Common use of Agency Responsibilities and Monitoring Clause in Contracts

Agency Responsibilities and Monitoring. 1.4.7.1 The Agency will: 1.4.7.1.1 Provide the ACO with periodic cost and utilization reports to enhance health care management and coordination that will support member education efforts, and allow PMs to compare peer utilization levels. 1.4.7.1.2 Utilize its managed health care advisory committee to examine peer utilization and establish standards for acceptable levels of utilization, consult and make recommendations for action on quality of care issues, and make recommendations for corrective action measures to take with PMs when utilization of quality of care deficiencies are identified. 1.4.7.1.3 Ensure that enrollments, disenrollments, requests for exception to policy, appeals, and access to the state's fair hearing system are in compliance with state and federal laws and regulations. 1.4.7.1.4 Establish protocols for (1) PMs to use in authorization of medical services in routine, urgent, and emergent situations, (2) reviewing and acting upon utilization review reports, and (3) other procedures necessary for the administration of the Iowa Wellness Plan. These protocols will be created in cooperation with the managed health care advisory committee and will be published in the form of an Agency provider manual. 1.4.7.1.5 Provide tools and reports of the Iowa Wellness Plan members attributed to the PMs within the ACO. The information available in the tools and reports shall be in form and content acceptable to the Agency, including without limitation, the data elements available through the tools and reports. The Agency will periodically seek input from the ACO as to expanded content of the tools and reports. 1.4.7.1.6 Provide PMs with a monthly report of Iowa Wellness Plan members attributed to them. 1.4.7.1.7 Provide the ACO with a monthly report of all Iowa Wellness Plan members attributed to the PMs within the ACO. 1.4.7.1.8 Provide PMs and ACOs with dashboard reports via Treo Solutions VIS measurements. These will be updated monthly. 1.4.7.1.9 Develop a process to regularly share with the ACO claims data for attributed members.

Agency Responsibilities and Monitoring. 1.4.7.1 The Agency will: 1.4.7.1.1 Provide the ACO with periodic cost and utilization reports to enhance health care management and coordination that will support member education efforts, and allow PMs to compare peer utilization levels. 1.4.7.1.2 Utilize its managed health care advisory committee to examine peer utilization and establish standards for acceptable levels of utilization, consult and make recommendations for action on quality of care issues, and make recommendations for corrective action measures to take with PMs when utilization of quality of care deficiencies are identified. 1.4.7.1.3 Ensure that enrollments, disenrollments, requests for exception to policy, appeals, and access to the state's fair hearing system are in compliance with state and federal laws and regulations. 1.4.7.1.4 Establish protocols for (1) PMs to use in authorization of medical services in routine, urgent, and emergent situations, (2) reviewing and acting upon utilization review reports, and (3) other procedures necessary for the administration of the Iowa Wellness Plan. These protocols will be created in cooperation with the managed health care advisory committee and will be published in the form of an Agency provider manual. 1.4.7.1.5 Provide tools and reports of the Iowa Wellness Plan members attributed to the PMs within the ACO. The information available in the tools and reports shall be in form and content acceptable to the Agency, including without limitation, the data elements available through the tools and reports. The Agency will periodically seek input from the ACO as to expanded content of the tools and reports. 1.4.7.1.6 Provide PMs with a monthly report of Iowa Wellness Plan members attributed to them. 1.4.7.1.7 Provide the ACO with a monthly report of all Iowa Wellness Plan members attributed to the PMs within the ACO. 1.4.7.1.8 Provide PMs and ACOs with dashboard reports via Treo Solutions VIS measurements. These will be updated monthly. 1.4.7.1.9 Develop a process to regularly share with the ACO claims data for attributed members.