IMPLEMENTATION PLAN AND PROGRESS REPORTS. 1. Within calendar 10 days of award of this contract, the Contractor shall submit to the (COTR) a project implementation plan that highlights each step of implementation of this contract and that is consistent with the Contractors’ proposal. The implementation plan, at a minimum, shall include a copy of the Contractor’s draft enrollment application as well as the specific dates on which the Contractor will: a) Announce the availability of the high risk pool program to the public; b) Begin accepting high risk pool program enrollments; and c) Begin to cover the claims submitted by or on behalf of high risk pool program enrollees. 2. The Contractor shall submit progress reports to HHS on the status of implementing and carrying out the high risk pool program. Reports should be submitted in a format to be provided by HHS. The first progress report will be due on the last business day of the month following the calendar quarter being reported. At a minimum, progress reports shall include: a) Evidence that the major milestones of the implementation plan have been met and clear identification of milestones yet to be met; b) An updated timeline for implementing the program and meeting other identified milestones; c) Risks and problems identified or encountered by the Contractor and mitigation strategies implemented to address those risks and problems; d) A description of the enrollment into the high risk pool program, at least broken down geographically and demographically to describe whether the enrollees in the program are representative of the eligible individuals in the State e) The number of new enrollees into the program; f) The number of individuals who have disenrolled from the program since the previous progress report, including the reason for the disenrollments, if known; g) The average length of enrollment in the program; h) A breakdown of how enrollees satisfied the pre-existing condition requirement; and i) In the first progress report of each year, updated annual cost projections, based on actual expenditures and enrollment. If a shortfall is projected, a plan with specific cost-containment strategies will be submitted to HHS that assures high risk pool expenditures stay within allotment levels. The quarterly reports shall not contain personally identifiable information about the enrollees in the high risk pool program. 3. The Contractor shall submit monthly reports to HHS, beginning on the last business day of the month following the month of the effective date of the contract and continuing on the last business day of the month after the month being reported until the expiration of the contract. The monthly reports shall provide information on the previous calendar month of operations and contain a complete accounting of temporary high risk pool expenditures and revenue, as follows: a) Medical claims paid on behalf of high risk pool enrollees; b) Prescription drug claims paid on behalf of high risk pool enrollees; c) Estimated claims incurred but not reported; d) The total number of high risk pool program enrollees; e) The amount of premiums billed and the amount of premiums collected; f) The amount of administrative costs; g) The number of new enrollments and disenrollments, h) Average out-of-pocket costs for enrollees. The Contractor must certify that all information submitted to HHS in these reports is true, accurate, and complete. The monthly reports shall not contain personally identifiable information about the enrollees in the high risk pool program. 4. No later than March 15 of the year following each period of performance, as described in Section E.1, Contractor shall provide an annual reconciliation of the difference between premiums collected plus federal payments under this Contract and claims plus allowable administrative expenses. After such reconciliation, Contractor shall report to HHS with necessary changes. To the extent the Contractor has received an excess of payments, the payments will be credited or returned to HHS. To the extent the Contractor identifies any underpayment for administrative costs, it will xxxx to and receive from HHS such underpayments subject to the limitations of the appropriation in Section 1101 of the Affordable Care Act and the estimated cost provisions of this Contract. 5. By June 30, 2011, and each June 30 thereafter, the Contractor shall submit an independently audited financial report detailing the finances of the high risk pool program operated by the Contractor.
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Samples: Contract to Operate a Qualified High Risk Pool, Contract to Operate a Qualified High Risk Pool, Contract to Operate a Qualified High Risk Pool
IMPLEMENTATION PLAN AND PROGRESS REPORTS. 1. Within calendar 10 days of award of this contract, the Contractor shall submit to the (COTR) a project implementation plan that highlights each step of implementation of this contract and that is consistent with the Contractors’ proposal. The implementation plan, at a minimum, shall include a copy of the Contractor’s draft enrollment application as well as the specific dates on which the Contractor will:
a) Announce the availability of the high risk pool program to the public;
b) Begin accepting high risk pool program enrollments; and
c) Begin to cover the claims submitted by or on behalf of high risk pool program enrollees.
