Common use of Oversight and Monitoring Clause in Contracts

Oversight and Monitoring. i. The organization’s Medical Director shall be involved in the review and oversight of access system policies and clinical practices. ii. The organization shall assure that the access system staff are qualified, credentialed and trained consistent with the Medicaid Provider Manual, MIChild Provider Manual, the Michigan Mental Health Code, the Michigan Public Health Code, and this contract35. iii. The organization shall have mechanisms to prevent conflict of interest between the coverage determination function and access to, or authorization of, services. iv. The organization shall monitor provider capacity to accept new individuals, and be aware of any provider organizations not accepting referrals at any point in time36. v. The organization shall routinely measure telephone answering rates, call abandonment rates and timeliness of appointments and referrals. Any resulting performance issues are addressed through the organization’s Quality Improvement Plan. vi. The organization shall assure that the access system maintains medical records in compliance with state and federal standards37. vii. The organization staff shall work with individuals, families, local communities, and others to address barriers to using the access system, including those caused by lack of transportation38.

Oversight and Monitoring. i. The organization’s Medical Director shall be involved in the review and oversight of access system policies and clinical practices. ii. The organization shall assure that the access system staff are qualified, credentialed and trained consistent with the Medicaid Provider Manual, MIChild XXXxxxx Provider Manual, the Michigan Mental Health Code, the Michigan Public Health Code, and this contract35contract21. iii. The organization shall have mechanisms to prevent conflict of interest between the coverage determination function and access to, or authorization of, services. iv. The organization shall monitor provider capacity to accept new individuals, and be aware of any provider organizations not accepting referrals at any point in time36time22. v. The organization shall routinely measure telephone answering rates, call abandonment rates and timeliness of appointments and referrals. Any resulting performance issues are addressed through the organization’s Quality Improvement Plan. vi. The organization shall assure that the access system maintains medical records in compliance with state and federal standards37standards23. vii. The organization staff shall work with individuals, families, local communities, and others to address barriers to using the access system, including those caused by lack of transportation38transportation.