Contract Management and Readiness Review Requirements. 2.2.1. Contract Readiness Review Requirements 2.2.1.1. CMS, or its designee, with participation by DHCS, will conduct a Readiness Review of each Contractor, which must be completed successfully prior to the Contract Operational Start Date. 2.2.1.2. CMS and DHCS Readiness Review Responsibilities 2.2.1.2.1. CMS and DHCS, or its designees, will conduct a Readiness Review of each Contactor that will include, at a minimum, one on-site review. This review shall be conducted prior to enrollment of beneficiaries into the Contractor’s Plan. CMS and DHCS, or its designees, will conduct the Readiness Review to verify the Contractor’s assurances that the Contractor is ready and able to meet its obligations under the Contract. 2.2.1.2.2. The scope of the Readiness Review will include, but is not limited to, a review of the following elements: 2.2.1.2.2.1. Network Provider composition and access, in accordance with Section 2.9; 2.2.1.2.2.2. Staffing, including Key Personnel and functions directly impacting on Enrollees (e.g., adequacy of Enrollee Services staffing), in accordance with Section 2.10; 2.2.1.2.2.3. Capabilities of First Tier, Downstream and Related Entities, in accordance with Appendix C; 2.2.1.2.2.4. Care Coordination capabilities, in accordance with Section 2.5.1; 2.2.1.2.2.5. Provider contracts templates, including any Provider Performance Incentives, in accordance with Sections 2.9 and 5.1.7; 2.2.1.2.2.6. Enrollee services capability (materials, processes and infrastructure, e.g., call center capabilities), in accordance with Section 2.12; 2.2.1.2.2.7. Comprehensiveness of quality management/quality improvement and utilization management strategies, in accordance with Section 2.11.5 and 2.16; 2.2.1.2.2.8. Internal grievance and Appeal policies and procedures, in accordance with Section 2.14 and 2.15; 2.2.1.2.2.9. Fraud and abuse and program integrity, in accordance with Section 2.1.2; 2.2.1 2.2.10. Financial solvency, in accordance with Section 2.18;
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Contract Management and Readiness Review Requirements.
2.2.1. Contract Readiness Review Requirements
2.2.1.1. CMSCMS and ODM, or its their designee, with participation by DHCS, will conduct a Readiness Review of each ContractorICDS Plan, which must be completed successfully successfully, as determined by CMS and ODM, prior to the Contract Operational Start Date.
2.2.1.22.2.1 2. CMS and DHCS ODM Readiness Review Responsibilities
2.2.1.2.1. CMS and DHCS, ODM or its designees, their designee will conduct a Readiness Review of each Contactor ICDS Plan that will include, at a minimum, one on-site review. This review shall be conducted prior to enrollment marketing to and Enrollment of beneficiaries Beneficiaries into the Contractor’s ICDS Plan. CMS and DHCS, ODM or its designees, their designee will conduct the Readiness Review to verify the ContractorICDS Plan’s assurances that the Contractor ICDS Plan is ready and able to meet its obligations under the Contract.
2.2.1.2.2. The scope of the Readiness Review will include, but is not limited to, a review of the following elements:
2.2.1.2.2.1. Network Provider composition and access, in accordance with Section 2.9Sections 2.6, 2.7, 2.8 of this Contract;
2.2.1.2.2.2. Staffing, including Key Personnel key management positions and functions directly impacting on Enrollees Beneficiaries (e.g., adequacy of Enrollee Beneficiary Services staffing), in accordance with Section 2.10Sections 2.2.3 and 2.9 of this Contract;
2.2.1.2.2.3. Capabilities of First Tier, Downstream and Related Entities, in accordance with Section 2.7 and Appendix CC of this Contract;
2.2.1.2.2.4. Care Coordination capabilities, in accordance with Section 2.5.1Sections 2.5 of this Contract;
2.2.1.2.2.5. Provider contracts templates, including any Provider Performance Incentives, in accordance with Sections 2.9 and 5.1.7;
2.2.1.2.2.6. Enrollee Beneficiary services capability (materials, processes and infrastructure, e.g., call center capabilities), in accordance with Section 2.122.9 of this Contract;
2.2.1.2.2.72.2.1.2.2.6. Comprehensiveness of quality management/quality improvement and utilization management Utilization Management strategies, in accordance with Section 2.11.5 and 2.162.11 of this Contract;
2.2.1.2.2.82.2.1.2.2.7. Internal grievance Grievance and Appeal policies and procedures, in accordance with Section 2.14 and 2.152.10 of this Contract;
2.2.1.2.2.92.2.1.2.2.8. Fraud and abuse and program integrity, in accordance with Section 2.1.22.1 of this Contract;
2.2.1 2.2.102.2.1.2.2.9. Financial solvency, in accordance with Section 2.182.13 of this Contract;
2.2.1.2.2.10. Information systems, including Claims payment system performance, interfacing and reporting capabilities and validity testing of Encounter Data, in accordance with Sections 2.14 and 2.15 of this Contract, including IT testing and security assurances.
