Health Plan Responsibilities Sample Clauses

Health Plan Responsibilities. Client agrees to assume full responsibility for the integration of the Everside Health Center into Client’s health plan and associated documents and to make all amendments, disclosures and reports required by state or federal law.

Health Plan Responsibilities. A. Coordination of Benefits (CMS SMAC Requirements Matrix #1. Health Plan shall coordinate the delivery of all benefits covered by both Medicare and New York’s Medicaid Plan as administered by SDOH. Health Plan is further responsible for coordinating care of all of its Members with other managed care organizations as applicable. In furtherance of these obligations, Health Plan shall specifically: 1. Identify for its Members the benefits they may be eligible for under New York’s Medicaid Plan that are not covered by the D-SNP; 2. Assist in the coordination and access to needed Medicaid services, and arrange for the provision of such Medicaid services, to its Members by identifying participating Medicaid providers in the D-SNP’s provider network; and 3. Develop and apply care coordination policies describing services Health Plan will provide or arrange, including, without limitation, care management, disease management, and discharge planning.

Health Plan Responsibilities. 1. Health Plans have delegated the RxUM responsibilities describe in Section C based on a pre-delegation assessment of CompCare’s RxUM Program, which found the RxUM Program to be in substantial compliance with all application regulatory and accreditation requirements and required corrective action for all aspects that were not found to be fully compliant. 2. Health Plans will provide CompCare with monthly reports of Member complaints received on the Health Plans Member Services toll-free line and adverse event information for CompCare Members. 3. Health Plans will review monthly and quarter report information and follow-up with CompCare as necessary. 4. Health Plans will require a corrective action plan, as established in Section 4.9 of the Agreement, for any compliance issues identified and tracking it to completion. 5. Annual Program Assessment: Subsequent to pre-delegation assessment, and following reasonable advance notice, Health Plans shall conduct annual assessments of CompCare’s RxUM Program. Health Plans shall base such assessment on NCQA, ASES, CMS, and OIG standards for RxUM and will include review of files. CompCare shall provide access to all records necessary to assess CompCare’s RxUM Program.

Health Plan Responsibilities. All Health Plans must be partnered with a clinic to participate in the Collaborative. Select a team of at least two people representing the suggested categories of administration, medical director or quality coordinator. Select a clinic partner through which the plan does business to participate in the Collaborative. Participate in each of three, two-day learning sessions and the two-day Outcomes Congress beginning [dates here]. Health plan expenses will include travel, lodging, [$ amount] registration per person per Learning Session and dedicated staff support to assist clinic partner. Define, with your clinic partner, the specific outcomes for your health plan/clinic team. Report on the required outcome measures of the Collaborative. The percent of the pilot [condition] population with: [mandatory measures here] a documented self-management goal Facilitate and provide support for your clinic partner to implement the Chronic Disease Model to achieve lasting change within the clinic delivery system. Assist in the completion of monthly reports to [SPONSOR or other party to MOU] identifying progress and rapid change cycles implemented. (See Attachment A). Assist in the creation of storyboards with clinic partner for presentation at each Learning Session. Participate in the communication network established by [SPONSOR or other party to MOU] to provide support throughout the Collaborative. Maintain and safeguard the confidentiality of privileged data or information, written, photographed, or electronically recorded, generated and/or acquired by {insert health plan name} which can be used to identify an individual patient, practitioner, participating provider organization, facility, health plan or patient population. CHANGE IN STATUS - In the event of substantive change in the legal status, organizational structure, or fiscal reporting responsibility of the Health Plan, the Health plan agrees to notify [SPONSOR] project manager of the change. Health Plan shall provide notice as soon as practicable, but no later than thirty days after such a change takes effect.

Health Plan Responsibilities