Content of Provider Contracts, including any Provider Performance Incentives, in accordance with Sections 2.7.B., 2.13.D. and 6.1.H; Contractual Agreements with Community Partners, in accordance with Sections 2.5.F and 2.5.G. Enrollee Services capability (materials, processes and infrastructure, e.g., call center capabilities), in accordance with Section 2.10; Comprehensiveness of quality management/quality improvement strategies, in accordance with Section 2.13; Comprehensiveness of Utilization Management strategies, in accordance with Section 2.6.D; Internal Grievance and Appeal policies and procedures, in accordance with Section 2.12; Fraud and Abuse and program integrity, in accordance with Section 2.3.C.3.; Financial solvency, in accordance with Section 2.15; At the request of EOHHS, a walk-through of any information systems, including but not limited to enrollment, claims payment system performance, interfacing and reporting capabilities and validity testing of Encounter Data, in accordance with Section 2.14, including IT testing and security assurances. The scope of the Readiness Review will also include an assessment of the Contractor’s ability and capability to perform satisfactorily in the areas set forth in 42 CFR 438.66(d)(4). MassHealth Members shall not be enrolled into the Contractor’s Plan unless and until EOHHS determines that the Contractor is ready and able to perform its obligations under the Contract as demonstrated during the Readiness Review, except as provided below. EOHHS will identify to the Contractor all areas where the Contractor is not ready and able to meet its obligations under the Contract and may, in its discretion, allow the Contractor to propose a plan to remedy all deficiencies prior to the Contract Operational Start Date. EOHHS may, in its discretion, postpone the Contract Operational Start Date for any Contractor that fails to satisfy all Readiness Review requirements. If, for any
Content of Provider Contracts, including any Provider Performance Incentives, in accordance with Sections 2.7.B., 2.13.D. and 6.1.H; Contractual Agreements with Community Partners, in accordance with Sections 2.5.F and 2.5.G. Enrollee Services capability (materials, processes and infrastructure, e.g., call center capabilities), in accordance with Section 2.10; Comprehensiveness of quality management/quality improvement strategies, in accordance with Section 2.13; Comprehensiveness of Utilization Management strategies, in accordance with Section 2.6.D; Internal Grievance and Appeal policies and procedures, in accordance with Section 2.12; Fraud and Abuse and program integrity, in accordance with Section 2.3.C.3.; Financial solvency, in accordance with Section 2.15; At the request of EOHHS, a walk-through of any information systems, including but not limited to enrollment, claims payment system performance, interfacing and reporting capabilities and validity testing of Encounter Data, in accordance with Section 2.14, including IT testing and security assurances. The scope of the Readiness Review will also include an assessment of the Contractor’s ability and capability to perform satisfactorily in the areas set forth in 42 CFR 438.66(d)(4). MassHealth Members shall not be enrolled into the Contractor’s Plan unless and until EOHHS determines that the Contractor is ready and able to perform its obligations under the Contract as demonstrated during the Readiness Review, except as provided below. EOHHS will identify to the Contractor all areas where the Contractor is not ready and able to meet its obligations under the Contract and may, in its discretion, allow the Contractor to propose a plan to remedy all deficiencies prior to the Contract Operational Start Date. EOHHS may, in its discretion, postpone the Contract Operational Start Date for any Contractor that fails to satisfy all Readiness Review requirements. If, for any
accountable-care-partnership-plan-model-contract.docx