Common use of Contract Readiness Review Requirements Clause in Contracts

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. 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 Contractor 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 Section2.9Section 2.8; 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 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 2.182.20; 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.

Contract Readiness Review Requirements. 2.2.1.1. CMSCMS and HHSC, or its their designee, with participation by DHCS, will conduct a Readiness Review of each ContractorSTAR+PLUS MMP, which must be completed successfully successfully, as determined by CMS and HHSC, prior to the Contract Operational Start Date. 2.2.1.2. CMS and DHCS HHSC Readiness Review Responsibilities 2.2.1.2.1. CMS and DHCS, HHSC or its designees, their designees will conduct a Readiness Review of each Contactor STAR+PLUS MMP that will include, at a minimum, one on-site review. This review shall be conducted completed prior to enrollment marketing to and Enrollment of beneficiaries Eligible Beneficiaries into the Contractor’s PlanSTAR+PLUS MMP. CMS and DHCS, HHSC or its designees, their designees will conduct the Readiness Review to verify the ContractorSTAR+PLUS MMP’s assurances that the Contractor STAR+PLUS MMP 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, include a review of the following elements: 2.2.1.2.2.1. Network Provider composition and access, in accordance with Section2.9Section 2.6.6.5; 2.2.1.2.2.2. Staffing, including Key Personnel key personnel and functions directly impacting on Enrollees (e.g., adequacy of Enrollee Member Services staffing), in accordance with Section 2.102.2.2; 2.2.1.2.2.3. Capabilities of First Tier, Downstream and or Related Entities, in accordance with Appendix C; 2.2.1.2.2.4. Care Coordination management capabilities, in accordance with Section 2.5.12.5; 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 services Member Services capability (materials, processes and infrastructure, e.g., call center capabilities), in accordance with Section 2.12Sections 2.8, 2.9, and 2.15; 2.2.1.2.2.72.2.1.2.2.6. Comprehensiveness of quality management/quality improvement and utilization management Utilization Management (UM) strategies, in accordance with Section 2.11.5 and 2.162.14.5; 2.2.1.2.2.82.2.1.2.2.7. Internal Grievance and Appeal policies and procedures, in accordance with Section 2.14 Sections 2.11 and 2.152.12; 2.2.1.2.2.92.2.1.2.2.8. Fraud Fraud, Waste, and abuse Abuse and program integrityintegrity policies and procedures, in accordance with Section 2.1.22.1.4; 2.2.1 2.2.102.2.1.2.2.9. Financial solvency, in accordance with Section 2.16; 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 Section 2.18;, including IT testing and security assurances. 2.2.1.2.3. No individual shall be enrolled into the STAR+PLUS MMP unless and until CMS and HHSC determine that the STAR+PLUS MMP is ready and able to perform its obligations under the Contract as demonstrated during the Readiness Review. 2.2.1.2.4. CMS and HHSC or their designee will identify to the STAR+PLUS MMP all areas where a STAR+PLUS MMP is not ready and able to meet its obligations under the Contract and provide an opportunity for the STAR+PLUS MMP to remedy all deficiencies prior to the Contract Operational Start Date. 2.2.1.2.5. CMS or HHSC may, at its discretion, postpone the Contract Operational Start Date for the STAR+PLUS MMP that fails to satisfy any or all Readiness Review requirements. If, for any reason, the STAR+PLUS MMP does not fully satisfy CMS or HHSC that it is ready and able to perform its obligations under the Contract prior to the Contract Operational Start Date, and CMS or HHSC 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 HHSC may terminate the Contract. 2.2.1.3. STAR+PLUS MMP Readiness Review Responsibilities 2.2.1.3.1. The STAR+PLUS MMP must demonstrate to CMS and HHSC’s satisfaction that the STAR+PLUS MMP is ready and able to meet all Contract requirements identified in the Readiness Review prior to the Contract Operational Start Date, and prior to the STAR+PLUS MMP engaging in marketing of its Demonstration product.