Common use of General Performance Requirements Clause in Contracts

General Performance Requirements. (1) For each eligible Individual receiving Case Management Services, the CDDP shall create and submit a Client Prior Authorization (CPA) in eXPRS for Case Management Services within five business days of the CDDP’s determination that the Individual is eligible for Case Management Services. Updates or changes to an Individual’s eligibility or service period for Case Management Services must be reflected in the Individual’s CPA within five business days of the CDDP’s receipt of notification of change. The Case Management CPAs that are submitted successfully by the CDDP and are accepted through eXPRS will serve as the CDDP enrollment roster for Case Management Services. (2) Providers of Case Management Services funded by ODHS shall: (a) Comply with the requirements of OAR Chapter 411 Division 320 “Community Developmental Disabilities Program” and Division 415 “Case Management Services for Individuals with Intellectual or Developmental Disabilities”, as such rules may be revised from time to time. (b) Complete annual plan entry into eXPRS for any Plan of Care Services under the guidelines identified in OAR 000-000-0000 “Service Planning”. Failure to follow the guidelines identified may result in payment withholding for services rendered or other actions as deemed appropriate by ODHS. (c) Develop, maintain, and effectively implement systems and procedures for the timely and accurate documentation of Case Management Services. (d) Comply with all ODHS requirements designed to assure the timely and accurate enrollment, Service Authorization, and service payment for Individuals receiving Case Management Services. (e) Ensure that all Claims billed are for activities that meet ODHS guidelines for Case Management. (f) Ensure each Individual receiving Case Management Services is eligible for DD Services, with eligibility determined in accordance with OAR Chapter 411, Division 320, as such rules may be revised from time to time. (g) Complete and submit Case Management Service eligibility or enrollment information via established methods, and update forms following instructions and using forms(s) or method(s) designated by ODHS. Failure to submit the Case Management Service eligibility or enrollment form may delay the approval of the service authorization for Case Management Services. (h) Ensure that all Oregon Administrative Rules and ODHS policies, procedures, and Transmittals are complied with and that CDDP staff provide Case Management Operations in compliance with Exhibit B Part 2 of this Agreement.

General Performance Requirements. (1) For each eligible Individual receiving Case Management DD 48 Services, the CDDP shall create and submit a Client Prior Authorization (CPA) in eXPRS for Case Management DD 48 Services within five business days of the CDDP’s determination that the Individual is eligible for Case Management DD 48 Services. Updates or changes to an Individual’s eligibility or service period for Case Management DD 48 Services must be reflected in the Individual’s CPA within five business days of the CDDP’s receipt of notification of change. The Case Management DD 48 CPAs that are submitted successfully by the CDDP and are accepted through eXPRS will serve as the CDDP enrollment roster for Case Management DD 48 Services. (2) Providers of Case Management DD 48 Services funded by ODHS DHS shall: (a) Comply with the requirements of OAR Chapter 411 Division 320 “Community Developmental Disabilities Program” and Division 415 “Case Management Services for Individuals with Intellectual or Developmental Disabilities”, as such rules may be revised from time to time. (b) Complete annual plan entry into eXPRS for any Plan of Care Services under the guidelines identified in OAR 000-000-0000 “Service Planning”. Failure to follow the guidelines identified may result in payment withholding for services rendered or other actions as deemed appropriate by ODHSDHS. (c) Develop, maintain, and effectively implement systems and procedures for the timely and accurate documentation of Case Management DD 48 Services. (d) Comply with all ODHS DHS requirements designed to assure the timely and accurate enrollment, Service Authorization, and service payment for Individuals receiving Case Management DD 48 Services. (e) Provide, at minimum, one annual qualifying billable RFFS Claim for each Individual enrolled in DD 48 Services. (f) Ensure that all Claims billed are for activities that meet ODHS DHS guidelines for Case Managementas qualifying billable RFFS Claims. (fg) Ensure each Individual receiving Case Management DD 48 Services is eligible for DD Services, with eligibility determined in accordance with OAR Chapter 411, Division 320, as such rules rule may be revised from time to time. (gh) Complete and submit Case Management DD 48 Service eligibility or enrollment information via established methods, and update forms following instructions and using forms(s) or method(s) designated by ODHSDHS. Failure to submit the Case Management DD 48 Service eligibility or enrollment form may delay the approval of the service authorization CPA for Case Management DD 48 Services. (hi) Ensure that all Oregon Administrative Rules and ODHS DHS policies, procedures, and Transmittals are complied with and that CDDP staff provide Case Management Operations in compliance with Exhibit B Part 2 of this the Agreement. (j) Assist DHS with the implementation of and compliance with Executive Order 15-01 and OAR Chapter 407, Division 025 “Employment Services” and as outlined in Exhibit B Part 1 of the Agreement.

General Performance Requirements. (1) For each eligible Individual receiving Case Management DD 48 Services, the CDDP shall create and submit a Client Prior Authorization (CPA) in eXPRS for Case Management DD 48 Services within five business days of the CDDP’s determination that the Individual is eligible for Case Management DD 48 Services. Updates or changes to an Individual’s eligibility or service period for Case Management DD 48 Services must be reflected in the Individual’s CPA within five business days of the CDDP’s receipt of notification of change. The Case Management DD 48 CPAs that are submitted successfully by the CDDP and are accepted through eXPRS will serve as the CDDP enrollment roster for Case Management DD 48 Services.; (2) Providers of Case Management DD 48 Services funded by ODHS DHS shall: (a) Comply with the requirements of OAR Chapter 411 Division 320 “Community Developmental Disabilities Program” and Division 415 “Case Management Services for Individuals with Intellectual or Developmental Disabilities”415, as such rules may be revised from time to time; (b) Whether County, a CDDP, or Subcontractor, employ the staff indicated on its workload model in the specific position type indicated for case management services. The Provider must hire as many employees as possible for each identified position per the funding allocated to Provider. (bc) Complete annual plan entry into eXPRS for any Plan of Care Services under the guidelines identified in OAR 000-000-0000 0000. CDDP must utilize the code “Service Planning”TBD” for any services where a provider has not yet been identified. Failure to follow the guidelines identified may result in payment withholding for services rendered or other actions as deemed appropriate by ODHSDHS. (cd) Develop, maintain, and effectively implement systems and procedures for the timely and accurate documentation of Case Management DD 48 Services.; (de) Comply with all ODHS DHS requirements designed to assure the timely and accurate enrollment, Service Authorizationservice authorization, and service payment for Individuals receiving Case Management DD 48 Services.; (ef) Provide, at minimum, one annual qualifying billable Claim for each Individual enrolled in DD 48 Services; (g) Ensure that all Claims billed are for activities that meet ODHS DHS guidelines for Case Management.as qualifying billable Claims; (fh) Ensure each Individual receiving Case Management DD 48 Services is eligible for DD Services, with eligibility determined in accordance with OAR Chapter 411, Division 320, as such rules rule may be revised from time to time.; and (gi) Complete and submit Case Management DD 48 Service eligibility or enrollment information via established methods, and update forms following instructions and using forms(s) or method(s) designated by ODHSDHS. Failure to submit the Case Management DD 48 Service eligibility or enrollment form may delay the approval of the service authorization CPA for Case Management DD 48 Services. (h) Ensure that all Oregon Administrative Rules and ODHS policies, procedures, and Transmittals are complied with and that CDDP staff provide Case Management Operations in compliance with Exhibit B Part 2 of this Agreement.