Common use of Management Information System Requirements Clause in Contracts

Management Information System Requirements. The MCO must maintain a Management Information System (MIS) that supports all functions of the MCO’s processes and procedures for the flow and use of MCO data. If the MCO subcontracts a MIS function, the Subcontractor’s MIS must comply with the requirements of this section. The MCO must have hardware, software, and a network and communications system with the capability and capacity to handle and operate all MIS subsystems for the following operational and administrative areas: 1. Enrollment/Eligibility Subsystem; 2. Provider Subsystem; 3. Encounter/Claims Processing Subsystem; 4. Financial Subsystem; 5. Utilization/Quality Improvement Subsystem; 6. Reporting Subsystem; 7. Interface Subsystem; and 8. TPL/TPR Subsystem, as applicable to each MCO Program. The MIS must enable the MCO to meet the Contract requirements, including all applicable state and federal laws, rules, and regulations. The MIS must have the capacity and capability to capture and utilize various data elements required for MCO administration. The MCO must have a system that can be adapted to changes in Business Practices/Policies within the timeframes negotiated by the Parties. The MCO is expected to cover the cost of such systems modifications over the life of the Contract. The MCO is required to participate in the HHSC Systems Work Group. The MCO must provide HHSC written notice of major systems changes and implementations no later than 180 days prior to the planned change or implementation, including any changes relating to Material Subcontractors, in accordance with the requirements of this Contract and Attachment A, "Uniform Managed Care Contract Terms and Conditions." HHSC retains the right to modify or waive the notification requirement contingent upon the nature of the request from the MCO. The MCO must provide HHSC any updates to the MCO’s organizational chart relating to MIS and the description of MIS responsibilities at least 30 days prior to the effective date of the change. The MCO must provide HHSC official points of contact for MIS issues on an ongoing basis. HHSC, or its agent, may conduct a Systems Readiness Review to validate the MCO’s ability to meet the MIS requirements as described in Section 7, “Transition Phase Requirements.” The System Readiness Review may include a desk review and/or an onsite review and must be conducted for the following events: 1. a new plan is brought into the MCO Program; 2. an existing plan begins business in a new Service Area or a Service Area expansion; 3. an existing plan changes location; 4. an existing plan changes its processing system, including changes in Material Subcontractors performing MIS or claims processing functions; and 5. an existing plan in one (1) or two (2) HHSC MCO Programs is initiating a Contract to participate in any additional MCO Programs. If HHSC determines that it is necessary to conduct an onsite review, the MCO is responsible for all reasonable travel costs associated with such onsite reviews. For purposes of this section, “reasonable travel costs” include airfare, lodging, meals, car rental and fuel, taxi, mileage, parking, and other incidental travel expenses incurred by HHSC or its authorized agent in connection with the onsite reviews. This provision does not limit HHSC’s ability to collect other costs as damages in accordance with Attachment A, Section 12.02(e), “Damages.” If for any reason an MCO does not fully meet the MIS requirements, then the MCO must, upon request by HHSC, either correct such deficiency or submit to HHSC a Corrective Action Plan and Risk Mitigation Plan to address such deficiency. Immediately upon identifying a deficiency, HHSC may impose contractual remedies according to the severity of the deficiency. Refer to Attachment A, "Uniform Managed Care Contract Terms and Conditions," Article 12 and Attachment B-3, “Deliverables/Liquidated Damages Matrix,” for additional information regarding remedies and damages. Refer to Section 7, “Transition Phase Requirements,” and Section 8.1.1.2, “Additional Readiness Reviews and Monitoring Efforts,” for additional information regarding MCO Readiness Reviews. Refer to Attachment A, "Uniform Managed Care Contract Terms and Conditions," Section 4.08(c) for information regarding Readiness Reviews of the MCO’s Material Subcontractors.

