MCO Performance. The MCO is expected to meet or exceed all BMS’ objectives and standards, as set forth in the Contract. All areas of responsibility and all Contract requirements will be subject to performance evaluation by BMS. A designated representative of the MCO and a designated representative of BMS may meet as requested by either party, to review the performance of the MCO under this Contract. Written minutes of such meetings will be kept. In the event of any disagreement regarding the performance of services by the MCO under this Contract, the designated representatives must discuss the performance problem and negotiate in good faith in an effort to resolve the disagreement. For purposes of this Contract, an item of non-compliance/non-performance means a specific action of the MCO or its Subcontractor, agent and/or consultant that: • Violates a provision of this Contract including Appendices; • Fails to meet an agreed measure of performance and/or standard; or • Represents a failure of the MCO to be reasonably responsive to a reasonable request of BMS for information, assistance, or support within the timeframe specified by BMS. Non-performance of this Contract includes, but not limited to: • Failing substantially to provide Medically Necessary covered services that the MCO is required to provide, under law or under its Contract with BMS, to an enrollee covered under the Contract; • Imposing premiums, copays, or charges to enrollees that are in excess of the premiums, copays, or charges permitted under the Medicaid or WVCHIP program; • Acting to discriminate among enrollees on the basis of their health status or need for health care services, including terminating of enrollment or refusal to reenroll an enrollee, except as permitted under the Medicaid program, or any practice that would reasonably be expected to discourage enrollment by enrollees whose medical condition or history indicates probable need for substantial future medical services; • Misrepresenting or falsifying information that the MCO furnishes to CMS or to the State; • Misrepresenting or falsifying of information that the MCO furnishes to an enrollee, potential enrollee, or health care provider; • Distributing directly, or indirectly through any agent or independent contractor, marketing materials that have not been approved by the State or that contain false or materially misleading information; • Failing to maintain an adequate network of properly credentialed providers; • Failing to comply with t...
