Common use of Information Sharing Clause in Contracts

Information Sharing. (a) HHSC will provide the MA Dual SNP with resources regarding the LTSS covered by Medicaid in accordance with this section. (b) Texas Medicaid benefits are described in Attachment B, Texas Medicaid Summary of Benefits. The MA Dual SNP must include the Texas Medicaid Summary of Benefits in its Member Handbook for the MA Product. (c) HHSC and the MA Dual SNP will identify and share information, such as the following: (1) HHSC will provide the MA Dual SNP with links to online Medicaid LTSS provider information for the traditional fee-for-service and STAR+PLUS programs. Within thirty (30) business days after receiving such information, the MA Dual SNP must post a link to this information on its website. (2) The MA Dual SNP must: A) Notify Dual Eligible Members and Other Dual SNP Members, via its member communication materials that information concerning Medicaid provider participation is available on the MA Dual SNP’s website; and B) Notify Dual Eligible Members and Other Dual SNP Members that they may request written copies of Medicaid Provider directories by contacting their STAR+PLUS MCO, C) Assist the Dual Eligible Members and Other Dual SNP Members in obtaining printed copies of Medicaid Provider directories from their STAR+PLUS MCO, and D) Verify that the Dual Eligible Members and Other Dual SNP Member received the requested directory. (3) The MA Dual SNP must notify Network Providers that information concerning Medicaid provider participation is available on the MA Dual SNP’s website. The MA Dual SNP must provide this notice in the Network Provider agreement, Network Provider manuals, bulletins, faxes, policies and procedures, provider manual updates, or other contractual documents. (4) The MA Dual SNP must have written procedures for ensuring that Dual Eligible Members and Other Dual SNP Members have access to the services identified in the MA Product, including policies regarding network adequacy that are consistent with the requirements of the MA Agreement. The MA Dual SNP must provide HHSC with a copy of these policies no later than 5 business days after a request. (d) The MA Dual SNP must encourage Network Provider SNF to electronically submit to the HHSC Medicaid claims administrator a resident transaction notice within 72 hours after a Dual Eligible Member’s admission or discharge from the nursing facility, in accordance with 40 Tex. Admin. Code § 19.2615. (e) The MA Dual SNP is required to notify HHSC of significant changes to the terms of its CMS contract within 10 business days of such changes, which may include but is not limited to the following: changes in the services areas; plan benefit package (PBP) changes; non-renewal; terminations or deficiencies of the contract; notices of intent to deny; and any novation agreements. Plans must submit any CMS warning letters or corrective action plans within 10 business days of receipt to the HHSC point-of- contact identified in Section 9.06. (f) The MA Dual SNP is required to notify HHSC in the event the Plan receives less than a 3.0 star Medicare rating on either its Part C or Part D scores. The Plan must provide an outline of the steps proposed or implemented to improve the low score. (g) The MA Dual SNP must participate in meetings with HHSC, telephonic or in person, relating to the health care provided under this Agreement and their compliance with this Agreement's terms, and to timely provide any necessary information and data upon HHSC's request. (h) The MA Dual SNP, upon request from HHSC, must provide all documents it provides to and receives from CMS, within 30 days of the HHSC request, unless an extension is granted by HHSC.

