Provider Network Services. The PIHP is responsible for maintaining and continually evaluating an effective provider network adequate to fulfill the obligations of this contract. The PIHP remains the accountable party for the Medicaid beneficiaries in its service area, regardless of the functions it has delegated to its CSSNs and its provider networks. In this regard, the PIHP agrees to: A. Maintain a regular means of communicating and providing information on changes in policies and procedures to its providers. This may include guidelines for answering written correspondence to providers, offering provider-dedicated phone lines, and a regular provider newsletter; B. Have clearly written mechanisms to address provider grievances and complaints, and an appeal system to resolve disputes. C. Provide a copy of the PIHP's prior authorization policies to the provider when the provider joins the PIHP's provider network. The PIHP must notify providers of any changes to prior authorization policies as changes are made. D. Provide a copy of the PIHP's grievance, appeal and fair hearing procedures and timeframes to the provider when the provider joins the PIHP's provider network. The PIHP must notify providers of any changes to those procedures or timeframes. E. Provide to MDCH in the format specified by MDCH, provider agency information profiles that contain a complete listing and description of the provider network available to recipients in the service area. F. Notify MDCH within seven (7) days of any changes to the composition of the provider network organizations. PIHPs shall have procedures to address changes in its network that negatively affect access to care. Changes in provider network composition that MDCH determines to negatively affect recipient access to covered services may be grounds for sanctions. G. Assure that the provider network responds to the cultural, racial, and linguistic needs (including interpretive services as necessary) of the service area, and make oral interpretation services available free of charge to each potential beneficiary. This applies to all non-English languages not just those that the State identifies as prevalent. Each entity must notify its beneficiaries how to access oral interpretation services. H. Assure that services are accessible, taking into account travel time, availability of public transportation, and other factors that may determine accessibility. I. Assure that network providers do not segregate PIHP individuals in any way from other people receiving their services.
Appears in 2 contracts
Samples: Medicaid Managed Specialty Supports and Services Concurrent Waiver Program Agreement, Medicaid Managed Specialty Supports and Services Concurrent Waiver Program Agreement
Provider Network Services. The PIHP is responsible for maintaining and continually evaluating an effective provider network adequate to fulfill the obligations of this contract. The PIHP remains the accountable party for the Medicaid beneficiaries in its service area, regardless of the functions it has delegated to its CSSNs and its provider networks. In this regard, the PIHP agrees to:
A. Maintain a regular means of communicating and providing information on changes in policies and procedures to its providers. This may include guidelines for answering written correspondence to providers, offering provider-dedicated phone lines, and a regular provider newsletter;
B. Have clearly written mechanisms to address provider grievances and complaints, and an appeal system to resolve disputes.
C. Provide a copy of the PIHP's prior authorization policies to the provider when the provider joins the PIHP's provider network. The PIHP must notify providers of any changes to prior authorization policies as changes are made.
D. Provide a copy of the PIHP's grievance, appeal and fair hearing procedures and timeframes to the provider when the provider joins the PIHP's provider network. The PIHP must notify providers of any changes to those procedures or timeframes.
E. Provide to MDCH in the format specified by MDCH, provider agency information profiles that contain a complete listing and description of the provider network available to recipients in the service area.
F. Notify MDCH within seven (7) days of any changes to the composition of the provider network organizations. PIHPs shall have procedures to address changes in its network that negatively affect access to care. Changes in provider network composition that MDCH determines to negatively affect recipient access to covered services may be grounds for sanctions.
G. Assure that the provider network responds to the cultural, racial, and linguistic needs (including interpretive services as necessary) of the service area, and make oral interpretation services available free of charge to each potential beneficiary. This applies to all non-English languages not just those that the State identifies as prevalent. Each entity must notify its beneficiaries how to access oral interpretation services.
H. Assure that services are accessible, taking into account travel time, availability of public transportation, and other factors that may determine accessibility.
I. Assure that network providers do not segregate PIHP individuals in any way from other people receiving their services.
J. Annually evaluate providers who perform delegated functions.
K. The PIHP shall assure HIPAA compliant access to information about persons receiving services in their contractual residential settings by individuals who have completed training and are working under the auspices of the Dignified Lifestyles Community Connections program.
Appears in 1 contract
Samples: Medicaid Managed Specialty Supports and Services Concurrent Waiver Program Agreement
Provider Network Services. The PIHP is responsible for maintaining and continually evaluating an effective provider network adequate to fulfill the obligations of this contract. The PIHP remains the accountable party for the Medicaid beneficiaries in its service area, regardless of the functions it has delegated to its CSSNs and its provider networks. In this regard, the PIHP agrees to:
A. Maintain a regular means of communicating and providing information on changes in policies and procedures to its providers. This may include guidelines for answering written correspondence to providers, offering provider-dedicated phone lines, and a regular provider newsletter;
B. Have clearly written mechanisms to address provider grievances and complaints, and an appeal system to resolve disputes.
C. Provide a copy of the PIHP's prior authorization policies to the provider when the provider joins the PIHP's provider network. The PIHP must notify providers of any changes to prior authorization policies as changes are made.
D. Provide a copy of the PIHP's grievance, appeal and fair hearing procedures and timeframes to the provider when the provider joins the PIHP's provider network. The PIHP must notify providers of any changes to those procedures or timeframes.
E. Provide to MDCH in the format specified by MDCH, provider agency information profiles that contain a complete listing and description of the provider network available to recipients in the service area.
