Common use of Administration/Staffing Clause in Contracts

Administration/Staffing. The Contractor shall provide the functions and positions that shall be staffed by a sufficient number of qualified individuals to adequately provide for the Contractor’s enrollment or projected enrollment. Responsibility for the functions or staff positions may be combined or divided among departments, individuals, or subcontractors. For the purposes of this contract, the Contractor’s Executive Management shall consist of the Executive Director, Finance Director, Medical Director, Pharmacy Director, Dental Director, Behavioral Health Director, Compliance Director and Quality Improvement Director; shall be based in Kentucky; and shall be capable and responsible for oversight of all operations of the Contractor. The Contractor’s staff shall have the following minimum responsibilities: A. A Medical Director, who shall be a physician licensed to practice in Kentucky. The Medical Director shall be actively involved in all major health programs of the Contractor. The Medical director shall also be responsible for treatment policies, protocols, Quality Improvement activities and Utilization Management decisions and devote sufficient time to ensuring timely medical decisions. The Medical Director shall also be available for after-hours consultation, if needed. B. A Dental Director licensed to practice dentistry in Kentucky. The Dental Director shall be actively involved in all oral health programs of the Contractor and devote sufficient time to ensuring timely oral health decisions. The Dental Director shall also be available for after-hours consultation, if needed. C. A Finance Officer, who shall oversee the budget and accounting systems implemented by the Contractor. D. A Member Services function, which coordinates all communications with Members and acts as an advocate for Members. This function shall include sufficient Member Services staff to respond in a timely manner to Members seeking prompt resolution of problems or inquiries. E. A Provider Services function, which coordinates all communications with Contractor Providers and Subcontractors. This function shall include sufficient Provider Services staff to respond in a timely manner to Providers seeking prompt resolution of problems or inquiries. F. A Quality Improvement Director, who shall be responsible for the operation of the Contractor’s Quality Improvement Program and any subcontractors of the Contractor. G. A Behavioral Health Director, who shall be a behavioral health practitioner and actively involved in all programs or initiatives relating to behavioral health. The Behavioral Health Director shall also coordinate efforts to provide behavioral health services by the Contractor or any behavioral health subcontractors. H. A Case Management Coordinator, who shall be responsible for coordination and oversight of case management services and continuity of care for Contractor Members. I. An Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Coordinator, who shall coordinate and arrange for the provision of EPSDT services and EPSDT special services for Members. J. A Xxxxxx Care and Subsidized Adoption Liaison, who shall serve as the Contractor's primary liaison for meeting the needs of Members who are children in xxxxxx care and subsidized adoptive children. K. A Guardianship Liaison, who shall serve as the Contractor's primary liaison for meeting the needs of Members who are adult guardianship clients. L. A Management Information System Director, who shall oversee, manage and maintain the Contractor management information system (MIS). M. A Claims Processing function, which shall ensure the timely and accurate processing of claims, including original claims, corrected claims, and re-submissions, and the overall adjudication of claims, including the timely and accurate submission of Encounter data. N. A Program Integrity Coordinator, who shall be located in Kentucky and coordinate, manage, and oversee the Contractor’s Program Integrity unit to reduce fraud and abuse of Medicaid services. O. A Pharmacy Director, who shall coordinate, manage and oversee the provision of pharmacy services to Members. P. A Compliance Director, who shall maintain current knowledge of Federal and State legislation, legislative initiatives, and regulations relating to Contractors, and oversee the Contractor’s compliance with the laws and requirements of the Department. The Compliance Director shall also serve as the primary contact for and facilitate communications between Contractor leadership and the Department relating to Contract compliance issues. The Compliance Director shall also oversee Contractor implementation of and evaluate any actions required to correct a deficiency or address noncompliance with Contract requirements as identified by the Department. The Contractor shall submit to the Department on an annual basis and upon request by the Department, a current organizational chart depicting all functions including mandatory functions, number of employees in each functional department and key managers responsible for the functions. The Contractor shall notify the Department in writing of any change in the Executive Management within ten (10) business days. The Commonwealth reserves the right to approve or disapprove all key personnel (initial or replacement) prior to their assignment with the Contractor. The Contractor shall ensure that all staff, Providers and Subcontractors have appropriate training, education, experience, liability coverage and orientation to fulfill the requirements of their positions. Contractor shall provide notice to the Department of any changes relating to the personnel of its management staff, including a change in duties or time commitments. Contractor shall assure the adequacy of its administrator’s staffing to properly service the needs of Contractor if changes are proposed in the personnel, duties or time commitments of administrator’s staff from those in place on the Effective Date of each Contract. Contractor shall provide those assurances to the Department before permitting its administrator to implement such changes.

