi), 42 CFR 438.608 and 438.610 and the state contract.

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