Common use of Administration and Reporting Clause in Contracts

Administration and Reporting. 1. Demonstration Plan Contract Management: As more fully discussed in Appendix 7, CMS and the State agree to designate representatives to serve on a CMS-State Contract Management Team that shall conduct Demonstration Plan contract management activities related to ensuring access, quality, program integrity, program compliance, and financial solvency. These activities shall include but not be limited to: • Reviewing and analyzing Health Care Effectiveness Data and Information Set (HEDIS) data, Consumer Assessment of Health Care Providers and Systems (CAHPS) Survey data, Health Outcomes Survey (HOS) data, enrollment and disenrollment reports. • Reviewing any other performance metrics applied for quality withhold or other purposes. • Reviewing reports of Enrollee complaints, reviewing compliance with applicable CMS and/or State Medicaid Agency standards, and initiating programmatic changes and/or changes in clinical protocols, as appropriate. • Reviewing and analyzing reports on Demonstration Plans’ fiscal operations and financial solvency, conducting program integrity studies to monitor fraud, waste, and abuse as agreed upon by CMS and the State, and ensuring that Demonstration Plans take corrective action, as appropriate. • Reviewing and analyzing reports on Demonstration Plans’ network adequacy, including the Plans’ ongoing efforts to maintain their networks and to continually enroll qualified providers. • Reviewing any other applicable ratings and measures. • Reviewing reports from the Ombudsman. • Reviewing direct stakeholder input on both plan-specific and systematic performance. • Responding to and investigating beneficiary complaints and quality of care issues.

Administration and Reporting. 1. Demonstration Plan Contract Management: As more fully discussed in Appendix 7, CMS and the State agree to designate representatives to serve on a CMS-State Contract Management Team that shall conduct Demonstration Plan contract management activities related to ensuring access, quality, program integrity, program compliance, and financial solvency. These activities shall include but not be limited to: •  Reviewing and analyzing Health Care Effectiveness Data and Information Set (HEDIS) data, Consumer Assessment of Health Care Providers and Systems (CAHPS) Survey data, Health Outcomes Survey (HOS) data, enrollment and disenrollment reports. •  Reviewing any other performance metrics applied for quality withhold or other purposes. •  Reviewing reports of Enrollee complaints, reviewing compliance with applicable CMS and/or State Medicaid Agency standards, and initiating programmatic changes and/or changes in clinical protocols, as appropriate. •  Reviewing and analyzing reports on Demonstration Plans’ fiscal operations and financial solvency, conducting program integrity studies to monitor fraud, waste, and abuse as agreed upon by CMS and the State, and ensuring that Demonstration Plans take corrective action, as appropriate. •  Reviewing and analyzing reports on Demonstration Plans’ network adequacy, including the Plans’ ongoing efforts to maintain their networks and to continually enroll qualified providers. •  Reviewing any other applicable ratings and measures. •  Reviewing reports from the Ombudsman. •  Reviewing direct stakeholder input on both plan-specific and systematic performance. •  Responding to and investigating beneficiary complaints and quality of care issues.

Administration and Reporting. 1. Demonstration Plan ICO Contract Management: As more fully discussed in Appendix 7, CMS and the State MDCH agree to designate representatives to serve on a CMS-State Contract Management Team that team which shall conduct Demonstration Plan ICO contract management activities related to ensuring access, quality, program integrity, program compliance, and financial solvency. These activities shall include but not be limited to: •  Reviewing and analyzing Health Care Effectiveness Data and Information Set (HEDIS) data, Consumer Assessment of Health Care Providers and Systems (CAHPS) Survey data, Health Outcomes Survey (HOS) data, enrollment and disenrollment reports. •  Reviewing any other performance metrics applied for quality withhold or other purposes. •  Reviewing reports of Enrollee enrollee complaints, reviewing compliance with applicable CMS and/or State Medicaid Agency standards, and initiating programmatic changes and/or changes in clinical protocols, as appropriate. •  Reviewing and analyzing reports on Demonstration PlansICOs’ fiscal operations and financial solvency, conducting program integrity studies to monitor fraud, waste, waste and abuse as may be agreed upon by CMS and the StateMDCH, and ensuring that Demonstration Plans ICOs take corrective action, as appropriate. •  Reviewing and analyzing reports on Demonstration PlansICOs’ network adequacy, including the Plans’ ongoing efforts to maintain replenish their networks and to continually enroll qualified providers. •  Reviewing any other applicable ratings and measures. •  Reviewing reports from the Ombudsman. •  Reviewing direct stakeholder input on both plan-specific and systematic performance. •  Responding to and investigating beneficiary enrollee complaints and quality of care issues.