Common use of CONTRACT MONITORS Clause in Contracts

CONTRACT MONITORS. For the Department: Bureau Chief Bureau of Managed Care Division of Medical Programs Illinois Department of Healthcare and Family Services 000 Xxxxx Xxxxx Xxxxxx Xxxx Xxxxxxxxxxx, XX 00000 Telephone: Fax: E-mail: For Contractor: Contact Person: Contact Title: Address: Telephone: E-mail: Fax: ATTACHMENT XXIII: ILLINOIS MEDICAID HEALTH PLAN ENCOUNTER UTILIZATION MONITORING (EUM) REQUIREMENTS State of Illinois Department of Healthcare and Family Services 2019 HealthChoice MCO EUM Requirements - DRAFT Table 1: Appendix A Spend and Encounters and Appendix F Rejection Waterfall Analysis Data Limitations Due Dates $100,000 Financial Penalty Auto- Assignment shut-off Eval Period Scored Service Dates (CY) Submitted Service Dates (CY) Run-out Date Preliminary Appendix A Final Appendix A Final Appendix F Final Evaluation Date All Services Threshold Subcategory Threshold All Services Threshold 1 2017Q1 - 2018Q2 2017Q1 - 2018Q4 12/31/2018 1/31/2019 2/28/2019 3/15/2019 3/15/2019 95% 85% 90% 2 2017Q2 - 2018Q3 2017Q1 - 2019Q1 3/31/2019 4/30/2019 5/31/2019 6/14/2019 6/14/2019 96% 85% 90% 3 2017Q3 - 2018Q4 2017Q1 - 2019Q2 6/30/2019 7/31/2019 8/30/2019 9/14/2019 9/14/2019 96% 85% 90% 4 2017Q4 - 2019Q1 2017Q1 - 2019Q3 9/30/2019 10/31/2019 11/29/2019 12/13/2019 12/13/2019 96% 85% 90% Appendix A General Implementation Procedures:

CONTRACT MONITORS. For the Department: Bureau Chief Bureau of Managed Care Division of Medical Programs Illinois Department of Healthcare and Family Services 000 Xxxxx Xxxxx Xxxxxx Xxxx Xxxxxxxxxxx, XX 00000 Telephone: Fax: E-mail: For Contractor: Contact Person: Contact Title: Address: Telephone: E-mail: Fax: ATTACHMENT Attachment XXIII: ILLINOIS MEDICAID HEALTH PLAN ENCOUNTER UTILIZATION MONITORING Illinois Medicaid Health Plan Encounter Utilization Monitoring (EUM) REQUIREMENTS requirements State of Illinois Department of Healthcare and Family Services 2019 HealthChoice MCO EUM Requirements - DRAFT Table 1: Appendix A Spend and Encounters and Appendix F Rejection Waterfall Analysis Data Limitations Due Dates $100,000 Financial Penalty Auto- Assignment shut-off Eval Period Scored Service Dates (CY) Submitted Service Dates (CY) Run-out Date Preliminary Appendix A Final Appendix A Final Appendix F Final Evaluation Date All Services Threshold Subcategory Threshold All Services Threshold 1 2017Q1 - 2018Q2 2017Q1 - 2018Q4 12/31/2018 1/31/2019 2/28/2019 3/15/2019 3/15/2019 95% 85% 90% 2 2017Q2 - 2018Q3 2017Q1 - 2019Q1 3/31/2019 4/30/2019 5/31/2019 6/14/2019 6/14/2019 96% 85% 90% 3 2017Q3 - 2018Q4 2017Q1 - 2019Q2 6/30/2019 7/31/2019 8/30/2019 9/14/2019 9/14/2019 96% 85% 90% 4 2017Q4 - 2019Q1 2017Q1 - 2019Q3 9/30/2019 10/31/2019 11/29/2019 12/13/2019 12/13/2019 96% 85% 90% Appendix A General Implementation Procedures:

