Participating Plan Selection Sample Clauses
Participating Plan Selection. CMS and the Commonwealth shall contract with qualified Participating Plans on a selective basis. See Appendix 7 for more information on the plan selection process.
Participating Plan Selection. California, in consultation with CMS, drafted a Request for Solutions that included all of the California and CMS requirements to become a Prime Contractor Plan under this Demonstration. California and CMS engaged in a joint selection process that considered previous performance in Medicare and Medi-Cal and ensured that bidders met CMS’ requirements, as specified in this MOU. The State selection criteria included the following mandatory qualifications:
a. Applicant has a current ▇▇▇▇ ▇▇▇▇▇ Act License or is a county organized health system.
b. Applicant is in good financial standing with DMHC.
c. Applicant has experience operating a Medicare Dual Eligible Special Needs Plan (D-SNP) in the county in which it is applying in the last three years, or applicant has not operated a D-SNP in the county in which it is applying in the last three years but agrees to work in good faith to meet all D-SNP requirements by the time the Demonstration begins.
d. Applicant has a current Medi-Cal contract with DHCS. Applicant will coordinate with relevant entities to ensure coverage of the entire county’s population of duals.
e. Applicant has listed all sanctions and penalties taken by Medicare or a state of California government entity in the last five years.
f. Applicant is not under sanction by Centers for Medicare & Medicaid Services within California.
g. Applicant currently holds, or will work in good faith to achieve National Committee for Quality Assurance (NCQA) Managed Care Accreditation by the end of the third year of the Demonstration.
h. Applicant will provide complete and accurate encounter data to support the monitoring and evaluation of the Demonstration.
i. Applicant has certified that it intends to fully comply with all state and Federal disability accessibility and civil rights laws, including but not limited to the ADA and the Rehabilitation Act of 1973.
j. Applicant has demonstrated its establishment of a local stakeholder process that includes health plans, providers, community programs, consumers, and other interested stakeholders regarding the development, implementation, and continued operation of the Demonstration. The State evaluated the responses to the Request for Solutions and identified counties and plans that met the State’s criteria.1 Applicants were also required to meet the Medicare components of plan selection process, including submission of a successful Capitated Financial Alignment Application to CMS, and adherence to annual contractual r...
Participating Plan Selection. The State procurement and CMS plan selection process has been utilized to identify entities that will be eligible to contract with CMS and the State. California applicants were permitted to contract with Medicare Advantage Prescription Drug (MA-PD) plans (“Subcontracted Plans”) and other subcontracted plan partners to offer enrollees multiple plan benefit packages. See Appendix 7 for more information on the plan selection process.
Participating Plan Selection. The DMAS procurement and CMS plan selection process will be utilized to select entities that will be eligible to contract with CMS and the Commonwealth. CMS and DMAS shall contract with qualified Participating Plans on a selective basis. See Appendix 7 for more information on the plan selection process.