Management Information System Requirements. The MCO HMO must maintain a Management Information System (MIS) that supports all functions of the MCOHMO’s processes and procedures for the flow and use of MCO HMO data. If the MCO subcontracts a MIS function, the Subcontractor’s MIS must comply with the requirements of this section. The MCO HMO must have hardware, software, and a network and communications system with the capability and capacity to handle and operate all MIS subsystems for the following operational and administrative areas: 1. Enrollment/Eligibility Subsystem; 2. Provider Subsystem; 3. Encounter/Claims Processing Subsystem; 4. Financial Subsystem; 5. Utilization/Quality Improvement Subsystem; 6. Reporting Subsystem; 7. Interface Subsystem; and 8. TPL/TPR Subsystem, as applicable to each MCO HMO Program. The MIS must enable the MCO HMO to meet the Contract requirements, including all applicable state and federal laws, rules, and regulations. The MIS must have the capacity and capability to capture and utilize various data elements required for MCO HMO administration. HHSC will provide the HMO with pharmacy data on the HMO’s Members on a weekly basis through the HHSC Vendor Drug Program, or should these services be outsourced, through the Pharmacy Benefit Manager. HHSC will provide a sample format of pharmacy data to contract awardees. The MCO HMO must have a system that can be adapted to changes in Business Practices/Policies within the timeframes negotiated by the Parties. The MCO HMO is expected to cover the cost of such systems modifications over the life of the Contract. The MCO HMO is required to participate in the HHSC Systems Work Group. The MCO HMO must provide HHSC prior written notice of major systems changes and implementations implementations, no later than 180 days prior to the planned change or implementation, including any changes relating to Material Subcontractors, in accordance with the requirements of this Contract and Attachment A, "the Uniform Managed Care Contract Terms and Conditions." . HHSC retains the right to modify or waive the notification requirement contingent upon the nature of the request from the MCOHMO. The MCO HMO must provide HHSC any updates to the MCOHMO’s organizational chart relating to MIS and the description of MIS responsibilities at least 30 days prior to the effective date of the change. The MCO HMO must provide HHSC official points of contact for MIS issues on an ongoing on-going basis. HHSC, or its agent, may conduct a Systems Readiness Review to validate the MCOHMO’s ability to meet the MIS requirements as described in Attachment B-1, Section 7, “Transition Phase Requirements.” . The System Readiness Review may include a desk review and/or an onsite review and must be conducted for the following events: 1. a A new plan is brought into the MCO HMO Program; 2. an An existing plan begins business in a new Service Area or a Service Area expansionArea; 3. an An existing plan changes location; 4. an An existing plan changes its processing system, including changes in Material Subcontractors performing MIS or claims processing functions; and 5. an An existing plan in one (1) or two (2) HHSC MCO HMO Programs is initiating a Contract to participate in any additional MCO HMO Programs. If HHSC determines that it is necessary to conduct an onsite review, the MCO HMO is responsible for all reasonable travel costs associated with such onsite reviews. For purposes of this section, “reasonable travel costs” include airfare, lodging, meals, car rental and fuel, taxi, mileage, parking, and other incidental travel expenses incurred by HHSC or its authorized agent in connection with the onsite reviews. This provision does not limit HHSC’s ability to collect other costs as damages in accordance with Attachment A, Section 12.02(e), “Damages.” If for any reason an MCO reason, a HMO does not fully meet the MIS requirements, then the MCO HMO must, upon request by HHSC, either correct such deficiency or submit to HHSC a Corrective Action Plan and Risk Mitigation Plan to address such deficiencydeficiency as requested by HHSC. Immediately upon identifying a deficiency, HHSC may impose contractual remedies and either actual or liquidated damages according to the severity of the deficiency. HHSC may also freeze enrollment into the HMO’s plan for any of its HMO Programs until such deficiency is corrected. Refer to Attachment A, "Uniform Managed Care Contract Terms and Conditions," Article 12 and Attachment B-3, “Deliverables/Liquidated Damages Matrix,” B-5 for additional information regarding remedies and damages. Refer to Attachment X-0, Xxxxxxx 0 xxx Xxxxxxxxxx X-0, Section 7, “Transition Phase Requirements,” and Section 8.1.1.2, “Additional Readiness Reviews and Monitoring Efforts,” 8.1.1.2 for additional information regarding MCO HMO Readiness Reviews. Refer to Attachment A, "Uniform Managed Care Contract Terms and Conditions," Section 4.08(c) for information regarding Readiness Reviews of the MCOHMO’s Material Subcontractors.