2.2.1.2.3. No individual shall be enrolled into the ICDS Plan unless and until CMS and the ODM determine that the ICDS Plan is ready and able to perform its obligations under the Contract as demonstrated during the Readiness Review.
2.2.1.2.4. CMS and ODM or their designee will identify to the ICDS Plan all areas where the ICDS Plan has been determined not ready and not able to meet its obligations under the Contract and provide an opportunity for the ICDS Plan to correct such areas to remedy all deficiencies prior to the start of marketing.
2.2.1.2.5. CMS or the ODM may, in its discretion, postpone the date the ICDS Plan may start marketing or the Contract Operational Start Date if the ICDS Plan fails to satisfy all Readiness Review requirements. If, for any reason, the ICDS Plan does not fully satisfy to CMS or the ODM that it is ready and able to perform its obligations under the Contract prior to the start of marketing or the Contract Operational Start Date, and CMS or the ODM does not agree to postpone the Contract Operational Start Date, or extend the date for full compliance with the applicable Contract requirement, then CMS or the ODM may terminate the Contract pursuant to Section 5.5 of this Contract.
2.2.1.1. ICDS Plan Readiness Review Responsibilities
2.2.1.1.1. Demonstrate to CMS and ODM’s satisfaction that the ICDS Plan is ready and able to meet all Contract requirements identified in the Readiness Review prior to the ICDS Plan engaging in marketing of its Demonstration product, and prior to the Contract Operational Start Date.
2.2.1.1.2. Provide CMS and ODM or its designee with the corrected materials requested by the Readiness Review report.
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Contract Management and Readiness Review Requirements. 2.2.1. Contract Readiness Review Requirements
2.2.1.1. CMSCMS and DMAS, or its designee, with participation by DHCS, will conduct a Readiness Review of each Contractor, which must be completed successfully successfully, as determined by CMS and DMAS, prior to the Contract Operational Start Date.
2.2.1.2. CMS and DHCS DMAS Readiness Review Responsibilities
2.2.1.2.1. CMS and DHCS, DMAS or its designees, designee will conduct a Readiness Review of each Contactor that will include, at a minimum, one on-site review. This review shall be conducted prior to marketing to and enrollment of beneficiaries into the Contractor’s PlanMMP. CMS and DHCS, DMAS or its designees, designee will conduct the Readiness Review to verify the Contractor’s assurances that the Contractor is ready and able to meet its obligations under the Contract.
2.2.1.2.2. The scope of the Readiness Review will include, but is not limited to, a review of the following elements:
2.2.1.2.2.1. Network Provider composition and access, in accordance with Section 2.92.8;
2.2.1.2.2.2. Staffing, including Key Personnel and functions directly impacting on Enrollees (e.g., adequacy of Enrollee Services staffing), in accordance with Section 2.102.12);
2.2.1.2.2.3. Capabilities of First Tier, Downstream and Related Entities, in accordance with Appendix CD;
2.2.1.2.2.4. Care Coordination management capabilities, in accordance with Section 2.5.12.6.3;
2.2.1.2.2.5. Content of Provider contracts templatesContracts, including any Provider Performance Incentives, in accordance with Sections 2.9 , 2.6.3.2, 5.1.7 and 5.1.7Appendix D;
2.2.1.2.2.6. Enrollee services Services capability (materials, processes and infrastructure, e.g., call center capabilities), in accordance with Section 2.12;
2.2.1.2.2.7. Comprehensiveness of quality management/quality improvement and utilization management Utilization Management strategies, in accordance with Section 2.11.5 and 2.162.11.5;
2.2.1.2.2.8. Internal grievance Grievance and Appeal policies and procedures, in accordance with Section 2.14 2.13 and 2.152.14;
2.2.1.2.2.9. Fraud and abuse and program integrityintegrity policies and procedures, in accordance with Section 2.1.22.1.3;
2.2.1 2.2.102.2.1.2.2.10. Financial solvency, in accordance with Section 2.18;2.20; 2.2.1.2.2.11. Information systems, including claims payment system performance, interfacing and reporting capabilities and validity testing of Encounter Data, in accordance with Section 2.22, including IT testing and security assurances.