Appears in 18 contracts

Samples: Healthcare Agreements, Healthcare Agreements, Healthcare Agreements

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Information Sharing. (a) HHSC will provide the MA Dual SNP with resources regarding the LTSS covered by Medicaid in accordance with this section. (b) Texas Medicaid benefits are described in Attachment B, Texas Medicaid Summary of Benefits. The MA Dual SNP must include the Texas Medicaid Summary of Benefits in its Member Handbook for the MA Product. (c) HHSC and the MA Dual SNP will identify and share information, such as the following: (1) HHSC will provide the MA Dual SNP with links to online Medicaid LTSS provider information for the traditional fee-for-service and STAR+PLUS programs. Within thirty (30) business days after receiving such information, the MA Dual SNP must post a link to this information on its website. (2) The MA Dual SNP must: (A) Notify Dual Eligible Members and Other Dual SNP Members, via its member communication materials that information concerning Medicaid provider participation is available on the MA Dual SNP’s website; andavailable (B) Notify Dual Eligible Members and Other Dual SNP Members that they may request written copies of Medicaid Provider directories by contacting their STAR+PLUS MCO,; (C) Assist the Dual Eligible Members and Other Dual SNP Members in obtaining printed copies of Medicaid Provider directories from their STAR+PLUS MCO, ; and (D) Verify that the Dual Eligible Members and Other Dual SNP Member received the requested directory. (3) The MA Dual SNP must notify Network Providers that information concerning Medicaid provider participation is available on the MA Dual SNP’s website. The MA Dual SNP must provide this notice in the Network Provider agreement, Network Provider manuals, bulletins, faxes, policies and procedures, provider manual updates, or other contractual documents. (4) The MA Dual SNP must have written procedures for ensuring that Dual Eligible Members and Other Dual SNP Members have access to the services identified in the MA Product, including policies regarding network adequacy that are consistent with the requirements of the MA Agreement. The MA Dual SNP must provide HHSC with a copy of these policies no later than 5 five (5) business days after a request. (d) The MA Dual SNP must encourage Network Provider SNF to electronically submit to the HHSC Medicaid claims administrator a resident transaction notice within 72 hours after a Dual Eligible Member’s admission or discharge from the nursing facility, in accordance with 40 26 Tex. Admin. Code § 19.2615.§ (e) The MA Dual SNP is required to notify HHSC of significant changes to the terms of its CMS contract within 10 ten (10) business days of such changes, which may include but is not limited to the following: changes in the services areas; plan benefit package (PBP) changes; non-renewal; terminations or deficiencies of the contract; notices of intent to deny; and any novation agreements. Plans must submit any to HHSC all CMS warning letters or corrective action plans within 10 ten (10) business days of receipt to the HHSC point-of- contact identified in Section 9.06receipt. (f) The MA Dual SNP is required to notify HHSC in the event the Plan receives less than a 3.0 star Medicare rating on either its Part C or Part D scores. The Plan must provide an outline of the steps proposed or implemented to improve the low score. (g) The MA Dual SNP must participate in meetings with HHSC, telephonic or in person, relating to the health care provided under this Agreement and their compliance with this Agreement's terms, and to timely provide any necessary information and data upon HHSC's request. (h) The MA Dual SNP, upon request from HHSC, must provide all documents it provides to and receives from CMS, within 30 thirty (30) business days of the HHSC request, unless an extension is granted by HHSC.

Appears in 11 contracts

Samples: Health and Human Services Commission Contract, Health and Human Services Commission Contract, Health and Human Services Commission Contract

