Appears in 1 contract

Samples: Contract Amendment (Centene Corp)

Appears in 1 contract

Samples: Contract Amendment (Centene Corp)

Sub Goals. Goal 1: Improve Access to Primary Care Services for Members 90% of initial credentialing of PCPs will be finalized within 70 calendar days of receipt of application. The percentage of Family Practitioners with open panels will increase by 5 percentage points over baseline. Goal 2: Improve Access to Behavioral Health Services for Members Increase Behavioral Health Urgent Care Appointment Availability by 5 percentage points over baseline. Increase Behavioral Health Routine Care Appointment Availability by 5 percentage points over baseline. Goal 3: Increase Utilization of New Member Medical Check-Ups within 90 days of Enrollment 100% of new members with valid phone numbers will receive three call attempts within 30 days of enrollment to encourage a medical check-up within 90 days of enrollment. 100% of new members that did not select a valid PCP from the plan's network will be defaulated to a local, appropriate network PCP by the 15th of each month. Subject: Attachment B-5 - Deliverables/Liquidated Damages Matrix STATUS1 DOCUMENT REVISION2 EFFECTIVE DATE DESCRIPTION3 Baseline n/a Initial version of Attachment B-5, Deliverables/Liquidated Damage Matrix. Revision 1.1 June 30, 2006 Contract amendment did not revise Attachment B-5, Deliverables/Liquidated Damage Matrix. Revision 1.2 September 1, 2006 Amended Attachment B-5, Deliverables/Liquidated Damages Matrix, to add a footnote clarifying the deliverable due dates. Also amended the provisions regarding Claims Processing Requirements and the Reporting Requirements for the Claims Summary Report. Revision 1.3 September 1, 2006 Amended Attachment B-5, Deliverables/Liquidated Damages Matrix, performance standard for Provider Directories for the CHIP Perinatal Program. Revision 1.4 September 1, 2006 Contract amendment did not revise Attachment B-5, Deliverables/Liquidated Damage Matrix. Revision 1.5 January 1, 2007 Contract amendment did not revise Attachment B-5, Deliverables/Liquidated Damage Matrix. Revision 1.6 February 1, 2007 Contract amendment did not revise Attachment B-5, Deliverables/Liquidated Damage Matrix. Revision 1.7 July 1, 2007 Amended Attachment B-5, Deliverables/Liquidated Damages Matrix, to add clarifications to the provisions addressing Claims Processing Requirements and the Reporting Requirements for the Claims Summary Report. Revision 1.8 September 1, 2007 Contract amendment did not revise Attachment B-5, Deliverables/Liquidated Damage Matrix. Revision 1.9 December 1, 2007 Contract amendment did not revise Attachment B-5, Deliverables/Liquidated Damage Matrix. Revision 1.10 March 1, 2008 Amended Attachment B-5 to add or revise performance standards and liquidated damages regarding: Failure to Perform an Administrative Service; Failure to Provide a Covered Service; Behavioral Health Services Hotline; Member Services Hotline; and Provider Hotline. Revision 1.11 September 1, 2008 Amended Attachment B-5 to revise performance standards regarding: Line 1 – Failure to Perform an Administrative Service and Line 2 – Failure to Provide a Covered Service; and to replace the MDS-HC instrument with the Community Medical Necessity and Level of Care Assessment Instrument in the Performance Standard for Line 21 – Contract Amendment B-1 RFP §8.3.3 – STAR+PLUS Assessment Instruments Revision 1.12 March 1, 2009 Lines 8, 9, and 13 are modified to add a performance standard, measurement assessment, and damages for each 30 second time increment, or portion thereof, by which the average hold time exceeds the maximum acceptable hold time. Line 15 is modified to clarify reporting timeframes and requirements. 1 Status should be represented as “Baseline” for initial issuances, “Revision” for changes to the Baseline version, and “Cancellation” for withdrawn versions 2 Revisions should be numbered in accordance according to the version of the issuance and sequential numbering of the revision—e.g., “1.2” refers to the first version of the document and the second revision. 3 Brief description of the changes to the document made in the revision. Service/ Component1 Performance Standard2 Measurement Period3 Measurement Assessment4 Liquidated Damages General Requirement: Failure to Perform an Administrative Service Contract Attachment A HHSC Uniform Managed Care Contract Terms and Conditions, Contract Attachment B-1 RFP §§ 6, 7, 8 and 9 The HMO fails to timely perform an HMO Administrative Service that is not otherwise associated with a performance standard in this matrix and, in the determination of HHSC, such failure either: (1) results in actual harm to a Member or places a Member at risk of imminent harm, or (2) materially affects HHSC’s ability to administer the Program(s). Ongoing Each incident of non-compliance per HMO Program and SA. HHSC may assess up to $5,000 per calendar day for each incident of non-compliance per HMO Program and SA.

Appears in 1 contract

Samples: Contract Amendment (Centene Corp)

Sub Goals. Goal 1: Improve ~~Access to Primary Care Services for Members 90% of initial credentialing of PCPs will be finalized within 70 calendar days of receipt of application. The~~ prenatal care received by CHIP Perinate members Increase the percentage of ~~Family Practitioners with open panels will increase~~ deliveries by 5 percentage points over baseline. Goal 2: Improve Access to Behavioral Health Services for Members Increase Behavioral Health Urgent Care Appointment Availability by 5 percentage points over baseline. Increase Behavioral Health Routine Care Appointment Availability by 5 percentage points over baseline. Goal 3: Increase Utilization of New Member Medical Check-Ups 1% that received a prenatal care visit in the first trimester or within ~~90 days of Enrollment 100% of new members with valid phone numbers will receive three call attempts within 30~~ 42 days of enrollment ~~to encourage a medical check~~in the organization. Increase 17P utilization by 5% by year-~~up within 90 days of enrollment. 100% of new members that did not select a valid PCP from the plan's network will be defaulated to a local, appropriate network PCP by the 15th of each month~~end. Subject: Attachment B-5 - Deliverables/Liquidated Damages Matrix STATUS1 DOCUMENT REVISION2 EFFECTIVE DATE DESCRIPTION3 Baseline n/a Initial version of Attachment B-5, Deliverables/Liquidated Damage Matrix. Revision 1.1 June 30, 2006 Contract amendment did not revise Attachment B-5, Deliverables/Liquidated Damage Matrix. Revision 1.2 September 1, 2006 Amended Attachment B-5, Deliverables/Liquidated Damages Matrix, to add a footnote clarifying the deliverable due dates. Also amended the provisions regarding Claims Processing Requirements and the Reporting Requirements for the Claims Summary Report. Revision 1.3 September 1, 2006 Amended Attachment B-5, Deliverables/Liquidated Damages Matrix, performance standard for Provider Directories for the CHIP Perinatal Program. Revision 1.4 September 1, 2006 Contract amendment did not revise Attachment B-5, Deliverables/Liquidated Damage Matrix. Revision 1.5 January 1, 2007 Contract amendment did not revise Attachment B-5, Deliverables/Liquidated Damage Matrix. Revision 1.6 February 1, 2007 Contract amendment did not revise Attachment B-5, Deliverables/Liquidated Damage Matrix. Revision 1.7 July 1, 2007 Amended Attachment B-5, Deliverables/Liquidated Damages Matrix, to add clarifications to the provisions addressing Claims Processing Requirements and the Reporting Requirements for the Claims Summary Report. Revision 1.8 September 1, 2007 Contract amendment did not revise Attachment B-5, Deliverables/Liquidated Damage Matrix. Revision 1.9 December 1, 2007 Contract amendment did not revise Attachment B-5, Deliverables/Liquidated Damage Matrix. Revision 1.10 March 1, 2008 Amended Attachment B-5 to add or revise performance standards and liquidated damages regarding: Failure to Perform an Administrative Service; Failure to Provide a Covered Service; Behavioral Health Services Hotline; Member Services Hotline; and Provider Hotline. Revision 1.11 September 1, 2008 Amended Attachment B-5 to revise performance standards regarding: Line 1 – Failure to Perform an Administrative Service and Line 2 – Failure to Provide a Covered Service; and to replace the MDS-HC instrument with the Community Medical Necessity and Level of Care Assessment Instrument in the Performance Standard for Line 21 – Contract Amendment B-1 RFP §8.3.3 – STAR+PLUS Assessment Instruments Revision 1.12 March 1, 2009 Lines 8, 9, and 13 are modified to add a performance standard, measurement assessment, and damages for each 30 second time increment, or portion thereof, by which the average hold time exceeds the maximum acceptable hold time. Line 15 is modified to clarify reporting timeframes and requirements. Revision 1.13 September 1, 2009 Line 16.5 Contract Attachment B-1 RFP §8.1.18.1 Encounter Data is added. Line 21 Performance Standard is amended to clarify type of wiaver services. Revision 1.14 December 1, 2009 Line 21 Service/Component is amended to clarify contract references and Performance Standard is modified to require that assessment instructions must be submitted within 45 days Revision 1.15 March 1, 2010 Line 3 modified to conform to language in Attachment A, Sections 4.08(b)(3) and (4). Revision 1.16 September 1, 2010 Item 3 is modified to conform to language in Attachment A, Sections 4.08(b)(3) and (4). Item 8 is added to add liquidated damages for Out-of-Network Utilization. Item 22 is added to add liquidated damages for timely HMO response to complaints. All subsequent items are renumbered. Revision 1.17 December 1, 2010 Contract amendment did not revise Attachment B-5, Deliverables/Liquidated Damage Matrix. 1 Status should be represented as “Baseline” for initial issuances, “Revision” for changes to the Baseline version, and “Cancellation” for withdrawn versions 2 Revisions should be numbered in accordance according to the version of the issuance and sequential numbering of the revision—e.g., “1.2” refers to the first version of the document and the second revision. 3 Brief description of the changes to the document made in the revision. Service/ Component1 Performance Standard2 Measurement Period3 Measurement Assessment4 Liquidated Damages General Requirement: Failure to Perform an Administrative Service Contract Attachment A HHSC Uniform Managed Care Contract Terms and Conditions, Contract Attachment B-1 RFP §§ 6, 7, 8 and 9 The HMO fails to timely perform an HMO Administrative Service that is not otherwise associated with a performance standard in this matrix and, in the determination of HHSC, such failure either: (1) results in actual harm to a Member or places a Member at risk of imminent harm, or (2) materially affects HHSC’s ability to administer the Program(s). Ongoing Each incident of non-compliance per HMO Program and SA. HHSC may assess up to $5,000 per calendar day for each incident of non-compliance per HMO Program and SA.