2.2.1.2.3. No individual shall be enrolled into the Contractor’s MMP unless and until CMS and the DMAS determine that the Contractor is ready and able to perform its obligations under the Contract as demonstrated during the Readiness Review.
2.2.1.2.4. CMS and DMAS or its designee will identify to the Contractor all areas where the Contractor is not ready and able to meet its obligations under the Contract and provide an opportunity for the Contractor to correct such areas to remedy all deficiencies prior to the start of marketing.
2.2.1.2.5. CMS or DMAS may, at its discretion, postpone the date the Contractor may start marketing or the Contract Operational Start Date if the Contractor fails to satisfy all Readiness Review requirements. If, for any reason, the Contractor does not fully satisfy CMS or DMAS that it is ready and able to perform its obligations under the Contract prior to the start of marketing or the Contract Operational Start Date, and CMS or DMAS do not agree to postpone the Contract Operational Start Date, or extend the date for full compliance with the applicable Contract requirement, then CMS or DMAS may terminate the Contract pursuant to Section 5.5 of this Contract.
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Samples: Contract
Contract Management and Readiness Review Requirements.
2.2.1. Contract Readiness Review Requirements
2.2.1.1. CMSCMS and ODM, or its their designee, with participation by DHCS, will conduct a Readiness Review of each ContractorICDS Plan, which must be completed successfully successfully, as determined by CMS and ODM, prior to the Contract Operational Start Date.
2.2.1.2. CMS and DHCS ODM Readiness Review Responsibilities
2.2.1.2.1. CMS and DHCS, ODM or its designees, their designee will conduct a Readiness Review of each Contactor ICDS Plan that will include, at a minimum, one on-site review. This review shall be conducted prior to enrollment marketing to and Enrollment of beneficiaries Beneficiaries into the Contractor’s ICDS Plan. CMS and DHCS, ODM or its designees, their designee will conduct the Readiness Review to verify the ContractorICDS Plan’s assurances that the Contractor ICDS Plan is ready and able to meet its obligations under the Contract.
2.2.1.2.2. The scope of the Readiness Review will include, but is not limited to, a review of the following elements:
2.2.1.2.2.1. Network Provider composition and access, in accordance with Section 2.9Sections 2.6, 2.7, 2.8 of this Contract;
2.2.1.2.2.2. Staffing, including Key Personnel key management positions and functions directly impacting on Enrollees Beneficiaries (e.g., adequacy of Enrollee Beneficiary Services staffing), in accordance with Section 2.10Sections 2.2.3 and 2.9 of this Contract;
2.2.1.2.2.3. Capabilities of First Tier, Downstream and Related Entities, in accordance with Section 2.7 and Appendix CC of this Contract;
2.2.1.2.2.4. Care Coordination capabilities, in accordance with Section 2.5.1Sections 2.5 of this Contract;
2.2.1.2.2.5. Provider contracts templates, including any Provider Performance Incentives, in accordance with Sections 2.9 and 5.1.7;
2.2.1.2.2.6. Enrollee Beneficiary services capability (materials, processes and infrastructure, e.g., call center capabilities), in accordance with Section 2.122.9 of this Contract;
2.2.1.2.2.72.2.1.2.2.6. Comprehensiveness of quality management/quality improvement and utilization management Utilization Management strategies, in accordance with Section 2.11.5 and 2.162.11 of this Contract;
2.2.1.2.2.82.2.1.2.2.7. Internal grievance Grievance and Appeal policies and procedures, in accordance with Section 2.14 and 2.152.10 of this Contract;
2.2.1.2.2.92.2.1.2.2.8. Fraud and abuse and program integrity, in accordance with Section 2.1.22.1 of this Contract;
2.2.1 2.2.102.2.1.2.2.9. Financial solvency, in accordance with Section 2.182.13 of this Contract;
2.2.1.2.2.10. Information systems, including Claims payment system performance, interfacing and reporting capabilities and validity testing of Encounter Data, in accordance with Sections 2.14 and 2.15 of this Contract, including IT testing and security assurances.