Information Sharing. (a) HHSC will provide the MA Dual SNP with resources regarding the LTSS covered by Medicaid in accordance with this section. (b) Texas Medicaid benefits are described in Attachment B, Texas Medicaid Summary of Benefits. The MA Dual SNP must include the Texas Medicaid Summary of Benefits in its Member Handbook for the MA Product. (c) HHSC and the MA Dual SNP will identify and share information, such as the following: (1) HHSC will provide the MA Dual SNP with links to online Medicaid LTSS provider information for the traditional fee-for-service and STAR+PLUS programs. Within thirty (30) business days after receiving such information, the MA Dual SNP must post a link to this information on its website. (2) The MA Dual SNP must: A) Notify Dual Eligible Members and Other Dual SNP Members, via its member communication materials that information concerning Medicaid provider participation is available on the MA Dual SNP’s website; and B) Notify Dual Eligible Members and Other Dual SNP Members that they may request written copies of Medicaid Provider directories by contacting their STAR+PLUS MCO, C) Assist the Dual Eligible Members and Other Dual SNP Members in obtaining printed copies of Medicaid Provider directories from their STAR+PLUS MCO, and D) Verify that the Dual Eligible Members and Other Dual SNP Member received the requested directory. (3) The MA Dual SNP must notify Network Providers that information concerning Medicaid provider participation is available on the MA Dual SNP’s website. The MA Dual SNP must provide this notice in the Network Provider agreement, Network Provider manuals, bulletins, faxes, policies and procedures, provider manual updates, or other contractual documents. (4) The MA Dual SNP must have written procedures for ensuring that Dual Eligible Members and Other Dual SNP Members have access to the services identified in the MA Product, including policies regarding network adequacy that are consistent with the requirements of the MA Agreement. The MA Dual SNP must provide HHSC with a copy of these policies no later than 5 business days after a request. (d) The MA Dual SNP must encourage Network Provider SNF skilled nursing facilities to electronically submit to the HHSC Medicaid claims administrator a resident transaction notice within 72 hours after a Dual Eligible Member’s admission or discharge from the nursing facility, in accordance with 40 Tex. Admin. Code § 19.2615. (e) The MA Dual SNP is required to notify HHSC of significant changes to the terms of its CMS contract within 10 business days of such changes, which may include but is not limited to the following: changes in the services areas; plan benefit package (PBP) changes; non-renewal; terminations or deficiencies of the contract; notices of intent to deny; and any novation agreements. Plans must submit any CMS warning letters or corrective action plans within 10 business days of receipt to the HHSC point-of- contact identified in Section 9.06. (f) The MA Dual SNP is required to notify HHSC in the event the Plan receives less than a 3.0 star Medicare rating on either its Part C or Part D scores. The Plan must provide an outline of the steps proposed or implemented to improve the low score. (g) The MA Dual SNP must participate in meetings with HHSC, telephonic or in person, relating to the health care provided under this Agreement Contract and their compliance with this AgreementContract's terms, and to timely provide any necessary information and data upon HHSC's request. (h) The MA Dual SNP, upon request from HHSC, must will provide all documents it provides to and receives from CMS, within 30 days of the HHSC request, unless an extension is granted by HHSC.

Appears in 8 contracts

Samples: Healthcare Agreements, Healthcare Agreements, Healthcare Agreements

Information Sharing. (a) HHSC will provide the MA Dual SNP with resources regarding the LTSS covered by Medicaid in accordance with this section. (b) Texas Medicaid benefits are described in Attachment B, Texas Medicaid Summary of Benefits. The MA Dual SNP must include the Texas Medicaid Summary of Benefits in its Member Handbook for the MA Product. (c) HHSC and the MA Dual SNP will identify and share information, such as the following: (1) HHSC will provide the MA Dual SNP with links to online Medicaid LTSS provider information for the traditional fee-for-service and STAR+PLUS programs. Within thirty (30) business days after receiving such information, the MA Dual SNP must post a link to this information on its website. (2) The MA Dual SNP must: A) Notify Dual Eligible Members and Other Dual SNP Members, via its member communication materials that information concerning Medicaid provider participation is available on the MA Dual SNP’s website; and; B) Notify Dual Eligible Members and Other Dual SNP Members that they may request written copies of Medicaid Provider directories by contacting their STAR+PLUS MCO,; C) Assist the Dual Eligible Members and Other Dual SNP Members in obtaining printed copies of Medicaid Provider directories from their STAR+PLUS MCO, ; and D) Verify that the Dual Eligible Members and Other Dual SNP Member received the requested directory. (3) The MA Dual SNP must notify Network Providers that information concerning Medicaid provider participation is available on the MA Dual SNP’s website. The MA Dual SNP must provide this notice in the Network Provider agreement, Network Provider manuals, bulletins, faxes, policies and procedures, provider manual updates, or other contractual documents. (4) The MA Dual SNP must have written procedures for ensuring that Dual Eligible Members and Other Dual SNP Members have access to the services identified in the MA Product, including policies regarding network adequacy that are consistent with the requirements of the MA Agreement. The MA Dual SNP must provide HHSC with a copy of these policies no later than 5 five (5) business days after a request. (d) The MA Dual SNP must encourage Network Provider SNF to electronically submit to the HHSC Medicaid claims administrator a resident transaction notice within 72 hours after a Dual Eligible Member’s admission or discharge from the nursing facility, in accordance with 40 26 Tex. Admin. Code § 19.2615554.2615. (e) The MA Dual SNP is required to notify HHSC of significant changes to the terms of its CMS contract within 10 ten (10) business days of such changes, which may include but is not limited to the following: changes in the services areas; plan benefit package (PBP) changes; non-renewal; terminations or deficiencies of the contract; notices of intent to deny; and any novation agreements. Plans must submit any to HHSC all CMS warning letters or corrective action plans within 10 ten (10) business days of receipt to the HHSC point-of- contact identified in Section 9.06receipt. (f) The MA Dual SNP is required to notify HHSC in the event the Plan receives less than a 3.0 star Medicare rating on either its Part C or Part D scores. The Plan must provide an outline of the steps proposed or implemented to improve the low score. (g) The MA Dual SNP must participate in meetings with HHSC, telephonic or in person, relating to the health care provided under this Agreement and their compliance with this Agreement's terms, and to timely provide any necessary information and data upon HHSC's request. (h) The MA Dual SNP, upon request from HHSC, must provide all documents it provides to and receives from CMS, within 30 thirty (30) business days of the HHSC request, unless an extension is granted by HHSC.