Management Information System Requirements. The MCO HMO must maintain a Management Information System (MIS) that supports all functions of the MCOHMO’s processes and procedures for the flow and use of MCO HMO data. If the MCO subcontracts a MIS function, the Subcontractor’s MIS must comply with the requirements of this section. The MCO HMO must have hardware, software, and a network and communications system with the capability and capacity to handle and operate all MIS subsystems for the following operational and administrative areas: 1. Enrollment/Eligibility Subsystem; 2. Provider Subsystem; 3. Encounter/Claims Processing Subsystem; 4. Financial Subsystem; 5. Utilization/Quality Improvement Subsystem; 6. Reporting Subsystem; 7. Interface Subsystem; and 8. TPL/TPR Subsystem, as applicable to each MCO HMO Program. The MIS must enable the MCO HMO to meet the Contract requirements, including all applicable state and federal laws, rules, and regulations. The MIS must have the capacity and capability to capture and utilize various data elements required for MCO HMO administration. HHSC will provide the HMO with pharmacy data on the HMO’s Members on a weekly basis through the HHSC Vendor Drug Program, or should these services be outsourced, through the Pharmacy Benefit Manager. HHSC will provide a sample format of pharmacy data to contract awardees. The MCO HMO must have a system that can be adapted to changes in Business Practices/Policies within the timeframes negotiated by the Parties. The MCO HMO is expected to cover the cost of such systems modifications over the life of the Contract. The MCO HMO is required to participate in the HHSC Systems Work Group. The MCO HMO must provide HHSC prior written notice of major systems changes changes, generally within 90 days, and implementations no later than 180 days prior to the planned change or implementationimplementations, including any changes relating to Material Subcontractors, in accordance with the requirements of this Contract and Attachment A, "the Uniform Managed Care Contract Terms and Conditions." HHSC retains the right to modify or waive the notification requirement contingent upon the nature of the request from the MCO. The MCO HMO must provide HHSC any updates to the MCOHMO’s organizational chart relating to MIS and the description of MIS responsibilities at least 30 days prior to the effective date of the change. The MCO HMO must provide HHSC official points of contact for MIS issues on an ongoing on-going basis. HHSC, or its agent, may conduct a Systems Readiness Review to validate the MCOHMO’s ability to meet the MIS requirements as described in Attachment B-1, Section 7, “Transition Phase Requirements.” . The System Readiness Review may include a desk review and/or an onsite review and must be conducted for the following events: 1. a new plan is brought into the MCO Program; 2. an existing plan begins business in a new Service Area or a Service Area expansion; 3. an existing plan changes location; 4. an existing plan changes its processing system, including changes in Material Subcontractors performing MIS or claims processing functions; and 5. an existing plan in one (1) or two (2) HHSC MCO Programs is initiating a Contract to participate in any additional MCO Programs. If HHSC determines that it is necessary to conduct an onsite review, the MCO is responsible for all reasonable travel costs associated with such onsite reviews. For purposes of this section, “reasonable travel costs” include airfare, lodging, meals, car rental and fuel, taxi, mileage, parking, and other incidental travel expenses incurred by HHSC or its authorized agent in connection with the onsite reviews. This provision does not limit HHSC’s ability to collect other costs as damages in accordance with Attachment A, Section 12.02(e), “Damages.” If for any reason an MCO does not fully meet the MIS requirements, then the MCO must, upon request by HHSC, either correct such deficiency or submit to HHSC a Corrective Action Plan and Risk Mitigation Plan to address such deficiency. Immediately upon identifying a deficiency, HHSC may impose contractual remedies according to the severity of the deficiency. Refer to Attachment A, "Uniform Managed Care Contract Terms and Conditions," Article 12 and Attachment B-3, “Deliverables/Liquidated Damages Matrix,” for additional information regarding remedies and damages. Refer to Section 7, “Transition Phase Requirements,” and Section 8.1.1.2, “Additional Readiness Reviews and Monitoring Efforts,” for additional information regarding MCO Readiness Reviews. Refer to Attachment A, "Uniform Managed Care Contract Terms and Conditions," Section 4.08(c) for information regarding Readiness Reviews of the MCO’s Material Subcontractors.

Management Information System Requirements. The MCO HMO must maintain a Management Information System (MIS) that supports all functions of the MCOHMO’s processes and procedures for the flow and use of MCO HMO data. If the MCO subcontracts a MIS function, the Subcontractor’s MIS must comply with the requirements of this section. The MCO HMO must have hardware, software, and a network and communications system with the capability and capacity to handle and operate all MIS subsystems for the following operational and administrative areas: 1. Enrollment/Eligibility Subsystem; 2. Provider Subsystem; 3. Encounter/Claims Processing Subsystem; 4. Financial Subsystem; 5. Utilization/Quality Improvement Subsystem; 6. Reporting Subsystem; 7. Interface Subsystem; and 8. TPL/TPR Subsystem, as applicable to each MCO HMO Program. The MIS must enable the MCO HMO to meet the Contract requirements, including all applicable state and federal laws, rules, and regulations. The MIS must have the capacity and capability to capture and utilize various data elements required for MCO HMO administration. HHSC will provide the HMO with pharmacy data on the HMO’s Members on a weekly basis through the HHSC Vendor Drug Program, or should these services be outsourced, through the Pharmacy Benefit Manager. HHSC will provide a sample format of pharmacy data to contract awardees. The MCO HMO must have a system that can be adapted to changes in Business Practices/Policies within the timeframes negotiated by the Parties. The MCO HMO is expected to cover the cost of such systems modifications over the life of the Contract. The MCO HMO is required to participate in the HHSC Systems Work Group. The MCO HMO must provide HHSC prior written notice of major systems changes changes, generally within 90 days, and implementations no later than 180 days prior to the planned change or implementationimplementations, including any changes relating to Material Subcontractors, in accordance with the requirements of this Contract and Attachment A, "the Uniform Managed Care Contract Terms and Conditions." . Responsible Office: HHSC retains the right to modify or waive the notification requirement contingent upon the nature Office of the request from the MCO. General Counsel (OGC) Subject: Attachment B-1 – HHSC Joint Medicaid/CHIP HMO RFP, Section 8 Version 1.0 The MCO HMO must provide HHSC any updates to the MCOHMO’s organizational chart relating to MIS and the description of MIS responsibilities at least 30 days prior to the effective date of the change. The MCO HMO must provide HHSC official points of contact for MIS issues on an ongoing on-going basis. HHSC, or its agent, may conduct a Systems Readiness Review to validate the MCOHMO’s ability to meet the MIS requirements as described in Attachment B-1, Section 7, “Transition Phase Requirements.” . The System Readiness Review may include a desk review and/or an onsite review and must be conducted for the following events: 1. a A new plan is brought into the MCO HMO Program; 2. an An existing plan begins business in a new Service Area or a Service Area expansionArea; 3. an An existing plan changes location; 4. an An existing plan changes its processing system, including changes in Material Subcontractors performing MIS or claims processing functions; and 5. an An existing plan in one (1) or two (2) HHSC MCO HMO Programs is initiating a Contract to participate in any additional MCO HMO Programs. If HHSC determines that it is necessary to conduct an onsite review, the MCO is responsible for all reasonable travel costs associated with such onsite reviews. For purposes of this section, “reasonable travel costs” include airfare, lodging, meals, car rental and fuel, taxi, mileage, parking, and other incidental travel expenses incurred by HHSC or its authorized agent in connection with the onsite reviews. This provision does not limit HHSC’s ability to collect other costs as damages in accordance with Attachment A, Section 12.02(e), “Damages.” If for any reason an MCO reason, a HMO does not fully meet the MIS requirements, then the MCO HMO must, upon request by HHSC, either correct such deficiency or submit to HHSC a Corrective Action Plan and Risk Mitigation Plan to address such deficiencydeficiency as requested by HHSC. Immediately upon identifying a deficiency, HHSC may impose contractual remedies and either actual or liquidated damages according to the severity of the deficiency. HHSC may also freeze enrollment into the HMO’s plan for any of its HMO Programs until such deficiency is corrected. Refer to Attachment A, "the Uniform Managed Care Contract Terms and Conditions," Article 12 Conditions and Attachment B-3, “Deliverables/Liquidated Damages Matrix,” B-5 for additional information regarding remedies and damages. Refer to Section 7, “Transition Phase Requirements,” and Section 8.1.1.2, “Additional Readiness Reviews and Monitoring Efforts,” for additional information regarding MCO Readiness Reviews. Refer to Attachment A, "Uniform Managed Care Contract Terms and Conditions," Section 4.08(c) for information regarding Readiness Reviews of the MCO’s Material Subcontractorsinformation.

