Common use of Network Reporting Clause in Contracts

Network Reporting. AHS shall review variable definitions used by DVHA and any relevant reporting by DVHA’s contractors relative to beneficiary access to services to ensure that providers enrolled in the Vermont Medicaid Program offers an appropriate range of covered services adequate for the anticipated number of enrollees for a given service area; and that it the network of providers that is sufficient in number, mix and geographic distribution to meet the needs of the enrollees in the service area. At the time it enters this IGA, and on a quarterly basis, DVHA will provide AHS with a network adequacy report that includes: geographic service area, a summary of all complaints received through DVHA's member services call center and maps that show provider-to-member ratios for primary care providers and specialists in the network. Whenever a significant change has been made to the provider network, DVHA will notify AHS immediately. DVHA and its IGA Partners will assure that a system, policies and procedures are in place through which providers must identify report and investigate critical incidents that occur within the delivery of Choices for Care Program services. Providers will also be educated about systems to prevent, detect and report, investigate and remediate abuse, neglect and exploitation for persons receiving Choices for Care Program services.

Network Reporting. AHS shall review variable definitions used by DVHA and any relevant reporting by DVHA’s contractors relative to beneficiary access to services to ensure that providers enrolled in the Vermont Medicaid Program offers an appropriate range of covered services adequate for the anticipated number of enrollees for a given service area; and that it the network of providers that is sufficient in number, mix and geographic distribution to meet the needs of the enrollees in the service area. At the time it enters this IGA, and on a quarterly basis, DVHA will provide AHS with a network adequacy report that includes: includes geographic service area, a summary of all complaints received through DVHA's member services call center and maps that show provider-to-member ratios for primary care providers and specialists in the network. Whenever a significant change has been made to the provider network, DVHA will notify AHS immediately. DVHA and its IGA Partners will assure that a system, policies and procedures are in place through which providers must identify report and investigate critical incidents that occur within the delivery of Choices for Care Program services. Providers will also be educated about systems to prevent, detect and report, investigate and remediate abuse, neglect and exploitation for persons receiving Choices for Care Program services.