Common use of READINESS OR ANNUAL REVIEW Clause in Contracts

READINESS OR ANNUAL REVIEW. 2.13.1 DCH will conduct a readiness review of each new CMO at least 30 days prior to Enrollment of Medicaid and/or PeachCare for Kids® recipients in the CMO plan and an annual review of each existing CMO plan. The readiness and financial review will include, at a minimum, one (1) or more as determined by DCH on-site review. DCH will conduct the reviews to provide assurances that the Contractor is able and prepared to perform all administrative functions and is providing for high quality of services to Members. 2.13.2 Specifically, DCH’s review will document the status of the Contractor with respect to meeting program standards set forth in this Contract, as well as any goals established by the Contractor. A multidisciplinary team appointed by DCH will conduct the readiness and annual review. The scope of the reviews will include, but not be limited to, review and/or verification of: · Network Provider composition and access; · Staff; · Marketing materials; · Content of Provider agreements; · EPSDT plan; · Member services capability; · Comprehensiveness of quality and Utilization Management strategies; · Policies and procedures for the Grievance System and Complaint System; · Financial solvency; · Contractor litigation history, current litigation, audits and other government investigations both in Georgia and in other states; and · Information systems’ Claims payment system performance and interfacing capabilities. The readiness review may assess the Contractor’s ability to meet any requirements set forth in this Contract and the documents referenced herein. Members may not be enrolled in a CMO plan until DCH has determined that the Contractor is capable of meeting these standards. A Contractor’s failure to pass the readiness review 30 days prior to the beginning of service delivery may result in immediate Contract termination. Contractor’s failure to pass the annual review may result in corrective action and pending contract termination. DCH will provide the Contractor with a summary of the findings as well as areas requiring remedial action.

READINESS OR ANNUAL REVIEW. 2.13.1 DCH will conduct a readiness review of each new CMO at least 30 days prior to Enrollment of Medicaid and/or PeachCare for Kids® ™ recipients in the CMO plan and an annual review of each existing CMO plan. The readiness and financial review will include, at a minimum, one (1) or more as determined by DCH on-site review. DCH will conduct the reviews to provide assurances that the Contractor is able and prepared to perform all administrative functions and is providing for high quality of services to Members. 2.13.2 Specifically, DCH’s review will document the status of the Contractor with respect to meeting program standards set forth in this Contract, as well as any goals established by the Contractor. A multidisciplinary team appointed by DCH will conduct the readiness and annual review. The scope of the reviews will include, but not be limited to, review and/or verification of: · Network Provider composition and access; · Staff; · Marketing materials; · Content of Provider agreements; · EPSDT plan; · Member services capability; · Comprehensiveness of quality and Utilization Management strategies; · Policies and procedures for the Grievance System and Complaint System; · Financial solvency; · Contractor litigation history, current litigation, audits and other government investigations both in Georgia and in other states; and · Information systems’ Claims payment system performance and interfacing capabilities. The readiness review may assess the Contractor’s ability to meet any requirements set forth in this Contract and the documents referenced herein. Members may not be enrolled in a CMO plan until DCH has determined that the Contractor is capable of meeting these standards. A Contractor’s failure to pass the readiness review 30 days prior to the beginning of service delivery may result in immediate Contract termination. Contractor’s failure to pass the annual review may result in corrective action and pending contract termination. DCH will provide the Contractor with a summary of the findings as well as areas requiring remedial action.

READINESS OR ANNUAL REVIEW. 2.13.1 DCH will conduct a readiness review of each new CMO at least 30 days prior to Enrollment of Medicaid and/or PeachCare for Kids® ™ recipients in the CMO plan and an annual review of each existing CMO plan. The readiness and financial review will include, at a minimum, one (1) or more as determined by DCH on-site review. DCH will conduct the reviews to provide assurances that the Contractor is able and prepared to perform all administrative functions and is providing for high quality of services to Members. 2.13.2 Specifically, DCH’s review will document the status of the Contractor with respect to meeting program standards set forth in this Contract, as well as any goals established by the Contractor. A multidisciplinary team appointed by DCH will conduct the readiness and annual review. The scope of the reviews will include, but not be limited to, review and/or verification of: · : 2.13.2.1 Network Provider composition and access; · ; 2.13.2.2 Staff; · ; 2.13.2.3 Marketing materials; · ; 2.13.2.4 Content of Provider agreements; · ; 2.13.2.5 EPSDT plan; · ; 2.13.2.6 Member services capability; · ; 2.13.2.7 Comprehensiveness of quality and Utilization Management strategies; · ; 2.13.2.8 Policies and procedures for the Grievance System and Complaint System; · ; 2.13.2.9 Financial solvency; · ; 2.13.2.10 Contractor litigation history, current litigation, audits and other government investigations both in Georgia and in other states; and · and 2.13.2.11 Information systems’ Claims payment system performance and interfacing capabilities. . 2.13.3 The readiness review may assess the Contractor’s ability to meet any requirements set forth in this Contract and the documents referenced herein. . 2.13.4 Members may not be enrolled in a CMO plan until DCH has determined that the Contractor is capable of meeting these standards. A Contractor’s failure to pass the readiness review 30 days prior to the beginning of service delivery may result in immediate Contract termination. Contractor’s failure to pass the annual review may result in corrective action and pending contract termination. . 2.13.5 DCH will provide the Contractor with a summary of the findings as well as areas requiring remedial action.

READINESS OR ANNUAL REVIEW. 2.13.1 DCH will conduct a readiness review of each new CMO at least 30 days prior to Enrollment of Medicaid and/or PeachCare for Kids® recipients in the CMO plan and an annual review of each existing CMO plan. The readiness and financial review will include, at a minimum, one (1) or more as determined by DCH on-site review. DCH will conduct the reviews to provide assurances that the Contractor is able and prepared to perform all administrative functions and is providing for high quality of services to Members. 2.13.2 Specifically, DCH’s review will document the status of the Contractor with respect to meeting program standards set forth in this Contract, as well as any goals established by the Contractor. A multidisciplinary team appointed by DCH will conduct the readiness and annual review. The scope of the reviews will include, but not be limited to, review and/or verification of: · • Network Provider composition and access; · • Staff; · • Marketing materials; · • Content of Provider agreements; · • EPSDT plan; · • Member services capability; · • Comprehensiveness of quality and Utilization Management strategies; · • Policies and procedures for the Grievance System and Complaint System; · • Financial solvency; · • Contractor litigation history, current litigation, audits and other government investigations both in Georgia and in other states; and · • Information systems’ Claims payment system performance and interfacing capabilities. The readiness review may assess the Contractor’s ability to meet any requirements set forth in this Contract and the documents referenced herein. Members may not be enrolled in a CMO plan until DCH has determined that the Contractor is capable of meeting these standards. A Contractor’s failure to pass the readiness review 30 days prior to the beginning of service delivery may result in immediate Contract termination. Contractor’s failure to pass the annual review may result in corrective action and pending contract termination. DCH will provide the Contractor with a summary of the findings as well as areas requiring remedial action.