F. Notify MDCH within seven (7) days of any changes to the composition of the provider network organizations. PIHPs shall have procedures to address changes in its network that negatively affect access to care. Changes in provider network composition that MDCH determines to negatively affect recipient access to covered services may be grounds for sanctions.
G. Assure that the provider network responds to the cultural, racial, and linguistic needs (including interpretive services as necessary) of the service area, and make oral interpretation services available free of charge to each potential beneficiary. This applies to all non-English languages not just those that the State identifies as prevalent. Each entity must notify its beneficiaries how to access oral interpretation services.
H. Assure that services are accessible, taking into account travel time, availability of public transportation, and other factors that may determine accessibility.
I. Assure that network providers do not segregate PIHP individuals in any way from other people receiving their services.
J. Annually monitors affiliates, as applicable, and provider networks who perform delegated functions to assure quality and performance in accordance with the standards in the Quality Assessment and Performance Improvement Technical Requirement (Attachment 6.7.1.
K. The PIHP shall assure HIPAA compliant access to information about persons receiving services in their contractual residential settings by individuals who have completed training and are working under the auspices of the Dignified Lifestyles Community Connections program.
Appears in 1 contract
Samples: Michigan Abw Non Pregnant Childless Adults Waiver (Adult Benefits Waiver) Section 1115 Demonstration
Provider Network Services. The PIHP is responsible for maintaining and continually evaluating an effective provider network adequate to fulfill the obligations of this contract. The PIHP remains the accountable party for the Medicaid beneficiaries in its service area, regardless of the functions it has delegated to its CSSNs and its provider networks. In this regard, the PIHP agrees to:
A. Maintain a regular means of communicating and providing information on changes in policies and procedures to its providers. This may include guidelines for answering written correspondence to providers, offering provider-dedicated phone lines, and a regular provider newsletter;
B. Have clearly written mechanisms to address provider grievances and complaints, and an appeal system to resolve disputes.
C. Provide a copy of the PIHP's prior authorization policies to the provider when the provider joins the PIHP's provider network. The PIHP must notify providers of any changes to prior authorization policies as changes are made.
D. Provide a copy of the PIHP's grievance, appeal and fair hearing procedures and timeframes to the provider when the provider joins the PIHP's provider network. The PIHP must notify providers of any changes to those procedures or timeframes.
E. Provide to MDCH in the format specified by MDCH, provider agency information profiles that contain a complete listing and description of the provider network available to recipients in the service area.
F. Notify MDCH within seven (7) days of any changes to the composition of the provider network organizations. PIHPs shall have procedures to address changes in its network that negatively affect access to care. Changes in provider network composition that MDCH determines to negatively affect recipient access to covered services may be grounds for sanctions.
G. Assure that the provider network responds to the cultural, racial, and linguistic needs (including interpretive services as necessary) of the service area, and make oral interpretation services available free of charge to each potential beneficiary. This applies to all non-English languages not just those that the State identifies as prevalent. Each entity must notify its beneficiaries how to access oral interpretation services.
H. Assure that services are accessible, taking into account travel time, availability of public transportation, and other factors that may determine accessibility.
I. Assure that network providers do not segregate PIHP individuals in any way from other people receiving their services.
J. Annually monitor affiliates, as applicable, and provider networks who perform delegated functions to assure quality and performance in accordance with the standards in the Quality Assessment and Performance Improvement Technical Requirement (Attachment 6.7.1.
Appears in 1 contract
Samples: Medicaid Managed Specialty Supports and Services Concurrent Waiver Program Agreement
Provider Network Services. The PIHP is responsible for maintaining and continually evaluating an effective provider network adequate to fulfill the obligations of this contract. The PIHP remains the accountable party for the Medicaid beneficiaries in its service area, regardless of the functions it has delegated to its CSSNs and its provider networks. In this regard, the PIHP agrees to:
A. Maintain a regular means of communicating and providing information on changes in policies and procedures to its providers. This may include guidelines for answering written correspondence to providers, offering provider-dedicated phone lines, and a regular provider newsletter;
B. Have clearly written mechanisms to address provider grievances and complaints, and an appeal system to resolve disputes.
C. Provide a copy of the PIHP's prior authorization policies to the provider when the provider joins the PIHP's provider network. The PIHP must notify providers of any changes to prior authorization policies as changes are made.
D. Provide a copy of the PIHP's grievance, appeal and fair hearing procedures and timeframes to the provider when the provider joins the PIHP's provider network. The PIHP must notify providers of any changes to those procedures or timeframes.
E. Provide to MDCH in the format specified by MDCH, provider agency information profiles that contain a complete listing and description of the provider network available to recipients in the service area.
F. Notify MDCH within seven (7) days of any changes to the composition of the provider network organizations. PIHPs shall have procedures to address changes in its network that negatively affect access to care. Changes in provider network composition that MDCH determines to negatively affect recipient access to covered services may be grounds for sanctions.
G. Assure that the provider network responds to the cultural, racial, and linguistic needs (including interpretive services as necessary) of the service area, and make oral interpretation services available free of charge to each potential beneficiary. This applies to all non-English languages not just those that the State identifies as prevalent. Each entity must notify its beneficiaries how to access oral interpretation services.
H. Assure that services are accessible, taking into account travel time, availability of public transportation, and other factors that may determine accessibility.
I. Assure that network providers do not segregate PIHP individuals in any way from other people receiving their services.
J. Annually evaluate providers who perform delegated functions.
Appears in 1 contract
Samples: Medicaid Managed Specialty Supports and Services Concurrent Waiver Program Agreement
