Community Care is committed to conducting its activities in a manner that complies with all applicable laws and regulations of Medicare Parts A, B or D. As part of an effective compliance program, the Centers for Medicare and Medicaid Services (CMS) requires Community Care to ensure FDRs performing administrative or health care services for Community Care also comply with all applicable laws and regulations. Therefore, Community Care has developed an attestation to validate that each contracted FDR has met CMS requirements.
My organization is contracted with Community Care to provide an administrative or health care function that relates to Community Care’s Medicare Parts A, B, or D contract (s) as established in 42 C.F.R. § 422.504 (i) and the Medicare Managed Care Manual Chapters 9 and 21.
All contracted providers of Medicare Parts A, B or D must complete an annual attestation by January 31, 2021.
Please complete this form by responding yes or no to each statement. If your organization responds no to any question, provide an explanation in the comments box.
I have the authority to attest for my organization, and I attest as follows: