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11/8 . p~..mt\~ mfonnation to an adult indiYWais on their poiicies concerning imp4ementation of these rights . Documenting in the individuafs medicaJ record whether the individual has executed an advance directive . Not conditioning the provision of care or otherwise discriminate against an individual based on whether that individual has executed an advance ditedive . Ensuring co~ance with requirements of state law (whether statutory or as recognized by the courts of1he state) concerning advanCe ditedives at facüities of the provider or organization . Providing for educating staff and the c:ommunity on advance directives . H. To comply with all requirements of the Texas Idedica1Aßimnce Program regulations, rules, handbooks, buUetinS. standards, and guideines pubtished by DHS or its heafth insuring contractor. , l To provide services to Medicaid ~nts in the same mamer and to the same degree and ~ality that these services are provided toO the genera! public. J. That c1aims submitted by me or on my behalf for payment by the Texas Medical Assistance Program shall be for services or items actually provided by me or under my personal supervision. as defined In DHS rules, to the eligible redpient identified as the patient for which I am entitled to payment. I understand 1ha1 payment and satisfaction of such claims wiD be from federal and/or state funds, and that any false claims, statements, documents, or concealment of a material fact. may be prosearted under app~e federal and/or state laws and subject to civil monetary penalty provisions as spedfied in state and federal law. K. To file cost reports as required by the T~as Med."1CaJ Assistance Program within ninety (go) days following the end of the provider's fiscal year or as otherwise spedfied by OtiS. L. To keep the information in the enrollment application o.unmt with the understancfang that the appflCation is hereby made a part of this agreement and to prorJ1)tly report change of address, cha~ In status including but not limited to change in name, change in ownership, loss of license, certification status, or change in Medicare provider status, and 10 notify DHS of any change in ownership information including change of stockholders of corporation status, f"~1 interest or business relationships, if apptica.b1e. M. To maintain the conftdentiaJity of records and other information relating to recipients in accordance with applicable state and federal law. rules, and regulations. ~ N. That this provider agreement may be terminated by either party upon thirty (30) days notice to the other party, except that termination may be earlier for loss of license, certifICation status. conviction of fraud, provider's breach of this agreement. loss of federal or state funds. change of federal or state laws that necessitate reduction or termination of the program or parts thereof, or for any actions or conduct specified in this department's agency rules relating ro grounds for administrative sanctions. Termination of this agreement shall not affed the records retention or access to records requirements under Paragraphs -- A and B above. That at the option of DHS this agreement wIn become Invalid upon change In ownership or cessation of operation as a business entity. O. To refund to the Medicaid program any overpayment, duplicate payment, or erroneous payment to which entitlement is not authorized under the Texas Medicaid program. P . If eligible to participate as a Medicare provider, agree to maintain provider enrollment and participation in the Medicare program as a condition to partidpate in MedicaId. Should Medicare status be terminated, participation in Medicaid may be terrtinated effective the date of Medicare termination. Q. That the recipient must be afforded freedom of choice unless otherwise limited by DHS or its designees in selecting services and/or a provider of services and that acceptance of services rrost be voluntary on the part of the recipient. R. To pay for all reasonable expenses of the Texas Department of Human Services and/or its health insuring contractor, including the costs of counsel Incident to the enfofcement of payment of all my obflgaiions as a Medicaid provider by any action or participation in. or connection with, a case or proceeding under Chapter 7, 11, or 13 of the U.S. Bankruptcy Code, or any successor statute thereto. (Signatu~ //~ 12/14/93 a (Date) Larry D. Gilley (Typed or Printed Name of Official) Rev. 08/92 Citv Manaqer (T rtkI )