2.2.1.2.3. No individual shall be enrolled into the ICDS Plan unless and until CMS and the ODM determine that the ICDS Plan is ready and able to perform its obligations under the Contract as demonstrated during the Readiness Review.
2.2.1.2.4. CMS and ODM or their designee will identify to the ICDS Plan all areas where the ICDS Plan has been determined not ready and not able to meet its obligations under the Contract and provide an opportunity for the ICDS Plan to correct such areas to remedy all deficiencies prior to the start of marketing.
2.2.1.2.5. CMS or the ODM may, in its discretion, postpone the date the ICDS Plan may start marketing or the Contract Operational Start Date if the ICDS Plan fails to satisfy all Readiness Review requirements. If, for any reason, the ICDS Plan does not fully satisfy to CMS or the ODM that it is ready and able to perform its obligations under the Contract prior to the start of marketing or the Contract Operational Start Date, and CMS or the ODM does not agree to postpone the Contract Operational Start Date, or extend the date for full compliance with the applicable Contract requirement, then CMS or the ODM may terminate the Contract pursuant to Section 5.5 of this Contract.
2.2.1.1. ICDS Plan Readiness Review Responsibilities
2.2.1.1.1. Demonstrate to CMS and ODM’s satisfaction that the ICDS Plan is ready and able to meet all Contract requirements identified in the Readiness Review prior to the ICDS Plan engaging in marketing of its Demonstration product, and prior to the Contract Operational Start Date.
2.2.1.1.2. Provide CMS and ODM or its designee with the corrected materials requested by the Readiness Review report.
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Samples: Contract
Contract Management and Readiness Review Requirements. 2.2.1. Contract Readiness Review Requirements
2.2.1.1. CMS, or its designee, with participation by DHCS, will conduct a Readiness Review of each Contractor, which must be completed successfully prior to the Contract Operational Start Date.
2.2.1.2. CMS and DHCS Readiness Review Responsibilities
2.2.1.2.1. CMS and DHCS, or its designees, will conduct a Readiness Review of each Contactor that will include, at a minimum, one on-on- site review. This review shall be conducted prior to enrollment of beneficiaries into the Contractor’s Plan. CMS and DHCS, or its designees, will conduct the Readiness Review to verify the Contractor’s assurances that the Contractor is ready and able to meet its obligations under the Contract.
2.2.1.2.2. The scope of the Readiness Review will include, but is not limited to, a review of the following elements:
2.2.1.2.2.1. Network Provider composition and access, in accordance with Section 2.92.10;
2.2.1.2.2.2. Staffing, including Key Personnel and functions directly impacting on Enrollees (e.g., adequacy of Enrollee Services staffing), in accordance with Section 2.102.11;
2.2.1.2.2.3. Capabilities of First Tier, Downstream and Related Entities, in accordance with Appendix C;
2.2.1.2.2.4. Care Coordination capabilities, in accordance with Section 2.5.12.5.2;
2.2.1.2.2.5. Provider contracts templates, including any Provider Performance Incentives, in accordance with Sections 2.9 and 5.1.7;
2.2.1.2.2.6. Enrollee services capability (materials, processes and infrastructure, e.g., call center capabilities), in accordance with Section 2.12;
2.2.1.2.2.7. Comprehensiveness of quality management/quality improvement and utilization management strategies, in accordance with Section 2.11.5 2.11.6 and 2.16;
2.2.1.2.2.8. Internal grievance Grievance and Appeal policies and procedures, in accordance with Section 2.14 and 2.15;
2.2.1.2.2.9. Fraud and abuse and program integrity, in accordance with Section 2.1.2;
2.2.1 2.2.102.2.1.2.2.10. Financial solvency, in accordance with Section 2.18;; 2.2.1.2.2.11. Information systems, including claims payment system performance, interfacing and reporting capabilities and validity testing of Encounter Data, in accordance with Section 2.19, including IT testing and security assurances.