Appears in 5 contracts

Samples: Health and Human Services Commission Contract, Health and Human Services Commission Contract, Health and Human Services Commission Contract

Information Sharing. (a) HHSC will provide the MA Dual SNP with resources regarding the LTSS covered by Medicaid in accordance with this section. (b) Texas Medicaid benefits are described in Attachment B, Texas Medicaid Summary of Benefits. The MA Dual SNP must include the Texas Medicaid Summary of Benefits in its Member Handbook for the MA Product. (c) HHSC and the MA Dual SNP will identify and share information, such as the following: (1) HHSC will provide the MA Dual SNP with links to online Medicaid LTSS provider information for the traditional fee-for-service and STAR+PLUS programs. Within thirty (30) business days Business Days after receiving such information, the MA Dual SNP must post a link to this information on its website. (2) The MA Dual SNP must: (A) Notify Dual Eligible Members and Other Dual SNP Members, via its member communication materials that information concerning Medicaid provider participation is available on the MA Dual SNP’s website; andavailable (B) Notify Dual Eligible Members and Other Dual SNP Members that they may request written copies of Medicaid Provider directories by contacting their STAR+PLUS MCO,; (C) Assist the Dual Eligible Members and Other Dual SNP Members in obtaining printed copies of Medicaid Provider directories from their STAR+PLUS MCO, ; and (D) Verify that the Dual Eligible Members and Other Dual SNP Member received the requested directory. (3) The MA Dual SNP must notify Network Providers that information concerning Medicaid provider participation is available on the MA Dual SNP’s website. The MA Dual SNP must provide this notice in the Network Provider agreement, Network Provider manuals, bulletins, faxes, policies and procedures, provider manual updates, or other contractual documents. (4) The MA Dual SNP must have written procedures for ensuring that Dual Eligible Members and Other Dual SNP Members have access to the services identified in the MA Product, including policies regarding network adequacy that are consistent with the requirements of the MA Agreement. The MA Dual SNP must provide HHSC with a copy of these policies no later than 5 business days five (5) Business Days after a request. (5) The MA Dual SNP must share the Health Risk Assessment and service plan with the STAR+PLUS Aligned Medicaid MCO no later than 10 Business Days after completion of the service plan. (d) The MA Dual SNP must encourage Network Provider SNF to electronically submit to the HHSC Medicaid claims administrator a resident transaction notice within 72 hours after a Dual Eligible Member’s admission or discharge from the nursing facility, in accordance with 40 26 Tex. Admin. Code § 19.2615.§ (e) The MA Dual SNP is required to notify HHSC of significant changes to the terms of its CMS contract within 10 business days ten (10) Business Days of such changes, which may include but is not limited to the following: changes in the services areas; plan benefit package (PBP) changes; non-renewal; terminations or deficiencies of the contract; notices of intent to deny; and any novation agreements. Plans must submit any to HHSC all CMS warning letters or corrective action plans within 10 business days ten (10) Business Days of receipt to the HHSC point-of- contact identified in Section 9.06receipt. (f) The MA Dual SNP is required to notify HHSC in the event the Plan receives less than a 3.0 star Medicare rating on either its Part C or Part D scores. The Plan must provide an outline of the steps proposed or implemented to improve the low score. (g) The MA Dual SNP must participate in meetings with HHSC, telephonic or in person, relating to the health care provided under this Agreement and their compliance with this Agreement's terms, and to timely provide any necessary information and data upon HHSC's request. (h) The MA Dual SNP, upon request from HHSC, must provide all documents it provides to and receives from CMS, within 30 days thirty (30) Business Days of the HHSC request, unless an extension is granted by HHSC. (i) The MA Dual SNP must invite its STAR+PLUS Aligned Medicaid MCO to its quarterly Member Advisory Committee meetings. The MA Dual SNP must allow the Member Advisory Committee to advise the STAR+PLUS Aligned Medicaid MCO

