Common use of Oversight Framework Clause in Contracts

Oversight Framework. i. Under the Demonstration, there will be a CMS-State Contract Management Team that will ensure access, quality, program integrity, compliance with applicable laws, including but not limited to the Emergency Medical Treatment and Active Labor Act (EMTALA) and the ADA, and financial solvency, including reviewing and acting on data and reports, conducting studies, and taking corrective action. CMS and the State will require Demonstration Plans to have a comprehensive plan to detect, correct, prevent, and report fraud, waste, and abuse. Demonstration Plans must have policies and procedures in place to identify and address fraud, waste, and abuse at both the Demonstration Plan and the third-party levels in the delivery of Demonstration benefits, including prescription drugs, medical care, behavioral health, and LTSS. In addition, all Medicare Part D requirements and many Medicare Advantage requirements regarding oversight, monitoring, and program integrity will be applied to Demonstration Plans by CMS in the same way they are currently applied for PDP sponsors and Medicare Advantage organizations. These responsibilities are not meant to detract from or weaken any current State or CMS oversight responsibilities, including oversight by the Medicare Drug Benefit Group and other relevant CMS groups and divisions, as those responsibilities continue to apply, but rather to assure that such responsibilities are undertaken in a coordinated manner. Neither party shall take a unilateral enforcement action relating to day-to-day oversight without notifying the other party in advance.

Oversight Framework. i. Under the Demonstration, there will be a CMS-State Contract Management Team that will ensure access, quality, program integrity, compliance with applicable laws, including but not limited to the Emergency Medical Treatment and Active Labor Act (EMTALA) and the ADA, and financial solvency, including reviewing and acting on data and reports, conducting studies, and taking corrective action. CMS and the State MDCH will require Demonstration Plans ICOs to have a comprehensive plan to detect, correct, prevent, and report fraud, waste, and abuse. Demonstration Plans ICOs must have policies and procedures in place to identify and address fraud, waste, and abuse at both the Demonstration Plan plan and the third-party levels in the delivery of Demonstration benefits, including prescription drugs, medical care, behavioral health, and LTSSlong term services and supports. In addition, all Medicare Part D requirements and many Medicare Advantage requirements regarding oversight, monitoring, and program integrity will be applied to Demonstration Plans ICOs by CMS in the same way they are currently applied for PDP Prescription Drug Plan (PDP) sponsors and Medicare Advantage organizations. These responsibilities are not meant to detract from or weaken any current State or CMS oversight responsibilities, including oversight by the Medicare Drug Benefit Group and other relevant CMS groups and divisions, as those responsibilities continue to apply, but rather to assure that such responsibilities are undertaken in a coordinated manner. Neither party shall take a unilateral enforcement action relating to day-to-day oversight without notifying the other party in advance.