Contract Readiness Review Requirements. EOHHS, or their designee, will conduct a Readiness Review of the Contractor, which must be completed successfully, as determined by EOHHS, prior to the Contract Operational Start Date.
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 Section2.9;
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;
Contract Readiness Review Requirements. 2.2.1.1. CMS and EOHHS, or their designee, will conduct a Readiness Review of each Contractor which must be completed successfully prior to the Contract Operational Start Date.
2.2.1.2.1. CMS and EOHHS or their designee will conduct a Readiness Review of each Contractor that will include, at a minimum, one on-site review. This review shall be conducted prior to enrollment of Medicare-Medicaid Beneficiaries into the Contractor‘s One Care Plan. CMS and EOHHS or their 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 2.7.1;
2.2.1.2.2.2. Staffing, including Key Personnel and functions directly impacting Enrollees (e.g., adequacy of Enrollee Services staffing), in accordance with Sections 2.10 and 5.3;
2.2.1.2.2.3. Capabilities of First Tier, Downstream, and Related Entities, in accordance with Appendix D;
Contract Readiness Review Requirements. 2.2.1.1. CMS and EOHHS, or their designee, 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 EOHHS Readiness Review Responsibilities
2.2.1.2.1. CMS and EOHHS or their designee will conduct a Readiness Review of each Contractor that will include, at a minimum, one on-site review. This review shall be conducted prior to enrollment of Medicare-Medicaid Beneficiaries into the Contractor’s One Care Plan. CMS and EOHHS or their 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 2.7.1;
2.2.1.2.2.2. Staffing, including Key Personnel and functions directly impacting Enrollees (e.g., adequacy of Enrollee Services staffing), in accordance with Sections 2.10 and 5.3;
2.2.1.2.2.3. Capabilities of First Tier, Downstream, and Related Entities, in accordance with Appendix D;
Contract Readiness Review Requirements. 15.1. Introduction 15.2. General Requirements 15.3. Readiness Review Schedule 15.4. Readiness Review Activities 15.5. Project Implementation 15.6. Implementation Work Plan 15.7. Additional Assurances
Contract Readiness Review Requirements. 2.2.1.1. CMS and HHSC, or their designee, will conduct a Readiness Review of each STAR+PLUS MMP, which must be completed successfully, as determined by CMS and HHSC, prior to the Contract Operational Start Date.
2.2.1.2. CMS and HHSC Readiness Review Responsibilities
2.2.1.2.1. CMS and HHSC or their designees will conduct a Readiness Review of each STAR+PLUS MMP that will include, at a minimum, one on-site review. This review shall be completed prior to marketing to and Enrollment of Eligible Beneficiaries into the STAR+PLUS MMP. CMS and HHSC or their designees will conduct the Readiness Review to verify the STAR+PLUS MMP’s assurances that the STAR+PLUS MMP is ready and able to meet its obligations under the Contract.
