04-B3 State Health Contract - Laserfiche WebLink

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General Provisions, Assurances and Certifications Article, Section 11.01, is revised to include: If appropriate, Contractor certifies that neither the Contractor, nor any individual who has a direct or indirect ownership or controlling interest of 5% or more of the Contracting Agency, nor any officer, director, agent or managing employee (e.g. general manager, business manager, administrator, director, or like individual who exercises operational or managerial control over the Contractor or who directly or indirectly conducts the day-to-day business of the Contractor is an entity or individual who: . Has been convicted of any offense under 42 U.S.C. 9 1320a-7(b)(1)-(3); . Has had a civil monetary penalty assessed under 42 U.S.C. 9 1320a and/or 42 U.S.C.9 1320a-8; or, . Has been excluded from participation in a program under 42 U.S.C. 9 1395 et seq.; or under a State health care program. If the foregoing statement is not true, Contractor shall submit a disclosure/ownership form to DSHS. Contractor shall immediately notify the DSHS in writing, in the event that the foregoing statement changes during the term of this contract Attachment. A false statement regarding Contractor's status will be treated as a material misrepresentation. General Provisions, Operations of Contractor Article, Section 12.19, IS revised to include: Contractor shall notify the Performance Management Unit, Contract Management Branch, of any clinic site information changes, e.g., changes in contact person, hours of operation, address, Texas Provider Identification (TPI) number, and the closure, relocation, and/or opening of clinic site(s). PROGRAM ATTACHMENT - Page 6