Management Information System Requirements. The MCO must maintain a Management Information System (MIS) that supports all functions of the MCO’s processes and procedures for the flow and use of MCO data. If the MCO subcontracts a MIS function, the Subcontractor’s MIS must comply with the requirements of this section. The MCO must have hardware, software, and a network and communications system with the capability and capacity to handle and operate all MIS subsystems for the following operational and administrative areas: 1. Enrollment/Eligibility Subsystem; 2. Provider Subsystem; 3. Encounter/Claims Processing Subsystem; 4. Financial Subsystem; 5. Utilization/Quality Improvement Subsystem; 6. Reporting Subsystem; 7. Interface Subsystem; and 8. TPL/TPR Subsystem, as applicable to each MCO Program. The MIS must enable the MCO to meet the Contract requirements, including all applicable state and federal laws, rules, and regulations. The MIS must have the capacity and capability to capture and utilize various data elements required for MCO administration. The MCO must have a system that can be adapted to changes in Business Practices/Policies within the timeframes negotiated by the Parties. The MCO is expected to cover the cost of such systems modifications over the life of the Contract. The MCO is required to participate in the HHSC Systems Work Group. The MCO must provide HHSC written notice of major systems changes Major Systems Changes and implementations no later than 180 days prior to the planned change or implementation, including any changes relating to Material Subcontractors, in accordance with the requirements of this Contract and Attachment A, "Uniform Managed Care Contract Terms and Conditions." The MCO must notify HHSC of Major Systems Changes in writing, as well as by e-mail to HPM staff. The notification must detail the following. • The aspects of the system that will be changed and date of implementation • How these changes will affect the Provider and Member community, if applicable • The communication channels that will be used to notify these communities, if applicable • A contingency plan in the event of downtime of system(s) Major Systems Changes are subject to HHSC desk review and onsite review of the MCO's facilities as necessary to test readiness and functionality prior to implementation. Prior to HHSC approval of the Major Systems Change, the MCO may not implement any changes to its operating systems. Failure to comply will result in contractual remedies, including damages. HHSC retains the right to modify or waive the notification requirement contingent upon the nature of the request from the MCO. The MCO must provide HHSC any updates to the MCO’s organizational chart relating to MIS and the description of MIS responsibilities at least 30 days prior to the effective date of the change. The MCO must provide HHSC official points of contact for MIS issues on an ongoing basis. HHSC, or its agent, may conduct a Systems Readiness Review to validate the MCO’s ability to meet the MIS requirements as described in Section 7, “Transition Phase Requirements.” The System Readiness Review may include a desk review and/or an onsite review and must be conducted for the following events: 1. a new plan is brought into the MCO Program; 2. an existing plan begins business in a new Service Area or a Service Area expansion; 3. an existing plan changes location; 4. an existing plan changes its processing system, including changes in Material Subcontractors performing MIS or claims processing functions; and 5. an existing plan in one (1) or two (2) HHSC MCO Programs is initiating a Contract to participate in any additional MCO Programs. If HHSC determines that it is necessary to conduct an onsite review, the MCO is responsible for all reasonable travel costs associated with such onsite reviews. For purposes of this section, “reasonable travel costs” include airfare, lodging, meals, car rental and fuel, taxi, mileage, parking, and other incidental travel expenses incurred by HHSC or its authorized agent in connection with the onsite reviews. This provision does not limit HHSC’s ability to collect other costs as damages in accordance with Attachment A, Section 12.02(e), “Damages.” If for any reason an MCO does not fully meet the MIS requirements, then the MCO must, upon request by HHSC, either correct such deficiency or submit to HHSC a Corrective Action Plan and Risk Mitigation Plan to address such deficiency. Immediately upon identifying a deficiency, HHSC may impose contractual remedies according to the severity of the deficiency. Refer to Attachment A, "Uniform Managed Care Contract Terms and Conditions," Article 12 and Attachment B-3, “Deliverables/Liquidated Damages Matrix,” for additional information regarding remedies and damages. Refer to Section 7, “Transition Phase Requirements,” and Section 8.1.1.2, “Additional Readiness Reviews and Monitoring Efforts,” for additional information regarding MCO Readiness Reviews. Refer to Attachment A, "Uniform Managed Care Contract Terms and Conditions," Section 4.08(c) for information regarding Readiness Reviews of the MCO’s Material Subcontractors.