Appears in 4 contracts

Samples: Health and Human Services Commission Contract, Health and Human Services Contract, Health and Human Services Commission Contract

Information Sharing. (a) HHSC will provide the MA Dual SNP with resources regarding the LTSS covered by Medicaid. These resources will include websites and similar resources to educate Network Providers about Medicaid in accordance with eligibility rules and LTSS covered by Medicaid for which Dual Eligible Members and Other Dual SNP Members may be eligible. Within 30 business days after receiving such information, the MA Dual SNP must post a link to this sectioninformation on its website. (b) Texas Medicaid benefits are described in Attachment B, Texas Medicaid Summary of Benefits. The MA Dual SNP must include the Texas Medicaid Summary of Benefits in its Member Handbook for the MA Product. (c) HHSC and the MA Dual SNP will identify and share information, such information on Medicaid provider participation as the following:follows. (1) HHSC will provide the MA Dual SNP with links to online Medicaid LTSS provider information for the traditional fee-for-service and STAR+PLUS programs. Within thirty (30) business days after receiving such information, the MA Dual SNP must post a link to this information on its website. (2) The MA Dual SNP must: A) Notify must notify Dual Eligible Members and Other Dual SNP Members, via its member communication materials materials, that information concerning Medicaid provider participation is available on the MA Dual SNP’s website; and B) Notify and HHSC’s websites, and that Dual Eligible Members and Other Dual SNP Members that they may request written copies of Medicaid Provider provider directories by contacting their STAR+PLUS MCO, C) Assist the Texas Medicaid enrollment broker. The MA Dual SNP must ensure this information is provided directly to members by the MA Dual SNP or through the MA Dual SNP’s providers. In addition, the MA Dual SNP must assist Dual Eligible Members and Other Dual SNP Members in obtaining printed copies of Medicaid Provider directories Directories from their the Texas Medicaid enrollment broker or STAR+PLUS MCO, and D) Verify that health plans if requested by the Dual Eligible Members and Other Dual SNP Member received the requested directorymember or his or her representative. (3) The MA Dual SNP must notify Network Providers that information concerning Medicaid provider participation is available on the MA Dual SNP’s websiteand HHSC’s websites. The MA Dual SNP must provide this notice in the Network Provider agreement, Network Provider manuals, bulletins, blast faxes, policies and procedures, provider manual updates, or other contractual documents. (4) The MA Dual SNP must have written procedures for ensuring that Dual Eligible Members and Other Dual SNP Members have access to the services identified in the MA Product, including policies regarding network adequacy that are consistent with the requirements of the MA Agreement. The MA Dual SNP must provide HHSC with a copy of these policies no later than 5 business days after a request. (d) The MA Dual SNP will provide the HHSC point-of-contact identified in Section 9.06 with the MA SNP HEDIS report submitted to CMS involving the Texas MA Product(s) within 45 calendar days of submission to CMS. Reports should be in the same format submitted to CMS. (e) The MA Dual SNP must furnish HHSC point-of-contact identified in Section 9.06 with a copy of the complaint tracking module (“CTM”) report created by CMS for all members within 30 business days of the MA Dual SNP’s receipt of this report from CMS. (f) The MA Dual SNP must encourage Network Provider SNF skilled nursing facilities to electronically submit to the HHSC Medicaid claims administrator a resident transaction notice within 72 hours after a Dual Eligible Member’s admission or discharge from the nursing facility, in accordance with 40 Tex. Admin. Code § 19.2615. (e) The MA Dual SNP is required to notify HHSC of significant changes to the terms of its CMS contract within 10 business days of such changes, which may include but is not limited to the following: changes in the services areas; plan benefit package (PBP) changes; non-renewal; terminations or deficiencies of the contract; notices of intent to deny; and any novation agreements. Plans must submit any CMS warning letters or corrective action plans within 10 business days of receipt to the HHSC point-of- contact identified in Section 9.06. (f) The MA Dual SNP is required to notify HHSC in the event the Plan receives less than a 3.0 star Medicare rating on either its Part C or Part D scores. The Plan must provide an outline of the steps proposed or implemented to improve the low score. (g) The MA Dual SNP must participate in meetings with HHSC, telephonic or in person, relating to the health care provided under this Agreement and their compliance with this Agreement's terms, and to timely provide any necessary information and data upon HHSC's request. (h) The MA Dual SNP, upon request from HHSC, must provide all documents it provides to and receives from CMS, within 30 days of the HHSC request, unless an extension is granted by HHSC.

