Day-to-Day Participating Plan Monitoring Sample Clauses

Day-to-Day Participating Plan Monitoring. CMS and the Commonwealth will establish procedures for Participating Plan daily monitoring, as described in Appendix 7. Oversight shall generally be conducted in line with the following principles: The Commonwealth and CMS will each retain, yet coordinate, current responsibilities toward the beneficiary such that beneficiaries maintain access to their benefits across both programs. CMS and the Commonwealth will leverage existing protocols (for example, in responding to beneficiary complaints, conducting account management, and analyzing enrollment data) to identify and solve beneficiary access problems in real-time. Oversight will be coordinated and subject to a unified set of requirements. CMS-State contract management teams, as described in Appendix 7, will be established. Oversight will build on areas of expertise and capacity of the Commonwealth and CMS. Oversight of the Participating Plans and providers will be at least as rigorous as existing procedures for Medicare Advantage, Part D, and the Commonwealth’s Medicaid managed care programs. Part D oversight will continue to be a CMS responsibility, with appropriate coordination and communication with the Commonwealth. Demonstration Plans will be included in all existing Medicare Advantage and Part D oversight activities, including (but not limited to) data-driven monitoring, secret shopping, contracted monitoring projects, plan ratings, formulary administration and transition review, and possibly audits. CMS and the Commonwealth will enhance existing mechanisms and develop new mechanisms to xxxxxx performance improvement and remove consistently poor performers from the program, leveraging existing CMS tools, such as the Complaints Tracking Module, and existing Commonwealth oversight and tracking tools. Standards for removal on the grounds of poor performance will be articulated in the three-way contract.

Day-to-Day Participating Plan Monitoring. CMS and the State will establish procedures for daily monitoring, as described in Appendix 4. Oversight shall generally be conducted in line with the following principles:‌  Oversight will be coordinated and subject to a unified set of requirements, and will build on areas of expertise and capacity of the State and CMS.‌  CMS and the State will enhance existing mechanisms and develop new mechanisms to xxxxxx performance improvement and remove consistently poorly performing plans from the program, leveraging existing CMS tools, such as the Complaints Tracking Module, and existing State oversight and tracking tools.