Administration and Contract Management Clause Samples
The Administration and Contract Management clause outlines the procedures and responsibilities for overseeing the execution and ongoing management of the contract. It typically specifies who is responsible for contract administration, how communications and documentation should be handled, and the processes for monitoring performance and compliance. By clearly defining these administrative roles and processes, the clause ensures that both parties understand how the contract will be managed on a day-to-day basis, reducing the risk of misunderstandings and facilitating smooth contract execution.
Administration and Contract Management. The HMO must comply, to the satisfaction of HHSC, with (1) all provisions set forth in this Contract, and (2) all applicable provisions of state and federal laws, rules, regulations, and waivers.
Administration and Contract Management. The MCO must comply, to the satisfaction of HHSC, with: (1) all provisions set forth in this Contract, and (2) all applicable provisions of state and federal laws, rules, regulations, and waiver agreements with the Centers for Medicare and Medicaid Services (CMS).
Administration and Contract Management. A. Organization, Staffing, and Key Personnel
1. Structure and Governance The Contractor shall:
a. Meet the definition of an MCO, as set forth in Section 1; b. Be located within the United States;
Administration and Contract Management.
A. Managed Care Contact The PCC shall identify a Managed Care Contact to represent the PCC on all matters related to the fulfillment of the PCC Contract.
B. Notification of PCC Changes
1. Notice to EOHHS The PCC shall notify EOHHS, in writing, at least 14 days prior to any changes affecting delivery of care, the administration of its PCC practice, or its performance of PCC Contract requirements. Such changes include, but are not limited to the following:
a. Voluntarily withdrawing from the PCC Plan or the MassHealth program for any reason;
b. A change in any information contained in the PCC Plan Provider application or other application submitted by the PCC to EOHHS;
c. A change of address;
d. A change in the Managed Care Contact required in Section 3.1.A.; and
e. A change in the PCC’s hours of operation or designation of PCC specialty.
2. Notice to PCC Plan Enrollees The PCC shall provide notice to its PCC Plan Enrollees in advance of any changes listed in Section 3.1.B.1.a. and c. above.
Administration and Contract Management. EOHHS shall:
A. Provide the PCC with information on how to contact relevant EOHHS units and vendors for assistance with issues such as billing, prior authorization, covered services and other PCC responsibilities;
B. Conduct ongoing data and record reviews to help ensure the delivery of services in the most appropriate setting in accordance with medical standards and protocols;
C. Conduct quality management activities such as HEDIS measurement and Member satisfaction surveys to assess the effectiveness of the PCC Plan performance and make the results available to PCCs;
D. Pay the PCC an enhanced rate for certain Primary Care services provided to the PCC’s Enrollees (see Sections 5.1 and 5.2);
E. Notify the PCC of all programmatic and policy changes that may affect the PCC's participation in MassHealth; and
F. Reserve the right to change the current MassHealth program, including but not limited to covered services, Member eligibility, cost-sharing, or PCC Plan programmatic features upon written notice to the PCC of any such changes.
Administration and Contract Management. Organization, Staffing and Key Personnel
1. Structure and Governance The Contractor shall: Meet the definition of an MCO, as set forth in Section 1; Be located within the United States; Not have, nor may any of the Contractor’s Material Subcontractors have, any financial, legal, contractual or other business interest in EOHHS’s enrollment broker, or in such vendor’s subcontractors, if any; Not have, nor may any of the Contractor’s Material Subcontractors have, any financial, legal, contractual or other business interest in EOHHS’s External Quality Review Organization Contractor, or in such vendor’s subcontractors, if any; Establish and maintain interdepartmental structures and processes to support the operation and management of its MassHealth line of business in a manner that fosters integration of physical and behavioral health service provision. The provision of all services shall be based on prevailing clinical knowledge and the study of data on the efficacy of treatment, when such data is available. The Contractor’s Behavioral Health Services and activities should be integral to the Plan, Enrollee-focused, and oriented to recovery and rehabilitation from behavioral health conditions. On an ad hoc basis when changes occur or as directed by EOHHS, the Contractor shall submit to EOHHS an overall organizational chart that includes senior and mid-level managers for the organization. The organizational chart must include the organizational staffing for Behavioral Health Services and activities. If such Behavioral Health Services and activities are provided by a Material Subcontractor, the Contractor shall submit the organizational chart of the behavioral health Material Subcontractor which clearly demonstrates the relationship with the Material Subcontractor and the Contractor’s oversight of the Material Subcontractor. For all organizational charts, the Contractor shall indicate any staff vacancies and provide a timeline for when such vacancies are anticipated to be filled; The Contractor shall submit to EOHHS a list of its Board of Directors as of the Contract Effective Date and an updated list of its Board of Directors whenever any changes are made.
2. Key Personnel and Other Staff The following roles shall be Key Personnel:
1) The Contractor’s MassHealth Executive Director, who shall have primary responsibility for the management of this contract and shall be authorized and empowered to represent the Contractor regarding all matters pertaining to this ...
Administration and Contract Management. 2.3.1. Organization, Staffing, and Key Personnel