Appears in 1 contract

Samples: Contract Amendment (Centene Corp)

Sub Goals. Goal 1-5: ~~Improve Access~~ Three to ~~Primary Care~~ five Goals for all applicable HMO Programs to be determined and negotiated prior to FY2008. To be determined for FY2008. Goal 6: (STAR+PLUS HMOs) Increase the use of the Consumer Directed Services (CDS) Program Increase the percentage of enrollees receiving Personal Assistance Services (PAS) through the Consumer Directed Services (CDS) Program by 15% as compared to the baseline rate of ____ Specific percentages for ~~Members 90% of initial credentialing of PCPs~~ Sub-Goals will be ~~finalized within 70 calendar days~~ negotiated by HHSC and the HMO before the beginning of ~~receipt of application~~FY2008. ~~The percentage of Family Practitioners with open panels will increase by 5 percentage points over baseline. Goal 2: Improve Access~~ Additional information related to Behavioral Health Services for Members Increase Behavioral Health Urgent Care Appointment Availability by 5 percentage points over baseline. Increase Behavioral Health Routine Care Appointment Availability by 5 percentage points over baseline. Goal 3: Increase Utilization of New Member Medical Check-Ups within 90 days of Enrollment 100% of new members with valid phone numbers will receive three call attempts within 30 days of enrollment the Performance Improvement Goals can be found in Attachment B-1, Section 8.1.1.1, to ~~encourage a medical check-up within 90 days of enrollment. 100% of new members that did not select a valid PCP from~~ the ~~plan's network will be defaulated to a local, appropriate network PCP by the 15th of each month~~Contract. Subject: Attachment B-5 ~~- Deliverables~~-Deliverables/Liquidated Damages Matrix Version 1.6 STATUS1 DOCUMENT REVISION2 EFFECTIVE DATE DESCRIPTION3 Baseline n/a Initial version of Attachment B-5, Deliverables/Liquidated Damage Matrix. Revision 1.1 June 30, 2006 Contract amendment did not revise Attachment B-5, Deliverables/Liquidated Damage Matrix. Revision 1.2 September 1, 2006 Amended Attachment ~~B-5,~~ B-5 Deliverables/Liquidated Damages ~~Matrix,~~ Matrix to add a footnote clarifying the deliverable due dates. Also amended the provisions regarding Claims Processing Requirements and the Reporting Requirements for the Claims Summary Report. Revision 1.3 September 1, 2006 Amended Attachment ~~B-5,~~ B-5 Deliverables/Liquidated Damages ~~Matrix,~~ Matrix performance standard for Provider Directories for the CHIP Perinatal Program. Revision 1.4 September 1, 2006 Contract amendment did not revise Attachment B-5, Deliverables/Liquidated Damage Matrix. Revision 1.5 January 1, 2007 Contract amendment did not revise Attachment B-5, Deliverables/Liquidated Damage Matrix. Revision 1.6 February 1, 2007 Contract amendment did not revise Attachment B-5, Deliverables/Liquidated Damage Matrix. ~~Revision 1.7 July 1~~1 Status should be represented as “Baseline” for initial issuances, ~~2007 Amended Attachment B-5~~“Revision” for changes to the Baseline version, ~~Deliverables/~~and “Cancellation” for withdrawn versions 2 Revisions should be numbered in accordance according to the version of the issuance and sequential numbering of the revision—e.g., “1.2” refers to the first version of the document and the second revision. 3 Brief description of the changes to the document made in the revision. Service/ Component1 Performance Standard2 Measurement Period3 Measurement Assessment4 Liquidated Damages ~~Matrix~~Contract Attachment B-1, RFP §7.3 --Transition Phase Schedule Contract Attachment B-1, RFP §7.3.1 -- Transition Phase Tasks Contract Attachment B-1, RFP §8.1 -- General Scope The HMO must be operational no later than the agreed upon Operations Start Date. HHSC, or its agent, will determine when the HMO is considered to ~~add clarifications~~ be operational based on the requirements in Section 7 and 8 of Attachment B-1. Operations Start Date Each calendar day of non-compliance, per HMO Program, per Service Area (SA). HHSC may assess up to $10,000 per calendar day for each day beyond the Operations Start date that the HMO is not operational until the day that the HMO is operational, including all systems. Contract Attachment B-1 RFP §7.3.1.5 -- Systems Readiness Review The HMO must submit to HHSC or to the ~~provisions addressing~~ designated Readiness Review Contractor the following plans for review, by December 14, 2005 for STAR and CHIP, and by July 31, 2006 for STAR+PLUS: • Joint Interface Plan; • Disaster Recovery Plan; • Business Continuity Plan; • Risk Management Plan; and • Systems Quality Assurance Plan. Transition Period Each calendar day of non-compliance, per report, per HMO Program, and per SA. HHSC may assess up to $1,000 per calendar day for each day a deliverable is late, inaccurate or incomplete. Modified by Version 1.1 Contract Attachment B-1 RFP §7.3.1.7 - Operations Readiness Final versions of the Provider Directory must be submitted to the Administrative Services Contractor no later than 95 days prior to the Operational Start Date for the CHIP, STAR, and STAR+PLUS HMOs, and no later than 30 days prior to the Operational Start Date for the CHIP Perinatal HMOs. Transition Period Each calendar day of non-compliance, per directory, per HMO Program and per SA. HHSC may assess up to $1,000 per calendar day for each day the directory is late, inaccurate or incomplete. Contract Attachment B-1 RFP §§ 6, 7, 8 and 9 Uniform Managed Care Manual All reports and deliverables as specified in Sections 6, 7, 8 and 9 of Attachment B-1 must be submitted according to the timeframes and requirements stated in the Contract (including all attachments) and HHSC’s Uniform Managed Care Manual. (Specific Reports or deliverables listed separately in this matrix are subject to the specified liquidated damages.) Transition Period, Quarterly during Operations Period Each calendar day of non-compliance, per HMO Program, per SA. HHSC may assess up to $250 per calendar day if the report/deliverable is late, inaccurate, or incomplete. Contract Attachment B-1 RFP §8.1.6 -- Marketing & Prohibited Practices Uniform Managed Care Manual The HMO may not engage in prohibited marketing practices. Transition, Measured Quarterly during the Operations Period Per incident of non-compliance. HHSC may assess up to $1,000 per incident of non-compliance. Contract Attachment B-1 RFP §8.1.17.2 --Financial Reporting Requirements Uniform Managed Care Manual - Chapter 5 Financial Statistical Reports (FSR): For each SA, the HMO must file quarterly and annual FSRs. Quarterly reports are due no later than 30 days after the conclusion of each State Fiscal Quarter (SFQ). The first annual report is due no later than 120 days after the end of each Contract Year and the second annual report is due no later than 365 days after the end of each Contract Year. Quarterly during the Operations Period Per calendar day of non-compliance, per HMO Program, per SA. HHSC may assess up to $1,000 per calendar day a quarterly or annual report is late, inaccurate or incomplete. Contract Attachment B-1 RFP §8.1.17.2 -- Financial Reporting Requirements: Uniform Managed Care Manual - Chapter 5 Medicaid Disproportionate Share Hospital (DSH) Reports: The Medicaid HMO must submit, on an annual basis, preliminary and final DSH Reports. The Preliminary report is due no later than June 1st after each reporting year, and the final report is due no later than July 15th after each reporting year. This standard does not apply to CHIP HMOs. Measured during 4th Quarter of the Operations Period (6/1-8/31) Per calendar day of non-compliance, per HMO Program, per SA. HHSC may assess up to $1,000 per calendar day, per program, per service area, for each day the report is late, incorrect, inaccurate or incomplete. Contract Attachment B-1 RFP §8.1.18 - Management Information System (MIS) Requirements The HMO’s MIS must be able to resume operations within 72 hours of employing its Disaster Recovery Plan. Measured Quarterly during the Operations Period Per calendar day of non-compliance, per HMO Program, per SA. HHSC may assess up to $5,000 per calendar day of non-compliance Contract Attachment B-1 RFP §8.1.18.3 - Management Information System (MIS) Requirements: System-Wide Functions The HMO’s MIS system must meet all requirements in Section 8.1.18.3 of Attachment B-1. Measured Quarterly during the Operations Period Per calendar day of non-compliance, per HMO Program, per SA. HHSC may assess up to $5,000 per calendar day of non-compliance. Contract Attachment B-1 RFP §8.1.18.5 -- Claims Processing Requirements Uniform Managed Care Manual Chapter 2 The HMO must adjudicate all provider Clean Claims within 30 days of receipt by the HMO. The HMO must pay providers interest at an 18% per annum, calculated daily for the full period in which the Clean Claim remains unadjudicated beyond the 30-day claims processing deadline. Measured Quarterly during the Operations Period Per incident of non-compliance. HHSC may assess up to $1,000 per claim if the HMO fails to timely pay interest. Modified by Version 1.2 Contract Attachment B-1 RFP §8.1.18.5 -- Claims Processing Requirements Uniform Managed Care Manual - Chapter 2 The HMO must comply with the claims processing requirements and standards as described in Section 8.1.18.5 of Attachment B-1 and in Chapter 2 of the Uniform Managed Care Manual. Measured Quarterly during the Operations Period Per quarterly reporting period, per HMO Program, per SA. HHSC may assess liquidated damages of up to $5,000 for the first quarter that an HMO’s Claims Performance percentages by type and by Program fall below the performance standards. HHSC may assess up to $25,000 per quarter for each additional quarter that the Claims Performance percentages by type and by Program fall below the performance standards. Modified by Version 1.2 Contract Attachment B-1 RFP §8.1.20.2-- Reporting Requirements ~~for the~~ Uniform Managed Care Manual Chapters 2 and 5 Claims Summary Report: The HMO must submit quarterly, Claims Summary Reports to HHSC by HMO Program and each SA and claims processing subcontractor by the 30th day following the reporting period unless otherwise specified. ~~Revision 1.8 September 1~~Measured Quarterly during the Operations Period Per calendar day of non-compliance, ~~2007~~ per HMO Program, per SA. HHSC may assess up to $1,000 per calendar day the report is late, inaccurate, or incomplete. Modified by Version 1.2 Contract ~~amendment did not revise~~ Attachment ~~B-5~~B-1 RFP §8.1.5.9-- Member Complaint and Appeal Process Contract Attachment B-1 RFP §8.2.7.1 -- Member Complaint Process Contract Attachment B-1 RFP §8.4.3 - CHIP Member Complaint and Appeal Process The HMO must resolve at least 98% of Member Complaints within 30 calendar days from the date the Complaint is received by the HMO. Measured Quarterly during the Operations Period Per reporting period, ~~Deliverables/Liquidated Damage Matrix~~per HMO Program, per SA. ~~Revision 1.9 December 1~~HHSC may assess up to $250 per reporting period if the HMO fails to meet the performance standard. Contract Attachment B-1 RFP §8.3.3 - STAR+PLUS Assessment Instruments Uniform Managed Care Manual The MDS-HC instrument must be completed and electronically submitted to HHSC in the specified format within 30 days of enrollment for every Member receiving Community-based Long-term Care Services, ~~2007 Contract amendment did not revise Attachment B-5~~and then each year by the anniversary of the Member’s date of enrollment. Operations, ~~Deliverables/Liquidated Damage Matrix~~Turnover Per calendar day of non-compliance, per Service Area. ~~Revision 1.10 March 1~~HHSC may assess up to $500 per calendar day per Service Area, ~~2008 Amended Attachment B-5 to add~~ for each day a report is late, inaccurate or revise performance standards and liquidated damages regarding: Failure to Perform an Administrative Service; Failure to Provide a Covered Service; Behavioral Health Services Hotline; Member Services Hotline; and Provider Hotline.incomplete. Added by Version 1.1

Appears in 1 contract

Samples: Contract Amendment (Centene Corp)

Sub Goals. Goal 1-5: ~~Improve Access~~ Three to ~~Primary Care~~ five Goals for all applicable HMO Programs to be determined and negotiated prior to FY2008. To be determined for FY2008. Goal 6: (STAR+PLUS HMOs) Increase the use of the Consumer Directed Services (CDS) Program Increase the percentage of enrollees receiving Personal Assistance Services (PAS) through the Consumer Directed Services (CDS) Program by 15% as compared to the baseline rate of ____ Specific percentages for ~~Members 90% of initial credentialing of PCPs~~ Sub-Goals will be ~~finalized within 70 calendar days~~ negotiated by HHSC and the HMO before the beginning of ~~receipt~~ FY2008. Responsible Office: HHSC Office of application. The percentage of Family Practitioners with open panels will increase by 5 percentage points over baseline. Goal 2: Improve Access to Behavioral Health Services for Members Increase Behavioral Health Urgent Care Appointment Availability by 5 percentage points over baseline. Increase Behavioral Health Routine Care Appointment Availability by 5 percentage points over baseline. Goal 3: Increase Utilization of New Member Medical Check-Ups within 90 days of Enrollment 100% of new members with valid phone numbers will receive three call attempts within 30 days of enrollment to encourage a medical check-up within 90 days of enrollment. 100% of new members that did not select a valid PCP from the plan's network will be defaulated to a local, appropriate network PCP by the 15th of each month. General Counsel (OGC) Subject: Attachment B-5 - –Deliverables/Liquidated Damages Matrix Version 1.6 STATUS1 DOCUMENT REVISION2 EFFECTIVE DATE DESCRIPTION3 Baseline n/a Initial version of Attachment B-5, Deliverables/Liquidated Damage Matrix. Revision 1.1 June 30, 2006 Contract amendment did not revise Attachment B-5, Deliverables/Liquidated Damage Matrix. Revision 1.2 September 1, 2006 Amended Attachment B-5, Deliverables/Liquidated Damages Matrix, to add a footnote clarifying the deliverable due dates. Also amended the provisions regarding Claims Processing Requirements and the Reporting Requirements for the Claims Summary Report. Revision 1.3 September 1, 2006 Amended Attachment B-5, Deliverables/Liquidated Damages Matrix, performance standard for Provider Directories for the CHIP Perinatal Program. Revision 1.4 September 1, 2006 Contract amendment did not revise Attachment B-5, Deliverables/Liquidated Damage Matrix. Revision 1.5 January 1, 2007 Contract amendment did not revise Attachment B-5, Deliverables/Liquidated Damage Matrix. Revision 1.6 February 1, 2007 Contract amendment did not revise Attachment B-5, Deliverables/Liquidated Damage Matrix. Revision 1.7 July 1, 2007 Amended Attachment B-5, Deliverables/Liquidated Damages Matrix, to add clarifications to the provisions addressing Claims Processing Requirements and the Reporting Requirements for the Claims Summary Report. ~~Revision 1.8 September 1~~1Status should be represented as “Baseline” for initial issuances, ~~2007 Contract amendment did not revise~~ “Revision” for changes to the Baseline version, and “Cancellation” for withdrawn versions 2Revisions should be numbered in accordance according to the version of the issuance and sequential numbering of the revision—e.g., “1.2” refers to the first version of the document and the second revision. 3Brief description of the changes to the document made in the revision. Responsible Office: HHSC Office of General Counsel (OGC) Subject: Attachment ~~B-5,~~ B-5 –Deliverables/Liquidated ~~Damage Matrix~~Damages Matrix Version 1.6 Service/ Component1 Performance Standard2 Measurement Period3 Measurement Assessment4 Liquidated Damages Contract Attachment B-1, RFP §7.3 --Transition Phase Schedule Contract Attachment B-1, RFP §7.3.1 -- Transition Phase Tasks Contract Attachment B-1, RFP §8.1 -- General Scope The HMO must be operational no later than the agreed upon Operations Start Date. ~~Revision 1.9~~ HHSC, or its agent, will determine when the HMO is considered to be operational based on the requirements in Section 7 and 8 of Attachment B-1 Operations Start Date Each calendar day of non-compliance, per HMO Program, per Service Area (SA). HHSC may assess up to $10,000 per calendar day for each day beyond the Operations Start date that the HMO is not operational until the day that the HMO is operational, including all systems. Contract Attachment B-1 RFP §7.3.1.5 – Systems Readiness Review The HMO must submit to HHSC or to the designated Readiness Review Contractor the following plans for review, by December 114, ~~2007~~ 2005 for STAR and CHIP, and by July 31, 2006 for STAR+PLUS: •Joint Interface Plan; •Disaster Recovery Plan; Transition Period Each calendar day of non-compliance, per report, per HMO Program, and per SA. HHSC may assess up to $1,000 per calendar day for each day a deliverable is late, inaccurate or incomplete. 1 Derived from the Contract ~~amendment did not revise~~ or HHSC’s Uniform Managed Care Manual. 2 Standard specified in the Contract. Note: Where the due date states 30 days, the HMO is to provide the deliverable by the last day of the month following the end of the reporting period. Where the due date states 45 days, the HMO is to provide the deliverable by the 15th day of the second month following the end of the reporting period. 3 Period during which HHSC will evaluate service for purposes of tailored remedies. 4 Measure against which HHSC will apply remedies. Responsible Office: HHSC Office of General Counsel (OGC) Subject: Attachment ~~B-5,~~ B-5 –Deliverables/Liquidated ~~Damage Matrix~~Damages Matrix Version 1.6 Service/ Component1 Performance Standard2 Measurement Period3 Measurement Assessment4 Liquidated Damages •Business Continuity Plan; •Risk Management Plan; and •Systems Quality Assurance Plan. ~~Revision 1.10 March 1~~Contract Attachment B-1 RFP §7.3.1.7 – Operations Readiness Final versions of the Provider Directory must be submitted to the Administrative Services Contractor no later than 95 days prior to the Operational Start Date for the CHIP, ~~2008 Amended~~ STAR, and STAR+PLUS HMOs, and no later than 30 days prior to the Operational Start Date for the CHIP Perinatal HMOs. Transition Period Each calendar day of non-compliance, per directory, per HMO Program and per SA. HHSC may assess up to $1,000 per calendar day for each day the directory is late, inaccurate or incomplete. Contract Attachment B-1 RFP §§ 6, 7, 8 and 9 Uniform Managed Care Manual All reports and deliverables as specified in Sections 6, 7, 8 and 9 of Attachment B-1 must be submitted according to the timeframes and requirements stated in the Contract (including all attachments) and HHSC’s Uniform Managed Care Manual. (Specific Reports or deliverables listed separately in this matrix are subject to the specified liquidated damages.) Transition Period, Quarterly during Operations Period Each calendar day of non-compliance, per HMO Program, per SA. HHSC may assess up to $250 per calendar day if the report/deliverable is late, inaccurate, or incomplete. Contract The HMO may not engage in Transition, Per incident of non- HHSC may assess up to $1,000 per 1 Derived from the Contract or HHSC’s Uniform Managed Care Manual. 2 Standard specified in the Contract. Note: Where the due date states 30 days, the HMO is to provide the deliverable by the last day of the month following the end of the reporting period. Where the due date states 45 days, the HMO is to provide the deliverable by the 15th day of the second month following the end of the reporting period. 3 Period during which HHSC will evaluate service for purposes of tailored remedies. 4 Measure against which HHSC will apply remedies. Responsible Office: HHSC Office of General Counsel (OGC) Subject: Attachment B-5 –Deliverables/Liquidated Damages Matrix Version 1.6 Service/ Component1 Performance Standard2 Measurement Period3 Measurement Assessment4 Liquidated Damages Attachment B-1 RFP §8.1.6 --Marketing & Prohibited Practices Uniform Managed Care Manual prohibited marketing practices. Measured Quarterly during the Operations Period compliance. incident of non-compliance. Contract Attachment B-1 RFP §8.1.17.2 --Financial Reporting Requirements Uniform Managed Care Manual – Chapter 5 Financial Statistical Reports (FSR): For each SA, the HMO must file quarterly and annual FSRs. Quarterly reports are due no later than 30 days after the conclusion of each State Fiscal Quarter (SFQ). The first annual report is due no later than 120 days after the end of each Contract Year and the second annual report is due no later than 365 days after the end of each Contract Year. Quarterly during the Operations Period Per calendar day of non-compliance, per HMO Program, per SA. HHSC may assess up to ~~add~~ $1,000 per calendar day a quarterly or ~~revise performance standards~~ annual report is late, inaccurate or incomplete. Contract Attachment B-1 RFP §8.1.17.2 -- Financial Reporting Requirements: Medicaid Disproportionate Share Hospital (DSH) Reports: The Medicaid HMO must submit, on an annual basis, preliminary and ~~liquidated damages regarding~~final DSH Reports. The Preliminary report is due no later than June 1st after each reporting year, and the Measured during 4th Quarter of the Operations Period (6/1–8/31) Per calendar day of non-compliance, per HMO Program, per SA. HHSC may assess up to $1,000 per calendar day, per program, per service area, for each day the report is late, incorrect, inaccurate or incomplete. 1 Derived from the Contract or HHSC’s Uniform Managed Care Manual. 2 Standard specified in the Contract. Note: ~~Failure~~ Where the due date states 30 days, the HMO is to ~~Perform an Administrative Service; Failure~~ provide the deliverable by the last day of the month following the end of the reporting period. Where the due date states 45 days, the HMO is to ~~Provide a Covered Service; Behavioral Health Services Hotline; Member Services Hotline; and Provider Hotline~~provide the deliverable by the 15th day of the second month following the end of the reporting period. 3 Period during which HHSC will evaluate service for purposes of tailored remedies. 4 Measure against which HHSC will apply remedies. Responsible Office: HHSC Office of General Counsel (OGC) Subject: Attachment B-5 –Deliverables/Liquidated Damages Matrix Version 1.6 Service/ Component1 Performance Standard2 Measurement Period3 Measurement Assessment4 Liquidated Damages Uniform Managed Care Manual – Chapter 5 final report is due no later than July 15th after each reporting year. This standard does not apply to CHIP HMOs.