Administration/Staffing. The Contractor shall provide the functions and positions that shall be staffed by a sufficient number of qualified individuals to adequately provide for the Contractor’s enrollment or projected enrollment. Responsibility for the functions or staff positions may be combined or divided among departments, individuals, or subcontractorssubcontractors unless otherwise specified. For the purposes of this contractContract, the Contractor’s Executive Management shall consist of the Executive Director, Finance Director, Medical Director, Pharmacy Director, Dental Director, Behavioral Health Director, Compliance Director and Quality Improvement Director; shall be based in Kentucky; and shall be capable and responsible for oversight of all operations of the Contractor. The Contractor’s staff shall have the following minimum responsibilities: A. A Medical Director, who shall be a physician licensed to practice in Kentucky. The Medical Director shall be actively involved in all major health programs of the Contractor. The Medical director shall also be responsible for treatment policies, protocols, Quality Improvement activities and Utilization Management decisions and devote sufficient time to ensuring timely medical decisions. The Medical Director shall also be available for after-hours consultation, if needed. B. A Dental Director licensed to practice dentistry in Kentucky. The Dental Director shall be actively involved in all oral health programs of the Contractor and devote sufficient time to ensuring timely oral health decisions. The Dental Director shall also be available for after-hours consultation, if needed. C. A Finance Officer, who shall oversee the budget and accounting systems implemented by the Contractor. D. A Member Services function, which coordinates all communications with Members and acts as an advocate for Members. This function shall include sufficient Member Services staff to respond in a timely manner to Members seeking prompt resolution of problems or inquiries. E. A Provider Services function, which coordinates all communications with Contractor Providers and Subcontractors. This function shall include sufficient Provider Services staff to respond in a timely manner to Providers seeking prompt resolution of problems or inquiries. F. A Quality Improvement Director, who shall be responsible for the operation of the Contractor’s Quality Improvement Program and any subcontractors of the Contractor. G. A Behavioral Health Director, who shall be a behavioral health practitioner and actively involved in all programs or initiatives relating to behavioral health. The Behavioral Health Director shall also coordinate efforts to provide behavioral health services by the Contractor or any behavioral health subcontractors. H. A Case Management Coordinator, who shall be responsible for coordination and oversight of case management services and continuity of care for Contractor Members. I. An Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Coordinator, who shall coordinate and arrange for the provision of EPSDT services and EPSDT special services for Members. J. A Xxxxxx Care and Subsidized Adoption Liaison, who shall serve as the Contractor's primary liaison for meeting the needs of Members who are children in xxxxxx care and subsidized adoptive children. K. A Guardianship Liaison, who shall serve as the Contractor's primary liaison for meeting the needs of Members who are adult guardianship clients. L. A Management Information System Director, who shall oversee, manage and maintain the Contractor management information system (MIS). M. A Claims Processing function, which shall ensure the timely and accurate processing of claims, including original claims, corrected claims, and re-submissions, and the overall adjudication of claims, including the timely and accurate submission of Encounter data. N. A Program Integrity Coordinator, who shall be located in Kentucky and coordinate, manage, and oversee the Contractor’s Program Integrity unit to reduce fraud and abuse of Medicaid services. O. A Pharmacy Director, who shall coordinate, manage and oversee the provision of pharmacy services to Members. P. A Compliance Director, who shall maintain current knowledge of Federal and State legislation, legislative initiatives, and regulations relating to Contractors, and oversee the Contractor’s compliance with the laws and requirements of the Department. The Compliance Director shall also serve as the primary contact for and facilitate communications between Contractor leadership and the Department relating to Contract compliance issues. The Compliance Director shall also oversee Contractor implementation of and evaluate any actions required to correct a deficiency or address noncompliance with Contract requirements as identified by the Department. The Contractor shall submit to the Department on an annual basis and upon request by the Department, a current organizational chart depicting all functions including mandatory functions, number of employees in each functional department and key managers responsible for the functions. The Contractor shall notify the Department in writing of any change in the Executive Management within ten (10) business days. The Commonwealth reserves the right to approve or disapprove all key personnel (initial or replacement) prior to their assignment with the Contractor. The Contractor shall ensure that all staff, Providers and Subcontractors have appropriate training, education, experience, liability coverage and orientation to fulfill the requirements of their positions. Contractor shall provide notice to the Department of any changes relating to the personnel of its management staff, including a change in duties or time commitments. Contractor shall assure the adequacy of its administrator’s staffing to properly service the needs of Contractor if changes are proposed in the personnel, duties or time commitments of administrator’s staff from those in place on the Effective Date of each Contract. Contractor shall provide those assurances to the Department before permitting its administrator to implement such changes.