Management Information System Requirements. The MCO HMO must maintain a Management Information System (MIS) that supports all functions of the MCOHMO’s processes and procedures for the flow and use of MCO HMO data. If the MCO subcontracts a MIS function, the Subcontractor’s MIS must comply with the requirements of this section. The MCO HMO must have hardware, software, and a network and communications system with the capability and capacity to handle and operate all MIS subsystems for the following operational and administrative areas: 1. Enrollment/Eligibility Subsystem; 2. Provider Subsystem; 3. Encounter/Claims Processing Subsystem; 4. Financial Subsystem; 5. Utilization/Quality Improvement Subsystem; 6. Reporting Subsystem; 7. Interface Subsystem; and 8. TPL/TPR Subsystem, as applicable to each MCO HMO Program. The MIS must enable the MCO HMO to meet the Contract requirements, including all applicable state and federal laws, rules, and regulations. The MIS must have the capacity and capability to capture and utilize various data elements required for MCO HMO administration. HHSC will provide the HMO with pharmacy data on the HMO’s Members on a weekly basis through the HHSC Vendor Drug Program, or should these services be outsourced, through the Pharmacy Benefit Manager. HHSC will provide a sample format of pharmacy data to contract awardees. The MCO HMO must have a system that can be adapted to changes in Business Practices/Policies within the timeframes negotiated by the Parties. The MCO HMO is expected to cover the cost of such systems modifications over the life of the Contract. The MCO HMO is required to participate in the HHSC Systems Work Group. The MCO HMO must provide HHSC prior written notice of major systems changes and implementations implementations, no later than 180 days prior to the planned change or implementationimplentation, including any changes relating to Material Subcontractors, in accordance with the requirements of this Contract and Attachment A, "the Uniform Managed Care Contract Terms and Conditions." HHSC retains the right to modify or waive the notification requirement contingent upon the nature of the request from the MCO. The MCO HMO must provide HHSC any updates to the MCOHMO’s organizational chart relating to MIS and the description of MIS responsibilities at least 30 days prior to the effective date of the change. The MCO HMO must provide HHSC official points of contact for MIS issues on an ongoing on-going basis. HHSC, or its agent, may conduct a Systems Readiness Review to validate the MCOHMO’s ability to meet the MIS requirements as described in Section Attachment B-1,Section 7, “Transition Phase Requirements.” . The System Readiness Review may include a desk review and/or an onsite review and must be conducted for the following events: 1. a A new plan is brought into the MCO HMO Program; 2. an An existing plan begins business in a new Service Area or a Service Area expansionArea; 3. an An existing plan changes location; 4. an An existing plan changes its processing system, including changes in Material Subcontractors performing MIS or claims processing functions; and 5. an An existing plan in one (1) or two (2) HHSC MCO HMO Programs is initiating a Contract to participate in any additional MCO HMO Programs. If HHSC determines that it is necessary to conduct an onsite review, the MCO is responsible for all reasonable travel costs associated with such onsite reviews. For purposes of this section, “reasonable travel costs” include airfare, lodging, meals, car rental and fuel, taxi, mileage, parking, and other incidental travel expenses incurred by HHSC or its authorized agent in connection with the onsite reviews. This provision does not limit HHSC’s ability to collect other costs as damages in accordance with Attachment A, Section 12.02(e), “Damages.” If for any reason an MCO reason, a HMO does not fully meet the MIS requirements, then the MCO HMO must, upon request by HHSC, either correct such deficiency or submit to HHSC a Corrective Action Plan and Risk Mitigation Plan to address such deficiencydeficiency as requested by HHSC. Immediately upon identifying a deficiency, HHSC may impose contractual remedies and either actual or liquidated damages according to the severity of the deficiency. HHSC may also freeze enrollment into the HMO’s plan for any of its HMO Programs until such deficiency is corrected. Refer to Attachment A, "Uniform Managed Care Contract Terms and Conditions," Article 12 and Attachment B-3, “Deliverables/Liquidated Damages Matrix,” B-5 for additional information regarding remedies and damages. Refer to Attachment X-0, Xxxxxxx 0 xxx Xxxxxxxxxx X-0, Section 7, “Transition Phase Requirements,” and Section 8.1.1.2, “Additional Readiness Reviews and Monitoring Efforts,” 8.1.1.2 for additional information regarding MCO HMO Readiness Reviews. Refer to Attachment A, "Uniform Managed Care Contract Terms and Conditions," Section 4.08(c) for information regarding Readiness Reviews of the MCOHMO’s Material Subcontractors.