2. The Contractor shall submit progress reports to HHS on the status of implementing and carrying out the high risk pool program. Reports should be submitted in a format to be provided by HHS. The first progress report will be due on the last business day of the month following the calendar quarter being reported. At a minimum, progress reports shall include:
a) Evidence that the major milestones of the implementation plan have been met and clear identification of milestones yet to be met;
b) An updated timeline for implementing the program and meeting other identified milestones;
c) Risks and problems identified or encountered by the Contractor and mitigation strategies implemented to address those risks and problems;
d) A description of the enrollment into the high risk pool program, at least broken down geographically and demographically to describe whether the enrollees in the program are representative of the eligible individuals in the State
e) The number of new enrollees into the program;
f) The number of individuals who have disenrolled from the program since the previous progress report, including the reason for the disenrollments, if known;
g) The average length of enrollment in the program;
h) A breakdown of how enrollees satisfied the pre-existing condition requirement; and
i) In the first progress report of each year, updated annual cost projections, based on actual expenditures and enrollment. If a shortfall is projected, a plan with specific cost-containment strategies will be submitted to HHS that assures high risk pool expenditures stay within allotment levels. The quarterly reports shall not contain personally identifiable information about the enrollees in the high risk pool program.
3. The Contractor shall submit monthly reports to HHS, beginning on the last business day of the second month following the month of the effective date of the contract and continuing on the last business day of the month after the month being reported until the expiration of the contract. The monthly reports shall provide information on the previous calendar month of operations and contain a complete accounting of temporary high risk pool expenditures and revenue, as follows:
a) Medical claims paid on behalf of high risk pool enrollees;
b) Prescription drug claims paid on behalf of high risk pool enrollees;
c) Estimated claims incurred but not reported;
d) The total number of high risk pool program enrollees;
e) The amount of premiums billed and the amount of premiums collected;
f) The amount of administrative costs;
g) The number of new enrollments and disenrollments,
h) Average out-of-pocket costs for enrollees. The Contractor must certify that all information submitted to HHS in these reports is true, accurate, and complete. The monthly reports shall not contain personally identifiable information about the enrollees in the high risk pool program.
4. No later than March 15 of the year following each period of performance, as described in Section E.1, Contractor shall provide an annual reconciliation of the difference between premiums collected plus federal payments under this Contract and claims plus allowable administrative expenses. After such reconciliation, Contractor shall report to HHS with necessary changes. To the extent the Contractor has received an excess of payments, the payments will be credited or returned to HHS. To the extent the Contractor identifies any underpayment for administrative costs, it will xxxx bill to and receive from HHS such underpayments subject to the limitations of the appropriation in Section 1101 of the Affordable Care Act and the estimated cost provisions of this Contract.
5. By June 30, 2011, and each June 30 thereafter, the Contractor shall submit an independently audited financial report detailing the finances of the high risk pool program operated by the Contractor.
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IMPLEMENTATION PLAN AND PROGRESS REPORTS. 1. Within calendar 10 days of award of this contract, the Contractor shall submit to the (COTR) a project implementation plan that highlights each step of implementation of this contract and that is consistent with the Contractors’ proposal. The implementation plan, at a minimum, shall include a copy of the Contractor’s draft enrollment application as well as the specific dates on which the Contractor will:
a) Announce the availability of the high risk pool program to the public;
b) Begin accepting high risk pool program enrollments; and
c) Begin to cover the claims submitted by or on behalf of high risk pool program enrollees.
2. The Contractor shall submit progress reports to HHS on the status of implementing and carrying out the high risk pool program. Reports should be submitted in a format to be provided by HHS. The first progress report will be due on the last business day of the month following the calendar quarter being reported. At a minimum, progress reports shall include:
a) Evidence that the major milestones of the implementation plan have been met and clear identification of milestones yet to be met;
b) An updated timeline for implementing the program and meeting other identified milestones;
c) Risks and problems identified or encountered by the Contractor and mitigation strategies implemented to address those risks and problems;
d) A description of the enrollment into the high risk pool program, at least broken down geographically and demographically to describe whether the enrollees in the program are representative of the eligible individuals in the State
e) The number of new enrollees into the program;
f) The number of individuals who have disenrolled from the program since the previous progress report, including the reason for the disenrollments, if known;
g) The average length of enrollment in the program;
h) A breakdown of how enrollees satisfied the pre-existing condition requirement; and
i) In the first progress report of each year, updated annual cost projections, based on actual expenditures and enrollment. If a shortfall is projected, a plan with specific cost-containment strategies will be submitted to HHS that assures high risk pool expenditures stay within allotment levels. The quarterly reports shall not contain personally identifiable information about the enrollees in the high risk pool program.
3. The Contractor shall submit monthly reports to HHS, beginning on the last business day of the month following the month of the effective date of the contract and continuing on the last business day of the month after the month being reported until the expiration of the contract. The monthly reports shall provide information on the previous calendar month of operations and contain a complete accounting of temporary high risk pool expenditures and revenue, as follows:
a) Medical claims paid on behalf of high risk pool enrollees;
b) Prescription drug claims paid on behalf of high risk pool enrollees;
c) Estimated claims incurred but not reported;
d) The total number of high risk pool program enrollees;
e) The amount of premiums billed and the amount of premiums collected;
f) The amount of administrative costs;
g) The the total number of enrollees,
h) the number of new enrollments and disenrollments,
hi) Average average out-of-pocket costs for enrollees. The Contractor must certify that all information submitted to HHS in these reports is true, accurate, and complete. The monthly reports shall not contain personally identifiable information about the enrollees in the high risk pool program.