2.2.1.2.3. For Contractors that are COHS plans, the scope of the Readiness Review will extend to the enrollment functions that the Contractor will be conducting as described in Section 2.3.1.
2.2.1.2.4. No individual shall be enrolled into the Contractor’s Cal MediConnect Plan unless and until CMS and the DHCS determine that the Contractor is ready and able to perform its obligations under the Contract as demonstrated during the Readiness Review.
2.2.1.2.5. CMS and DHCS or its designee will identify to the Contractor all areas where the Contractor is not ready and able to meet its obligations under the Contract and provide an opportunity for the Contractor to correct such areas to remedy all deficiencies prior to the start of marketing.
2.2.1.2.6. CMS or DHCS may, in its discretion, postpone the date the Contractor may start marketing or the Contract Operational Start Date for any Contractor that fails to satisfy all Readiness Review requirements. If, for any reason, the Contractor does not fully satisfy CMS or DHCS that it is ready and able to perform its obligations under the Contract prior to the start of marketing or the Contract Operational Start Date, and CMS or DHCS does not agree to postpone the Contract Operational Start Date, or extend the date for full compliance with the applicable Contract requirement, then CMS or DHCS may terminate the Contract pursuant to Section 5.5 of this Contract.
Appears in 1 contract
Samples: Contract
Contract Management and Readiness Review Requirements. 2.2.1. Contract Readiness Review Requirements
2.2.1.1. CMSCMS and ODM, or its their designee, with participation by DHCS, will conduct a Readiness Review of each ContractorICDS Plan, which must be completed successfully successfully, as determined by CMS and ODM, prior to the Contract Operational Start Date.
2.2.1.22.2.1 2. CMS and DHCS ODM Readiness Review Responsibilities
2.2.1.2.1. CMS and DHCS, ODM or its designees, their designee will conduct a Readiness Review of each Contactor ICDS Plan that will include, at a minimum, one on-site review. This review shall be conducted prior to marketing to and enrollment of beneficiaries Beneficiaries into the Contractor’s ICDS Plan. CMS and DHCS, ODM or its designees, their designee will conduct the Readiness Review to verify the ContractorICDS Plan’s assurances that the Contractor ICDS Plan is ready and able to meet its obligations under the Contract.
2.2.1.2.2. The scope of the Readiness Review will include, but is not limited to, a review of the following elements:
2.2.1.2.2.1. Network Provider composition and access, in accordance with Section 2.9Sections 2.6, 2.7, 2.8;
2.2.1.2.2.2. Staffing, including Key Personnel key management positions and functions directly impacting on Enrollees Beneficiaries (e.g., adequacy of Enrollee Beneficiary Services staffing), in accordance with Section 2.10Sections 2.2.3 and 2.11;
2.2.1.2.2.3. Capabilities of First Tier, Downstream and Related Entities, in accordance with Section 2.7 and Appendix C;
2.2.1.2.2.4. Care Coordination capabilities, in accordance with Section 2.5.1Sections 2.5;
2.2.1.2.2.5. Provider contracts templates, including any Provider Performance Incentives, in accordance with Sections 2.9 and 5.1.7;
2.2.1.2.2.6. Enrollee Beneficiary services capability (materials, processes and infrastructure, e.g., call center capabilities), in accordance with Section 2.122.9;
2.2.1.2.2.72.2.1.2.2.6. Comprehensiveness of quality management/quality improvement and utilization management Utilization Management strategies, in accordance with Section 2.11.5 and 2.162.11;
2.2.1.2.2.82.2.1.2.2.7. Internal grievance Grievance and Appeal policies and procedures, in accordance with Section 2.14 and 2.152.10;
2.2.1.2.2.92.2.1.2.2.8. Fraud and abuse and program integrity, in accordance with Section 2.1.22.1;
2.2.1 2.2.102.2.1. 2.2.9. Financial solvency, in accordance with Section 2.182.13;
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Samples: Contract
Contract Management and Readiness Review Requirements. 2.2.1. Contract Readiness Review Requirements
2.2.1.1. CMSCMS and ODM, or its their designee, with participation by DHCS, will conduct a Readiness Review of each ContractorICDS Plan, which must be completed successfully successfully, as determined by CMS and ODM, prior to the Contract Operational Start Date.