CONTRACT MONITORS. For the Department: Bureau Chief Bureau of Managed Care Division of Medical Programs Illinois Department of Healthcare and Family Services 000 Xxxxx Xxxxx Xxxxxx Xxxx XxxxxxxxxxxSpringfield, XX 00000 IL 62763 Telephone: Fax: E-mail: For Contractor: Contact Person: Contact Title: Address: Telephone: E-mail: Fax: ATTACHMENT Attachment XXIII: ILLINOIS MEDICAID HEALTH PLAN ENCOUNTER UTILIZATION MONITORING Illinois Medicaid Health Plan Encounter Utilization Monitoring (EUM) REQUIREMENTS requirements State of Illinois Department of Healthcare and Family Services 2019 HealthChoice MCO EUM Requirements - DRAFT Table 1: Appendix A Spend and Encounters and Appendix F Rejection Waterfall Analysis Data Limitations Due Dates $100,000 Financial Penalty Auto- Assignment shut-off Eval Period Scored Service Dates (CY) Submitted Service Dates (CY) Run-out Date Preliminary Appendix A Final Appendix A Final Appendix F Final Evaluation Date All Services Threshold Subcategory Threshold All Services Threshold 1 2017Q1 - 2018Q2 2017Q1 - 2018Q4 12/31/2018 1/31/2019 2/28/2019 3/15/2019 3/15/2019 95% 85% 90% 2 2017Q2 - 2018Q3 2017Q1 - 2019Q1 3/31/2019 4/30/2019 5/31/2019 6/14/2019 6/14/2019 96% 85% 90% 3 2017Q3 - 2018Q4 2017Q1 - 2019Q2 6/30/2019 7/31/2019 8/30/2019 9/14/2019 9/14/2019 96% 85% 90% 4 2017Q4 - 2019Q1 2017Q1 - 2019Q3 9/30/2019 10/31/2019 11/29/2019 12/13/2019 12/13/2019 96% 85% 90% Appendix A General Implementation Procedures:

CONTRACT MONITORS. For the Department: Bureau Chief Bureau of Managed Care Division of Medical Programs Illinois Department of Healthcare and Family Services 000 Xxxxx Xxxxx Xxxxxx Xxxx XxxxxxxxxxxSpringfield, XX 00000 IL 62763 Telephone: Fax: E-mail: For Contractor: Contact Person: Contact Title: Address: Telephone: E-mail: Fax: ATTACHMENT XXIII: ILLINOIS MEDICAID HEALTH PLAN ENCOUNTER UTILIZATION MONITORING (EUM) REQUIREMENTS State of Illinois Department of Healthcare and Family Services 2019 HealthChoice MCO EUM Requirements - DRAFT Table 1: Appendix A Spend and Encounters and Appendix F Rejection Waterfall Analysis Data Limitations Due Dates $100,000 Financial Penalty Auto- Assignment shut-off Eval Period Scored Service Dates (CY) Submitted Service Dates (CY) Run-out Date Preliminary Appendix A Final Appendix A Final Appendix F Final Evaluation Date All Services Threshold Subcategory Threshold All Services Threshold 1 2017Q1 - 2018Q2 2017Q1 - 2018Q4 12/31/2018 1/31/2019 2/28/2019 3/15/2019 3/15/2019 95% 85% 90% 2 2017Q2 - 2018Q3 2017Q1 - 2019Q1 3/31/2019 4/30/2019 5/31/2019 6/14/2019 6/14/2019 96% 85% 90% 3 2017Q3 - 2018Q4 2017Q1 - 2019Q2 6/30/2019 7/31/2019 8/30/2019 9/14/2019 9/14/2019 96% 85% 90% 4 2017Q4 - 2019Q1 2017Q1 - 2019Q3 9/30/2019 10/31/2019 11/29/2019 12/13/2019 12/13/2019 96% 85% 90% Appendix A General Implementation Procedures: