Common use of Resource Allocation and Management Clause in Contracts

Resource Allocation and Management. Grantee shall: a) Maintain an administrative and fiscal structure that separates local authority and provider functions, by allocating funding specifically and as specified within the various budget and quarterly financial reports Grantee submits to HHSC per this Statement of Work; b) Maintain a Utilization Management (UM) Committee that includes the following Grantee staff: (1) The UM physician, who: (a) Is a board eligible or board-certified psychiatrist; (b) Is licensed to practice medicine in the State of Texas; and (c) Provides oversight of the UM program’s design and implementation; (2) UM staff representative; (3) Quality management staff representative; and (4) Fiscal/financial services staff representative; c) Hire and ensure that its UM Manager: (1) Is licensed to practice in the State of Texas as a: (a) Physician; (b) Registered nurse or a registered nurse-advance practice nurse; (c) Physician assistant; (d) Licensed clinical social worker; (e) Licensed professional counselor; (f) Licensed doctoral level psychologist; or (g) Licensed marriage and family therapist; (2) Has a minimum of five years of experience in direct care of individuals with a serious mental illness and/or children with serious emotional disturbances, which may include experience in an acute care or crisis setting; (3) Has a demonstrated understanding of psychopharmacology and medical/psychiatric comorbidity through training or experience; (4) Has one year of experience in program oversight of mental health care services; and (5) Has demonstrated competence in performing UM and review activities; d) If Grantee does not have a UM Manager, and delegates UM activities to other staff, hire a UM Director and Utilization Reviewer or Utilization Care Manager with the requirements below: (1) A UM Director who is: (a) Licensed to practice in the State of Texas as a: i. Qualified UM physician as specified above in Section I(A)(5)(b)(1); ii. Registered nurse or a registered nurse-advance practice nurse; iii. Physician assistant; iv. Licensed clinical social worker; v. Licensed professional counselor; vi. Licensed doctoral level psychologist; or