Appears in 1 contract

Samples: Managed Care Contract (Centene Corp)

Sub Goals. Goal 1: Improve ~~Access to Primary Care Services for Members 90% of initial credentialing of PCPs will be finalized within 70 calendar days of receipt of application. The~~ prenatal care received by CHIP Perinate members Increase the percentage of ~~Family Practitioners with open panels will increase~~ deliveries by 5 percentage points over baseline. Goal 2: Improve Access to Behavioral Health Services for Members Increase Behavioral Health Urgent Care Appointment Availability by 5 percentage points over baseline. Increase Behavioral Health Routine Care Appointment Availability by 5 percentage points over baseline. Goal 3: Increase Utilization of New Member Medical Check-Ups 1% that received a prenatal care visit in the first trimester or within ~~90 days of Enrollment 100% of new members with valid phone numbers will receive three call attempts within 30~~ 42 days of enrollment ~~to encourage a medical check~~in the organization. Increase 17P utilization by 5% by year-~~up within 90 days of enrollment. 100% of new members that did not select a valid PCP from the plan's network will be defaulated to a local, appropriate network PCP by the 15th of each month~~end. Subject: Attachment B-5 - Deliverables/Liquidated Damages Matrix STATUS1 DOCUMENT REVISION2 EFFECTIVE DATE DESCRIPTION3 Baseline n/a Initial version of Attachment B-5, Deliverables/Liquidated Damage Matrix. Revision 1.1 June 30, 2006 Contract amendment did not revise Attachment B-5, Deliverables/Liquidated Damage Matrix. Revision 1.2 September 1, 2006 Amended Attachment B-5, Deliverables/Liquidated Damages Matrix, to add a footnote clarifying the deliverable due dates. Also amended the provisions regarding Claims Processing Requirements and the Reporting Requirements for the Claims Summary Report. Revision 1.3 September 1, 2006 Amended Attachment B-5, Deliverables/Liquidated Damages Matrix, performance standard for Provider Directories for the CHIP Perinatal Program. Revision 1.4 September 1, 2006 Contract amendment did not revise Attachment B-5, Deliverables/Liquidated Damage Matrix. Revision 1.5 January 1, 2007 Contract amendment did not revise Attachment B-5, Deliverables/Liquidated Damage Matrix. Revision 1.6 February 1, 2007 Contract amendment did not revise Attachment B-5, Deliverables/Liquidated Damage Matrix. Revision 1.7 July 1, 2007 Amended Attachment B-5, Deliverables/Liquidated Damages Matrix, to add clarifications to the provisions addressing Claims Processing Requirements and the Reporting Requirements for the Claims Summary Report. Revision 1.8 September 1, 2007 Contract amendment did not revise Attachment B-5, Deliverables/Liquidated Damage Matrix. Revision 1.9 December 1, 2007 Contract amendment did not revise Attachment B-5, Deliverables/Liquidated Damage Matrix. Revision 1.10 March 1, 2008 Amended Attachment B-5 to add or revise performance standards and liquidated damages regarding: Failure to Perform an Administrative Service; Failure to Provide a Covered Service; Behavioral Health Services Hotline; Member Services Hotline; and Provider Hotline. Revision 1.11 September 1, 2008 Amended Attachment B-5 to revise performance standards regarding: Line 1 – Failure to Perform an Administrative Service and Line 2 – Failure to Provide a Covered Service; and to replace the MDS-HC instrument with the Community Medical Necessity and Level of Care Assessment Instrument in the Performance Standard for Line 21 – Contract Amendment B-1 RFP §8.3.3 – STAR+PLUS Assessment Instruments Revision 1.12 March 1, 2009 Lines 8, 9, and 13 are modified to add a performance standard, measurement assessment, and damages for each 30 second time increment, or portion thereof, by which the average hold time exceeds the maximum acceptable hold time. Line 15 is modified to clarify reporting timeframes and requirements. Revision 1.13 September 1, 2009 Line 16.5 Contract Attachment B-1 RFP §8.1.18.1 Encounter Data is added. Line 21 Performance Standard is amended to clarify type of wiaver services. Revision 1.14 December 1, 2009 Line 21 Service/Component is amended to clarify contract references and Performance Standard is modified to require that assessment instructions must be submitted within 45 days Revision 1.15 March 1, 2010 Line 3 modified to conform to language in Attachment A, Sections 4.08(b)(3) and (4). Revision 1.16 September 1, 2010 Item 3 is modified to conform to language in Attachment A, Sections 4.08(b)(3) and (4). Item 8 is added to add liquidated damages for Out-of-Network Utilization. Item 22 is added to add liquidated damages for timely HMO response to complaints. All subsequent items are renumbered. 1 Status should be represented as “Baseline” for initial issuances, “Revision” for changes to the Baseline version, and “Cancellation” for withdrawn versions 2 Revisions should be numbered in accordance according to the version of the issuance and sequential numbering of the revision—e.g., “1.2” refers to the first version of the document and the second revision. 3 Brief description of the changes to the document made in the revision. Service/ Component1 Performance Standard2 Measurement Period3 Measurement Assessment4 Liquidated Damages General Requirement: Failure to Perform an Administrative Service Contract Attachment A HHSC Uniform Managed Care Contract Terms and Conditions, Contract Attachment B-1 RFP §§ 6, 7, 8 and 9 The HMO fails to timely perform an HMO Administrative Service that is not otherwise associated with a performance standard in this matrix and, in the determination of HHSC, such failure either: (1) results in actual harm to a Member or places a Member at risk of imminent harm, or (2) materially affects HHSC’s ability to administer the Program(s). Ongoing Each incident of non-compliance per HMO Program and SA. HHSC may assess up to $5,000 per calendar day for each incident of non-compliance per HMO Program and SA.