Appears in 2 contracts

Samples: Health Services Agreement, Health Services Agreement

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Information Sharing. (a) HHSC will provide the MA Dual SNP with resources regarding the LTSS covered by Medicaid in accordance with this section. (b) Texas Medicaid benefits are described in Attachment B, Texas Medicaid Summary of Benefits. The MA Dual SNP must include the Texas Medicaid Summary of Benefits in its Member Handbook for the MA Product. (c) HHSC and the MA Dual SNP will identify and share information, such as the following: (1) HHSC will provide the MA Dual SNP with links to online Medicaid LTSS provider information for the traditional fee-for-service and STAR+PLUS programs. Within thirty (30) business days Business Days after receiving such information, the MA Dual SNP must post a link to this information on its website. (2) The MA Dual SNP must: (A) Notify Dual Eligible Members and Other Dual SNP Members, via its member communication materials that information concerning Medicaid provider participation is available on the MA Dual SNP’s website; andavailable (B) Notify Dual Eligible Members and Other Dual SNP Members that they may request written copies of Medicaid Provider directories by contacting their STAR+PLUS MCO,; (C) Assist the Dual Eligible Members and Other Dual SNP Members in obtaining printed copies of Medicaid Provider directories from their STAR+PLUS MCO, ; and (D) Verify that the Dual Eligible Members and Other Dual SNP Member received the requested directory. (3) The MA Dual SNP must notify Network Providers that information concerning Medicaid provider participation is available on the MA Dual SNP’s website. The MA Dual SNP must provide this notice in the Network Provider agreement, Network Provider manuals, bulletins, faxes, policies and procedures, provider manual updates, or other contractual documents. (4) The MA Dual SNP must have written procedures for ensuring that Dual Eligible Members and Other Dual SNP Members have access to the services identified in the MA Product, including policies regarding network adequacy that are consistent with the requirements of the MA Agreement. The MA Dual SNP must provide HHSC with a copy of these policies no later than 5 business days five (5) Business Days after a request. (5) The MA Dual SNP must share the Health Risk Assessment and service plan with the STAR+PLUS Aligned Medicaid MCO no later than 10 Business Days after completion of the service plan. (d) The MA Dual SNP must encourage Network Provider SNF to electronically submit to the HHSC Medicaid claims administrator a resident transaction notice within 72 hours after a Dual Eligible Member’s admission or discharge from the nursing facility, in accordance with 40 Tex. Admin. Code § 19.2615554.2615. (e) The MA Dual SNP is required to notify HHSC of significant changes to the terms of its CMS contract within 10 business days ten (10) Business Days of such changes, which may include but is not limited to the following: changes in the services areas; plan benefit package (PBP) changes; non-renewal; terminations or deficiencies of the contract; notices of intent to deny; and any novation agreements. Plans must submit any to HHSC all CMS warning letters or corrective action plans within 10 business days ten (10) Business Days of receipt to the HHSC point-of- contact identified in Section 9.06receipt. (f) The MA Dual SNP is required to notify HHSC in the event the Plan receives less than a 3.0 star Medicare rating on either its Part C or Part D scores. The Plan must provide an outline of the steps proposed or implemented to improve the low score. (g) The MA Dual SNP must participate in meetings with HHSC, telephonic or in person, relating to the health care provided under this Agreement and their compliance with this Agreement's terms, and to timely provide any necessary information and data upon HHSC's request. (h) The MA Dual SNP, upon request from HHSC, must provide all documents it provides to and receives from CMS, within 30 days thirty (30) Business Days of the HHSC request, unless an extension is granted by HHSC. (i) The MA Dual SNP must invite its STAR+PLUS Aligned Medicaid MCO to its quarterly Member Advisory Committee meetings. The MA Dual SNP must allow the Member Advisory Committee to advise the STAR+PLUS Aligned Medicaid MCO