2.2.1.22.2.1 2. CMS and DHCS ODM Readiness Review Responsibilities
2.2.1.2.1. CMS and DHCS, ODM or its designees, their designee will conduct a Readiness Review of each Contactor ICDS Plan that will include, at a minimum, one on-site review. This review shall be conducted prior to enrollment marketing to and Enrollment of beneficiaries Beneficiaries into the Contractor’s ICDS Plan. CMS and DHCS, ODM or its designees, their designee will conduct the Readiness Review to verify the ContractorICDS Plan’s assurances that the Contractor ICDS Plan is ready and able to meet its obligations under the Contract.
2.2.1.2.2. The scope of the Readiness Review will include, but is not limited to, a review of the following elements:
2.2.1.2.2.1. Network Provider composition and access, in accordance with Section 2.9Sections 2.6, 2.7, 2.8 of this Contract;
2.2.1.2.2.2. Staffing, including Key Personnel key management positions and functions directly impacting on Enrollees Beneficiaries (e.g., adequacy of Enrollee Beneficiary Services staffing), in accordance with Section 2.10Sections 2.2.3 and 2.9 of this Contract;
2.2.1.2.2.3. Capabilities of First Tier, Downstream and Related Entities, in accordance with Section 2.7 and Appendix CC of this Contract;
2.2.1.2.2.4. Care Coordination capabilities, in accordance with Section 2.5.1Sections 2.5 of this Contract;
2.2.1.2.2.5. Provider contracts templates, including any Provider Performance Incentives, in accordance with Sections 2.9 and 5.1.7;
2.2.1.2.2.6. Enrollee Beneficiary services capability (materials, processes and infrastructure, e.g., call center capabilities), in accordance with Section 2.122.9 of this Contract;
2.2.1.2.2.72.2.1.2.2.6. Comprehensiveness of quality management/quality improvement and utilization management Utilization Management strategies, in accordance with Section 2.11.5 and 2.162.11 of this Contract;
2.2.1.2.2.82.2.1.2.2.7. Internal grievance Grievance and Appeal policies and procedures, in accordance with Section 2.14 and 2.152.10 of this Contract;
2.2.1.2.2.92.2.1.2.2.8. Fraud and abuse and program integrity, in accordance with Section 2.1.22.1 of this Contract;
2.2.1 2.2.102.2.1.2.2.9. Financial solvency, in accordance with Section 2.182.13 of this Contract;
2.2.1.2.2.10. Information systems, including Claims payment system performance, interfacing and reporting capabilities and validity testing of Encounter Data, in accordance with Sections 2.14 and 2.15 of this Contract, including IT testing and security assurances.
2.2.1.2.3. No individual shall be enrolled into the ICDS Plan unless and until CMS and the ODM determine that the ICDS Plan is ready and able to perform its obligations under the Contract as demonstrated during the Readiness Review.
2.2.1.2.4. CMS and ODM or their designee will identify to the ICDS Plan all areas where the ICDS Plan has been determined not ready and not able to meet its obligations under the Contract and provide an opportunity for the ICDS Plan to correct such areas to remedy all deficiencies prior to the start of marketing.
2.2.1.2.5. CMS or the ODM may, in its discretion, postpone the date the ICDS Plan may start marketing or the Contract Operational Start Date if the ICDS Plan fails to satisfy all Readiness Review requirements. If, for any reason, the ICDS Plan does not fully satisfy to CMS or the ODM that it is ready and able to perform its obligations under the Contract prior to the start of marketing or the Contract Operational Start Date, and CMS or the ODM does not agree to postpone the Contract Operational Start Date, or extend the date for full compliance with the applicable Contract requirement, then CMS or the ODM may terminate the Contract pursuant to Section 5.5 of this Contract.
2.2.1.1. ICDS Plan Readiness Review Responsibilities
2.2.1.1.1. Demonstrate to CMS and ODM’s satisfaction that the ICDS Plan is ready and able to meet all Contract requirements identified in the Readiness Review prior to the ICDS Plan engaging in marketing of its Demonstration product, and prior to the Contract Operational Start Date.
2.2.1.1.2. Provide CMS and ODM or its designee with the corrected materials requested by the Readiness Review report.
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Samples: Contract