Appears in 1 contract

Samples: Contract Amendment (Centene Corp)

Sub Goals. Goal 1: Improve ~~Access to Primary Care Services for Members 90% of initial credentialing of PCPs will be finalized within 70 calendar days of receipt of application. The~~ prenatal care received by CHIP Perinate members Increase the percentage of ~~Family Practitioners with open panels will increase~~ deliveries by 5 percentage points over baseline. Goal 2: Improve Access to Behavioral Health Services for Members Increase Behavioral Health Urgent Care Appointment Availability by 5 percentage points over baseline. Increase Behavioral Health Routine Care Appointment Availability by 5 percentage points over baseline. Goal 3: Increase Utilization of New Member Medical Check-Ups 1% that received a prenatal care visit in the first trimester or within ~~90 days of Enrollment 100% of new members with valid phone numbers will receive three call attempts within 30~~ 42 days of enrollment ~~to encourage a medical check~~in the organization. Increase 17P utilization by 5% by year-~~up within 90 days of enrollment. 100% of new members that did not select a valid PCP from the plan's network will be defaulated to a local, appropriate network PCP by the 15th of each month~~end. Subject: Attachment B-5 - Deliverables/Liquidated Damages Matrix STATUS1 DOCUMENT REVISION2 EFFECTIVE DATE DESCRIPTION3 Baseline n/a Initial version of Attachment B-5, Deliverables/Liquidated Damage Matrix. Revision 1.1 June 30, 2006 Contract amendment did not revise Attachment B-5, Deliverables/Liquidated Damage Matrix. Revision 1.2 September 1, 2006 Amended Attachment B-5, Deliverables/Liquidated Damages Matrix, to add a footnote clarifying the deliverable due dates. Also amended the provisions regarding Claims Processing Requirements and the Reporting Requirements for the Claims Summary Report. Revision 1.3 September 1, 2006 Amended Attachment B-5, Deliverables/Liquidated Damages Matrix, performance standard for Provider Directories for the CHIP Perinatal Program. Revision 1.4 September 1, 2006 Contract amendment did not revise Attachment B-5, Deliverables/Liquidated Damage Matrix. Revision 1.5 January 1, 2007 Contract amendment did not revise Attachment B-5, Deliverables/Liquidated Damage Matrix. Revision 1.6 February 1, 2007 Contract amendment did not revise Attachment B-5, Deliverables/Liquidated Damage Matrix. Revision 1.7 July 1, 2007 Amended Attachment B-5, Deliverables/Liquidated Damages Matrix, to add clarifications to the provisions addressing Claims Processing Requirements and the Reporting Requirements for the Claims Summary Report. Revision 1.8 September 1, 2007 Contract amendment did not revise Attachment B-5, Deliverables/Liquidated Damage Matrix. Revision 1.9 December 1, 2007 Contract amendment did not revise Attachment B-5, Deliverables/Liquidated Damage Matrix. Revision 1.10 March 1, 2008 Amended Attachment B-5 to add or revise performance standards and liquidated damages regarding: Failure to Perform an Administrative Service; Failure to Provide a Covered Service; Behavioral Health Services Hotline; Member Services Hotline; and Provider Hotline. Revision 1.11 September 1, 2008 Amended Attachment B-5 to revise performance standards regarding: Line 1 – Failure to Perform an Administrative Service and Line 2 – Failure to Provide a Covered Service; and to replace the MDS-HC instrument with the Community Medical Necessity and Level of Care Assessment Instrument in the Performance Standard for Line 21 – Contract Amendment B-1 RFP §8.3.3 – STAR+PLUS Assessment Instruments Revision 1.12 March 1, 2009 Lines 8, 9, and 13 are modified to add a performance standard, measurement assessment, and damages for each 30 second time increment, or portion thereof, by which the average hold time exceeds the maximum acceptable hold time. Line 15 is modified to clarify reporting timeframes and requirements. Revision 1.13 September 1, 2009 Line 16.5 Contract Attachment B-1 RFP §8.1.18.1 Encounter Data is added. Line 21 Performance Standard is amended to clarify type of wiaver services. Revision 1.14 December 1, 2009 Line 21 Service/Component is amended to clarify contract references and Performance Standard is modified to require that assessment instructions must be submitted within 45 days Revision 1.15 March 1, 2010 Line 3 modified to conform to language in Attachment A, Sections 4.08(b)(3) and (4). Revision 1.16 September 1, 2010 Item 3 is modified to conform to language in Attachment A, Sections 4.08(b)(3) and (4). Item 8 is added to add liquidated damages for Out-of-Network Utilization. Item 22 is added to add liquidated damages for timely HMO response to complaints. All subsequent items are renumbered. Revision 1.17 December 1, 2010 Contract amendment did not revise Attachment B-5, Deliverables/Liquidated Damage Matrix. Revision 1.18 March 1, 2011 Item 11 modified to add liquidated damages for failing to submit timely HMO response to Provider complaints. 1 Status should be represented as “Baseline” for initial issuances, “Revision” for changes to the Baseline version, and “Cancellation” for withdrawn versions 2 Revisions should be numbered in accordance according to the version of the issuance and sequential numbering of the revision—e.g., “1.2” refers to the first version of the document and the second revision. 3 Brief description of the changes to the document made in the revision. Service/ Component1 Performance Standard2 Measurement Period3 Measurement Assessment4 Liquidated Damages General Requirement: Failure to Perform an Administrative Service Contract Attachment A HHSC Uniform Managed Care Contract Terms and Conditions, Contract Attachment B-1 RFP §§ 6, 7, 8 and 9 The HMO fails to timely perform an HMO Administrative Service that is not otherwise associated with a performance standard in this matrix and, in the determination of HHSC, such failure either: (1) results in actual harm to a Member or places a Member at risk of imminent harm, or (2) materially affects HHSC’s ability to administer the Program(s). Ongoing Each incident of non-compliance per HMO Program and SA. HHSC may assess up to $5,000 per calendar day for each incident of non-compliance per HMO Program and SA.

Appears in 1 contract

Samples: Contract Amendment (Centene Corp)

Common use of Sub Goals Clause in Contracts