Management Information System Requirements. The MCO HMO must maintain a Management Information System (MIS) that supports all functions of the MCOHMO’s processes and procedures for the flow and use of MCO HMO data. If the MCO subcontracts a MIS function, the Subcontractor’s MIS must comply with the requirements of this section. The MCO HMO must have hardware, software, and a network and communications system with the capability and capacity to handle and operate all MIS subsystems for the following operational and administrative areas: 1. Enrollment/Eligibility Subsystem; 2. Provider Subsystem; 3. Encounter/Claims Processing Subsystem; 4. Financial Subsystem; 5. Utilization/Quality Improvement Subsystem; 6. Reporting Subsystem; 7. Interface Subsystem; and 8. TPL/TPR Subsystem, as applicable to each MCO HMO Program. The MIS must enable the MCO HMO to meet the Contract requirements, including all applicable state and federal laws, rules, and regulations. The MIS must have the capacity and capability to capture and utilize various data elements required for MCO HMO administration. HHSC will provide the HMO with pharmacy data on the HMO’s Members on a weekly basis through the HHSC Vendor Drug Program, or should these services be outsourced, through the Pharmacy Benefit Manager. HHSC will provide a sample format of pharmacy data to contract awardees. The MCO HMO must have a system that can be adapted to changes in Business Practices/Policies within the timeframes negotiated by the Parties. The MCO HMO is expected to cover the cost of such systems modifications over the life of the Contract. The MCO HMO is required to participate in the HHSC Systems Work Group. The MCO HMO must provide HHSC prior written notice of major systems changes changes, generally within 90 days, and implementations no later than 180 days prior to the planned change or implementationimplementations, including any changes relating to Material Subcontractors, in accordance with the requirements of this Contract and Attachment A, "the Uniform Managed Care Contract Terms and Conditions." HHSC retains the right to modify or waive the notification requirement contingent upon the nature of the request from the MCO. The MCO HMO must provide HHSC any updates to the MCOHMO’s organizational chart relating to MIS and the description of MIS responsibilities at least 30 days prior to the effective date of the change. The MCO HMO must provide HHSC official points of contact for MIS issues on an ongoing on-going basis. HHSC, or its agent, may conduct a Systems Readiness Review to validate the MCOHMO’s ability to meet the MIS requirements as described in Attachment B-1, Section 7, “Transition Phase Requirements.” . The System Readiness Review may include a desk review and/or an onsite review and must be conducted for the following events: 1. a A new plan is brought into the MCO HMO Program; 2. an An existing plan begins business in a new Service Area or a Service Area expansionArea; 3. an An existing plan changes location; 4. an An existing plan changes its processing system, including changes in Material Subcontractors performing MIS or claims processing functions; and 5. an An existing plan in one (1) or two (2) HHSC MCO HMO Programs is initiating a Contract to participate in any additional MCO HMO Programs. If HHSC determines that it is necessary to conduct an onsite review, the MCO is responsible for all reasonable travel costs associated with such onsite reviews. For purposes of this section, “reasonable travel costs” include airfare, lodging, meals, car rental and fuel, taxi, mileage, parking, and other incidental travel expenses incurred by HHSC or its authorized agent in connection with the onsite reviews. This provision does not limit HHSC’s ability to collect other costs as damages in accordance with Attachment A, Section 12.02(e), “Damages.” If for any reason an MCO reason, a HMO does not fully meet the MIS requirements, then the MCO HMO must, upon request by HHSC, either correct such deficiency or submit to HHSC a Corrective Action Plan and Risk Mitigation Plan to address such deficiencydeficiency as requested by HHSC. Immediately upon identifying a deficiency, HHSC may impose contractual remedies and either actual or liquidated damages according to the severity of the deficiency. HHSC may also freeze enrollment into the HMO’s plan for any of its HMO Programs until such deficiency is corrected. Refer to Attachment A, "the Uniform Managed Care Contract Terms and Conditions," Article 12 Conditions and Attachment B-3, “Deliverables/Liquidated Damages Matrix,” B-5 for additional information regarding remedies and damages. Refer to Section 7, “Transition Phase Requirements,” and Section 8.1.1.2, “Additional Readiness Reviews and Monitoring Efforts,” for additional information regarding MCO Readiness Reviews. Refer to Attachment A, "Uniform Managed Care Contract Terms and Conditions," Section 4.08(c) for information regarding Readiness Reviews of the MCO’s Material Subcontractorsinformation.