4. No later than March 15 of the year following each period of performance, as described in Section E.1, Contractor shall provide an annual reconciliation of the difference between premiums collected plus federal payments under this Contract and claims plus allowable administrative expenses. After such reconciliation, Contractor shall report to HHS with necessary changes. To the extent the Contractor has received an excess of payments, the payments will be credited or returned to HHS. To the extent the Contractor identifies any underpayment for administrative costs, it will xxxx to and receive from HHS such underpayments subject to the limitations of the appropriation in Section 1101 of the Affordable Care Act and the estimated cost provisions of this Contract.
5. By June 30, 2011, and each June 30 thereafter, the Contractor shall submit an independently audited financial report detailing the finances of the high risk pool program operated by the Contractor.
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IMPLEMENTATION PLAN AND PROGRESS REPORTS. 1. Within calendar 10 days of award of this contract, the Contractor shall submit to the (COTR) a project implementation plan that highlights each step of implementation of this contract and that is consistent with the Contractors’ proposal. The implementation plan, at a minimum, shall include a copy of the Contractor’s draft enrollment application as well as the specific dates on which the Contractor will:
a) Announce the availability of the high risk pool program to the public;
b) Begin accepting high risk pool program enrollments; and
c) Begin to cover the claims submitted by or on behalf of high risk pool program enrollees.
2. The Contractor shall submit progress reports to HHS on the status of implementing and carrying out the high risk pool program. Reports should be submitted in a format to be provided by HHS. The first progress report will be due on the last business day of the month following the calendar quarter being reported. At a minimum, progress reports shall include:
a) Evidence that the major milestones of the implementation plan have been met and clear identification of milestones yet to be met;
b) An updated timeline for implementing the program and meeting other identified milestones;
c) Risks and problems identified or encountered by the Contractor and mitigation strategies implemented to address those risks and problems;
d) A description of the enrollment into the high risk pool program, at least broken down geographically and demographically to describe whether the enrollees in the program are representative of the eligible individuals in the State
e) The number of new enrollees into the program;
f) The number of individuals who have disenrolled from the program since the previous progress report, including the reason for the disenrollments, if known;
g) The average length of enrollment in the program;
h) A breakdown of how enrollees satisfied the pre-existing condition requirement; and
i) In the first progress report of each year, updated annual cost projections, based on actual expenditures and enrollment. If a shortfall is projected, a plan with specific cost-containment strategies will be submitted to HHS that assures high risk pool expenditures stay within allotment levels. The quarterly reports shall not contain personally identifiable information about the enrollees in the high risk pool program.
3. The Contractor shall submit monthly reports to HHS, beginning on the last business day of the month following the month of the effective date of the contract and continuing on the last business day of the month after the month being reported until the expiration of the contract. The monthly reports shall provide information on the previous calendar month of operations and contain a complete accounting of temporary high risk pool expenditures and revenue, as follows:
a) : Medical claims paid on behalf of high risk pool enrollees;
b) ; Prescription drug claims paid on behalf of high risk pool enrollees;
c) ; Estimated claims incurred but not reported;
d) ; The total number of high risk pool program enrollees;
e) ; The amount of premiums billed and the amount of premiums collected;
f) ; The amount of administrative costs;
g) ; The number of new enrollments and disenrollments,
h) , Average out-of-pocket costs for enrollees. The Contractor must certify that all information submitted to HHS in these reports is true, accurate, and complete. The monthly reports shall not contain personally identifiable information about the enrollees in the high risk pool program.
4. No later than March 15 of the year following each period of performance, as described in Section E.1, Contractor shall provide an annual reconciliation of the difference between premiums collected plus federal payments under this Contract and claims plus allowable administrative expenses. After such reconciliation, Contractor shall report to HHS with necessary changes. To the extent the Contractor has received an excess of payments, the payments will be credited or returned to HHS. To the extent the Contractor identifies any underpayment for administrative costs, it will xxxx to and receive from HHS such underpayments subject to the limitations of the appropriation in Section 1101 of the Affordable Care Act and the estimated cost provisions of this Contract.
5. By June 30, 2011, and each June 30 thereafter, the Contractor shall submit an independently audited financial report detailing the finances of the high risk pool program operated by the Contractor.
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