Common use of Prerequisite to Enrolling Enrollees Clause in Contracts

Prerequisite to Enrolling Enrollees. The Department reserves the right to conduct a thorough readiness review prior to the enrollment of Medicaid Enrollees with the Contractor and its Subcontractors to ensure the Contractor and its Subcontractors are able and prepared to perform all administrative functions and to provide high quality services to Enrollees. Readiness reviews may include desk reviews of materials, policies, and procedures; systems demonstrations; onsite reviews; and interviews of staff. The Department reserves the right to also conduct onsite reviews in Subcontractor facilities. Specifically, the Department will assess the Contractor’s ability and readiness to, at a minimum, meet the requirements set forth in the Contract, Commonwealth requirements, and federal requirements outlined in 42 C.F.R. 438.66. The Department will designate a multi-disciplinary readiness review team, which may include DMS staff, sister agency representatives, and contract staff. The Department will establish and provide to the Contractor the timeline for conduct of the readiness reviews, including Contractor requirements. The Contractor and its Subcontractors shall meet all required timelines for submission of requested materials and deliverables to the Department, be responsive to questions within designated timeframes, and provide adequate space and facilities for conduct of onsite reviews. The Contractor shall include all staff and Subcontractor representatives in readiness review meetings or onsite reviews as identified and requested by the Department. The Department will provide the Contractor with a summary of findings and identified areas requiring remedial attention or corrective action. The Contractor shall develop a plan and relevant timelines for addressing the identified issues. The Department may conduct follow up reviews to assess the effectiveness of the Contractor’s implemented plan and subsequent readiness.