EOHHS Readiness Review Responsibilities. EOHHS or its designee will conduct a Readiness Review of the Contractor that will include, at a minimum, one on-site review. This review will be conducted prior to marketing to and enrollment of eligible beneficiaries into the Contractor. EOHHS or its 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. The scope of the Readiness Review will include, but is not limited to, a review of the following elements: • Network provider composition and access; • Staffing, including key personnel and functions directly impacting Enrollees; • Capabilities of First Tier, Downstream and Related Entities; • Content of Health Care Provider Contracts, including any provider performance incentives; • Enrollee Services capability (materials, processes and infrastructure, e.g., call center capabilities); • Comprehensiveness of quality management/quality improvement and Utilization Management strategies; • Internal Grievance and Appeal policies and procedures; • Fraud and abuse and program integrity policies and procedures; • Financial solvency; and • Information systems, including Claims payment system performance, interfacing and reporting capabilities and validity testing of encounter data. No individual will be enrolled into the Contractor’s MCO until EOHHS determines that the Contractor is ready and able to perform its obligations under the Contract as demonstrated during the Readiness Review. EOHHS or their 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 Contract Operational Start Date. EOHHS may, at its discretion, postpone the Contract Operational Start Date for the Contractor that fails to satisfy all Readiness Review requirements. If, for any reason, the Contractor does not fully satisfy EOHHS that it is ready and able to perform its obligations under the Contract prior to the Contract Operational Start Date, and EOHHS do not agree to postpone the Contract Operational Start Date, or extend the date for full compliance with the applicable Contract requirement, then EOHHS may terminate the Contract pursuant to this Contract. The Contractor must demonstrate to EOHHS’ satisfaction that the Contractor is ready and able to meet all Contract requirements identified in the ...
