Participating Plan Contract Management Sample Clauses

Participating Plan Contract Management. As more fully discussed in Appendix 7, CMS and California agree to designate representatives to serve on a CMS-State Contract Management team which shall conduct plan contract management activities related to ensuring access, quality, program integrity, program compliance, and financial solvency.
Sample 1
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Participating Plan Contract Management. CMS and the State agree to designate representatives to serve on a CMS-State Contract Management Team which shall conduct MSHO contract management activities related to ensuring access, quality, program integrity, program compliance, and financial solvency.‌  Reviewing reports of beneficiary complaints, reviewing compliance with applicable CMS and/or State Medicaid agency standards, and initiating programmatic changes as appropriate.  Reviewing and analyzing reports on MSHO Plans’ network adequacy, including the Plans’ ongoing efforts to replenish their networks and to continually enroll qualified providers.  Reviewing input from stakeholders and the Minnesota Ombudsman for Managed Care on both plan-specific and systematic performance.  Responding to and investigating beneficiary complaints and quality of care issues.  Addressing issues or concerns that arise from changes in policy that may impact the Demonstration and/or cause misalignment of the Medicare and Medicaid programs that may harm Beneficiaries’ access to care and services.
Sample 1
Participating Plan Contract Management. As more fully discussed in Appendix 7, CMS and DMAS agree to designate representatives to serve on a CMS-Commonwealth Contract Management team which shall conduct Participating Plan contract management activities related to ensuring access, quality, program integrity, program compliance, and financial solvency.
Sample 1
Participating Plan Contract Management. CMS and the State agree to designate representatives to serve on a CMS-State Contract Management Team which shall conduct MSHO contract management activities related to ensuring access, quality, program integrity, program compliance, and financial solvency.
Sample 1
Participating Plan Contract Management. As more fully discussed in Appendix 7, CMS and the Commonwealth agree to designate representatives to serve on a CMS-State Contract Management team which shall conduct Participating Plan contract management activities related to ensuring access, quality, program integrity, program compliance, and financial solvency. These activities shall include but not be limited to: Reviewing and analyzing Health Care Effectiveness Data and Information Set (HEDIS) data, Consumer Assessment of Health Care Providers and Systems (CAHPS) Survey data, Health Outcomes Survey (HOS) data, enrollment and disenrollment reports. Reviewing any other performance metrics applied for quality withhold or other purposes. Reviewing reports of Enrollee complaints, reviewing compliance with applicable CMS and/or State Medicaid Agency standards, and initiating programmatic changes and/or changes in clinical protocols, as appropriate. Reviewing and analyzing reports on Participating Plans’ fiscal operations and financial solvency, conducting program integrity studies to monitor fraud, waste and abuse as may be agreed upon by CMS and the Commonwealth, and ensuring that Participating Plans take corrective action, as appropriate. Reviewing and analyzing reports on Participating Plans’ network adequacy, including the Plans’ ongoing efforts to replenish their networks and to continually enroll qualified providers. Reviewing any other applicable ratings and measures. Responding to and investigating beneficiary complaints and quality of care issues.
Sample 1

Related to Participating Plan Contract Management

  • Project Management Plan 3.2.1 Developer is responsible for all quality assurance and quality control activities necessary to manage the Work, including the Utility Adjustment Work. Developer shall undertake all aspects of quality assurance and quality control for the Project and Work in accordance with the approved Project Management Plan, Good Industry Practice and applicable Law. 3.2.2 Developer shall develop the Project Management Plan and its component parts, plans and other documentation in accordance with the requirements set forth in Section 1.5.2.5

  • Contract Management To ensure full performance of the Contract and compliance with applicable law, the System Agency may take actions including: a. Suspending all or part of the Contract; b. Requiring the Grantee to take specific corrective actions in order to remain in compliance with term of the Contract; c. Recouping payments made to the Grantee found to be in error; d. Suspending, limiting, or placing conditions on the continued performance of the Project; e. Imposing any other remedies authorized under this Contract; and f. Imposing any other remedies, sanctions or penalties permitted by federal or state statute, law, regulation, or rule.

  • Construction Management Plan Contractor shall prepare and furnish to the Owner a thorough and complete plan for the management of the Project from issuance of the Proceed Order through the issuance of the Design Professional's Certificate of Material Completion. Such plan shall include, without limitation, an estimate of the manpower requirements for each trade and the anticipated availability of such manpower, a schedule prepared using the critical path method that will amplify and support the schedule required in Article 2.1.5 below, and the Submittal Schedule as required in Article 2.2.3. The Contractor shall include in his plan the names and resumés of the Project Superintendent, Project Manager and the person in charge of Safety.

  • STATEWIDE CONTRACT MANAGEMENT SYSTEM If the maximum amount payable to Contractor under this Contract is $100,000 or greater, either on the Effective Date or at any time thereafter, this section shall apply. Contractor agrees to be governed by and comply with the provisions of §§00-000-000, 00-000-000, 00-000-000, and 00- 000-000, C.R.S. regarding the monitoring of vendor performance and the reporting of contract information in the State’s contract management system (“Contract Management System” or “CMS”). Contractor’s performance shall be subject to evaluation and review in accordance with the terms and conditions of this Contract, Colorado statutes governing CMS, and State Fiscal Rules and State Controller policies.

  • Program Management 1.1.01 Implement and operate an Immunization Program as a Responsible Entity 1.1.02 Identify at least one individual to act as the program contact in the following areas: 1. Immunization Program Manager;

  • Contract Manager The Contract Manager for the Board is Xxxxxxx Xxxxx. The Contract Manager for the Contractor is the Contractor. The parties shall direct all matters arising in connection with the performance of this Agreement, other than notices, to the attention of the Contract Managers for attempted resolution or action. The Contract Managers shall be responsible for overall resolution, action, coordination, and oversight relating to the performance of this Agreement.

  • In-Service Education The parties recognize the value of in-service both to the employee and the Employer and shall encourage employees to participate in in-service. All employees scheduled by the Employer to attend in-service seminars shall receive regular wages.

  • Medical Services Plan Regular Full-Time and Temporary Full-Time Employees shall be entitled to be covered under the Medical Services Plan commencing the first day of the calendar month following the date of employment. The City shall pay one hundred percent (100%) of the premiums required by the plan.

  • Administration Services When a medical prescription drug is administered by infusion, the administration of the prescription drug may be covered separately from the prescription drug. See Infusion Therapy - Administration Services in the Summary of Medical Benefits for benefit limits and the amount you pay. Prescription drugs that are self-administered are not covered as a medical benefit but may be covered as a pharmacy benefit. Please see Pharmacy Prescription Drugs and Diabetic Equipment or Supplies – Pharmacy Benefits section above for additional information. For some medical prescription drugs, after the first administration, coverage may be limited to certain locations (for example, a designated outpatient or ambulatory service facility, physician’s office, or your home), provided the location is appropriate based on your medical status. For a list of medical prescription drugs that are subject to this Site of Care Program, visit our website. Preauthorization may be required to determine medical necessity as well as appropriate site of care. If we deny your request for preauthorization, or you disagree with our determination for the appropriate site of care, you can submit a medical appeal. See Appeals in Section 5 for information on how to file a medical appeal.

  • Management Plan The Management Plan is the description and definition of the phasing, sequencing and timing of the major Individual Project activities for design, construction procurement, construction and occupancy as described in the IPPA.

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