Operational/Policy Developments/Issues. Identify all significant program developments/issues/problems that have occurred in the current quarter, including but not limited to approval and contracting with new plans, benefit changes, and legislative activity.
Operational/Policy Developments/Issues. Identify all significant program developments/issues/problems that have occurred in the current quarter or anticipated to occur in the near future that affect health care delivery, including but not limited to, approval and contracting with new plans, benefit changes, enrollment; grievances; proposed or implemented LOC changes; quality of care; access; changes in provider qualification standards; access; proposed changes to payment rates; health plan financial performance that is relevant to the demonstration; and other operational issues. Also identify all significant policy and legislative developments/issues/problems that have occurred in the current quarter or anticipated to occur in the near future. Expenditure Containment Initiatives Identify all current activities, by program and or demonstration population. Include items such as status, and impact to date as well as short and long term challenges, successes and goals.
Operational/Policy Developments/Issues. Identify all significant program developments/issues/problems that have occurred in the current quarter, including but not limited to: approval and contracting with new plans; benefit changes; legislative activity; Healthy Behaviors program benefits by health plan and participation rates; network adequacy including customer service reporting; complaints, grievances and appeals; reporting on managed care plans critical incidents, efforts to promote alignment or integration for Medicare-Medicaid eligible individuals. Consumer Issues Provide a summary of the types of complaints or problems consumers identified about the program in the current quarter. Include any trends discovered, the resolution of complaints, and any actions taken or to be taken to prevent other occurrences. Identify and address any appeals related to medical necessity under the EPSDT benefit.
Operational/Policy Developments/Issues. Identify all significant program developments/issues/problems that have occurred in the current quarter or anticipated to occur in the near future that affect health care delivery, including but not limited to: systems and reporting issues, MetroHealth operations (such as network adequacy, assignment of a PCMH, contract amendments and rate certifications); approval and contracting with new plans; health care delivery; benefits; enrollment; grievances; quality of care; access; proposed changes to payment rates; proposed or implemented changes to the enrollment limit and/or state-specified income eligibility standard; health plan financial performance that is relevant to the demonstration; pertinent legislative activity; and other operational issues. Summarize the development, implementation, and administration of any action plans for addressing issues related to the demonstration. Include a discussion of the status of action plans implemented in previous periods until resolved. Provide any updates on the state’s monitoring, oversight, auditing, and training of eligibility determinations conducted by MetroHealth employees. Provide updates on the number of individuals who are disenrolled for lack of income verification documents.