Appears in 2 contracts

Samples: Health and Human Services Commission Contract, Health and Human Services Commission Contract

Information Sharing. (a) HHSC will provide the MA Dual SNP with resources regarding the LTSS covered by Medicaid in accordance with this section. (b) Texas Medicaid benefits are described in Attachment B, Texas Medicaid Summary of Benefits. The MA Dual SNP must include the Texas Medicaid Summary of Benefits in its Member Handbook for the MA Product. (c) HHSC and the MA Dual SNP will identify and share information, such as the following: (1) HHSC will provide the MA Dual SNP with links to online Medicaid LTSS provider information for the traditional fee-for-service and STAR+PLUS programs. Within thirty (30) business days after receiving such information, the MA Dual SNP must post a link to this information on its website. (2) The MA Dual SNP must: A) Notify Dual Eligible Members and Other Dual SNP Members, via its member communication materials that information concerning Medicaid provider participation is available on the MA Dual SNP’s website; and B) Notify Dual Eligible Members and Other Dual SNP Members that they may request written copies of Medicaid Provider directories by contacting their STAR+PLUS MCO, C) Assist the Dual Eligible Members and Other Dual SNP Members in obtaining printed copies of Medicaid Provider directories from their STAR+PLUS MCO, and D) Verify that the Dual Eligible Members and Other Dual SNP Member received the requested directory. (3) The MA Dual SNP must notify Network Providers that information concerning Medicaid provider participation is available on the MA Dual SNP’s website. The MA Dual SNP must provide this notice in the Network Provider agreement, Network Provider manuals, bulletins, faxes, policies and procedures, provider manual updates, or other contractual documents. (4) The MA Dual SNP must have written procedures for ensuring that Dual Eligible Members and Other Dual SNP Members have access to the services identified in the MA Product, including policies regarding network adequacy that are consistent with the requirements of the MA Agreement. The MA Dual SNP must provide HHSC with a copy of these policies no later than 5 business days after a request. (d) The MA Dual SNP must encourage Network Provider SNF skilled nursing facilities to electronically submit to the HHSC Medicaid claims administrator a resident transaction notice within 72 hours after a Dual Eligible Member’s admission or discharge from the nursing facility, in accordance with 40 Tex. Admin. Code § 19.2615.. DocuSign Envelope ID: (e) The MA Dual SNP is required to notify HHSC of significant changes to the terms of its CMS contract within 10 business days of such changes, which may include but is not limited to the following: changes in the services areas; plan benefit package (PBP) changes; non-renewal; terminations or deficiencies of the contract; notices of intent to deny; and any novation agreements. Plans must submit any CMS warning letters or corrective action plans within 10 business days of receipt to the HHSC point-of- contact identified in Section 9.06. (f) The MA Dual SNP is required to notify HHSC in the event the Plan receives less than a 3.0 star Medicare rating on either its Part C or Part D scores. The Plan must provide an outline of the steps proposed or implemented to improve the low score. (g) The MA Dual SNP must participate in meetings with HHSC, telephonic or in person, relating to the health care provided under this Agreement Contract and their compliance with this AgreementContract's terms, and to timely provide any necessary information and data upon HHSC's request. (h) The MA Dual SNP, upon request from HHSC, must will provide all documents it provides to and receives from CMS, within 30 days of the HHSC request, unless an extension is granted by HHSC.

