OPERATIONS PHASE REQUIREMENTS Sample Clauses

OPERATIONS PHASE REQUIREMENTS. 8-14 8.1 General Scope of Work....................................................................................8-14

OPERATIONS PHASE REQUIREMENTS. This Section describes Scope of Work requirements for the Operations Phase of the Contract.

OPERATIONS PHASE REQUIREMENTS. This Section is designed to provide HMOs with sufficient information to understand the HMOs' responsibilities. This Section describes scope of work requirements for the Operations Phase of the Contract.

OPERATIONS PHASE REQUIREMENTS. This Section is designed to provide HMOs with sufficient information to understand the HMOs' responsibilities. This Section describes scope of work requirements for the Operations Phase of the Contract. Section 8.1 includes the general scope of work that applies to the STAR, STAR+PLUS, CHIP, and CHIP Perinatal HMO Programs. Section 8.2 includes the additional Medicaid scope of work that applies only to the STAR and STAR+PLUS HMOs. Section 8.3 includes the additional scope of work that applies only to STAR+PLUS HMOs. Section 8.4 includes the additional scope of work that applies only to CHIP HMOs. Section 8.5 includes the additional scope of work that applies only to CHIP Perinatal HMOs. The Section does not include detailed information on the STAR, STAR+PLUS, CHIP, and CHIP Perinatal HMO Program requirements, such as the time frame and format for all reporting requirements. HHSC has included this information in the Uniform Managed Care Contract Terms and Conditions (Attachment A) and the Uniform Managed Care Manual. HHSC reserves the right to modify these documents as it deems necessary using the procedures set forth in the Uniform Managed Care Contract Terms and Conditions.

OPERATIONS PHASE REQUIREMENTS. This Section describes Scope of Work requirements for the Operations Phase of the Contract. Section 8.1 includes the general Scope of Work that applies to all MCO Programs (STAR, STAR+PLUS, and CHIP). Section 8.2 includes the additional Medicaid Scope of Work that applies only to the STAR and STAR+PLUS MCOs. Section 8.3 includes the additional Scope of Work that applies only to STAR+PLUS MCOs. Section 8.4 includes the additional CHIP Scope of Work that applies only to CHIP MCOs. The CHIP Perinatal Program is a CHIP subprogram. CHIP Program requirements apply to the CHIP Perinatal Program, unless the Contract otherwise indicates. Additional information regarding the STAR, STAR+PLUS, and CHIP Program requirements, such as reporting timeframes and formats is included in Attachment A, "Uniform Managed Care Contract Terms and Conditions," and the Uniform Managed Care Manual. HHSC reserves the right to modify these documents as it deems necessary using the procedures set forth in the Attachment A, “Uniform Managed Care Contract Terms and Conditions.”

OPERATIONS PHASE REQUIREMENTS. 8-14 8.1 General Scope of Work ...................................................................................... 8-14 8.1.1 Administration and Contract Management ................................................ 8-14 8.1.2 Covered Services ...................................................................................... 8-16 8.1.3 Access to Care .......................................................................................... 8-19 8.1.4 Provider Network ....................................................................................... 8-25 8.1.5 Member Services ....................................................................................... 8-37 8.1.6 Marketing and Prohibited Practices ........................................................... 8-45 8.1.7 Quality Assessment and Performance Improvement ................................ 8-45 8.1.8 Utilization Management ............................................................................. 8-49 8.1.9 Early Childhood Intervention (ECI) ............................................................ 8-51 8.1.10 Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) - Specific Requirements .................................................................. 8-52 8.1.11 Coordination with Texas Department of Family and Protective Services .. 8-53 8.1.12 Services for People with Special Health Care Needs ................................ 8-54 8.1.13 Service Management for Certain Populations ........................................... 8-56 8.1.14 Disease Management (DM) ....................................................................... 8-57 8.1.15 Behavioral Health (BH) Network and Services .......................................... 8-58 8.1.16 Financial Requirements for Covered Services .......................................... 8-62 8.1.17 Accounting and Financial Reporting Requirements ................................... 8-62 8.1.18 Management Information System Requirements ...................................... 8-68 8.1.19 Fraud and Abuse ....................................................................................... 8-75 8.1.20 General Reporting Requirements .............................................................. 8-78 8.1.21 Pharmacy Services .................................................................................... 8-82

OPERATIONS PHASE REQUIREMENTS. This Section is designed to provide HMOs with sufficient information to understand the HMOs’ responsibilities. This Section describes scope of work requirements for the Operations Phase of the Contract. Section 8.1 includes the general scope of work that applies to both the STAR and CHIP HMO Programs. Section 8.2 includes the additional Medicaid scope of work that applies only to STAR HMOs. Section 8.3 includes the additional scope of work that applies only to CHIP HMOs. The Section does not include detailed information on the STAR and CHIP HMO Program requirements, such as the time frame and format for all reporting requirements. HHSC has included this information in the Uniform Managed Care Contract Terms and Conditions (Attachment A) and the Uniform Managed Care Manual. HHSC reserves the right to modify these documents as it deems necessary using the procedures set forth in the Uniform Managed Care Contract Terms and Conditions.