Appears in 1 contract

Samples: Healthcare Agreements

Information Sharing. (a) HHSC will provide the MA Dual SNP with resources regarding the LTSS covered by Medicaid in accordance with this section. (b) Texas Medicaid benefits are described in Attachment B, Texas Medicaid Summary of Benefits. The MA Dual SNP must include the Texas Medicaid Summary of Benefits in its Member Handbook for the MA Product. (c) HHSC and the MA Dual SNP will identify and share information, such as the following: (1) HHSC will provide the MA Dual SNP with links to online Medicaid LTSS provider information for the traditional fee-for-service and STAR+PLUS programs. Within thirty (30) business days Business Days after receiving such information, the MA Dual SNP must post a link to this information on its website. (2) The MA Dual SNP must: (A) Notify Dual Eligible Members and Other Dual SNP Members, via its member communication materials that information concerning Medicaid provider participation is available on the MA Dual SNP’s website; andavailable (B) Notify Dual Eligible Members and Other Dual SNP Members that they may request written copies of Medicaid Provider directories by contacting their STAR+PLUS MCO,; (C) Assist the Dual Eligible Members and Other Dual SNP Members in obtaining printed copies of Medicaid Provider directories from their STAR+PLUS MCO, ; and (D) Verify that the Dual Eligible Members and Other Dual SNP Member received the requested directory. (3) The MA Dual SNP must notify Network Providers that information concerning Medicaid provider participation is available on the MA Dual SNP’s website. The MA Dual SNP must provide t this notice in the Network Provider agreement, Network Provider manuals, bulletins, faxes, policies and procedures, provider manual updates, or other contractual documents. (4) The MA Dual SNP must have written procedures for ensuring that Dual Eligible Members and Other Dual SNP Members have access to the services identified in the MA Product, including policies regarding network adequacy that are consistent with the requirements of the MA Agreement. The MA Dual SNP must provide HHSC with a copy of these policies no later than 5 business days five (5) Business Days after a request. (5) The MA Dual SNP must share the Health Risk Assessment and service plan with the STAR+PLUS Aligned Medicaid MCO no later than 10 Business Days after completion of the service plan. (d) The MA Dual SNP must encourage Network Provider SNF to electronically submit to the HHSC Medicaid claims administrator a resident transaction notice within 72 hours after a Dual Eligible Member’s admission on or discharge from the nursing facility, in accordance with 40 26 Tex. Admin. Code § 19.2615.§ (e) The MA Dual SNP is required to notify HHSC of significant changes to the terms of its CMS contract within 10 business days ten (10) Business Days of such changes, which may include but is not limited to the following: changes in the services areas; plan benefit package (PBP) changes; non-renewal; terminations or deficiencies of the contract; notices of intent to deny; and any novation agreements. Plans must submit any to HHSC all CMS warning letters or corrective action plans within 10 business days ten (10) Business Days of receipt to the HHSC point-of- contact identified in Section 9.06receipt. (f) The MA Dual SNP is required to notify HHSC in the event the Plan receives less than a 3.0 star Medicare rating on either its Part C or Part D scores. The Plan must provide an outline of the steps proposed or implemented to improve the low score. (g) The MA Dual SNP must participate in meetings with HHSC, telephonic or in person, relating to the health care provided under this Agreement and their compliance with this Agreement's terms, and to timely provide any necessary information and data upon HHSC's request. (h) The MA Dual SNP, upon request from HHSC, must provide all documents it provides to and receives from CMS, within 30 days thirty (30) Business Days of the HHSC request, unless an extension is granted by HHSC. (i) The MA Dual SNP must invite its STAR+PLUS Aligned Medicaid MCO to its quarterly Member Advisory Committee meetings. The MA Dual SNP must allow the Member Advisory Committee to advise the STAR+PLUS Aligned Medicaid MCO

Appears in 1 contract

Samples: Health and Human Services Commission Contract

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