Approval of Department. The Contractor shall submit provider or Enrollee materials, information, or documents to the Department and all such submissions will be reviewed by the Department (i) during Readiness Review; (ii) within thirty (30) days for standard submissions or (iii) five (5) Business Days for expedited submissions. The Contractor shall not use or distribute such materials with Enrollees or Providers until such time that Department approval has been received. Written material submitted to the Department for review and approval shall be considered received for review beginning with the date that the Department acknowledges to the Contractor receipt of the submission. Such acknowledgment may be demonstrated by evidence of a return receipt if sent via U.S. Mail, a delivery receipt if sent via e-mail, or the signature of a Cabinet for Health and Family Services employee taking receipt of the submission in the case of hand-delivery, including overnight mail or courier delivery. No materials will be considered approved unless such approval is sent to the Contractor in writing by the Department. General health education materials do not require prior approval by the Department. However, the Contractor shall ensure such materials are in compliance with this Contract and state and federal regulations and laws. The Contractor shall be subject to penalties for materials found to be non- compliant as set forth in Appendix B “Remedies for Violation, Breach, or Non-Performance of Contract.”
Approval of Department. The plan shall include the frequency of activities, the staff person responsible for the activities and how the activities will be documented and evaluated for effectiveness and need for change.
Approval of Department. An example of a provider communication requiring approval is notification of a rate change.
Approval of Department. Unless otherwise specified, where the Contractor is required to submit any materials, information, or documentation to the Department all such submissions will be deemed approved by the Department within (i) thirty (30) days for standard submissions or (ii) five (5) business days for expedited submissions, provided that the Department does not otherwise object or notify the Contractor within such time period. Written material submitted to the Department for review and approval shall be considered received for review beginning with the date that the Commissioner or a Deputy Commissioner of the Department acknowledge to the Contractor receipt of the submission. Such acknowledgment may be demonstrated by evidence of a return receipt if sent via U.S. Mail, a delivery receipt if sent via e- mail, or the signature of a Cabinet for Health and Family Services employee taking receipt of the submission in the case of hand-delivery, including overnight mail or courier delivery.
Approval of Department. Unless otherwise specified, where the Contractor is required to submit any materials, information, or documentation to the Department for approval, all such submissions will be deemed approved by the Department within (i) thirty (30) days for standard submissions or (ii) five (5) business days for expedited submissions, provided that the Department does not otherwise object or notify the Contractor within such time period.
Approval of Department. If the Contractor fails to properly report a case of suspected provider fraud, waste or abuse to the Department before the suspected fraud, waste or abuse is identified by the Commonwealth, its designees, the United States or private parties acting on behalf of the United States, any portion of the funds related to fraud or abuse recovered by the Commonwealth or designees shall be retained by the Commonwealth or its designees. If the Department performs or contracts with an entity that performs audits of claims paid by the Contractor and identifies an overpayment, then the Department shall send notice to the provider and collect and retain any overpayment. The Contractor shall, as requested by the Department, recoup on any outstanding overpayments owed by the provider if the provider has exhausted all appeals and fails to pay within sixty (60) days.
Approval of Department. In addition all Member materials concerning behavioral health, with the exception of written materials unique to individual Members, shall be submitted to DBHDID’s Director of the Division of Behavioral Health for review prior to publication and distribution to Members and shall also be subject to Section 4.4 “Approval of Department.”
Approval of Department. The Contractor will work directly with DBHDID to introduce the evidence based tool Screening, Brief Intervention, Referral, and Treatment (SBIRT) in appropriate PCP settings. The Contractor shall provide training to network PCPs on how to screen for and identify behavioral health disorders, the Contractor's referral process for Behavioral Health Services and clinical coordination requirements for such services. The Contractor shall include training on coordination and quality of care such as behavioral health screening techniques for PCPs and new models of behavioral health interventions. The Contractor shall develop policies and procedures and provide to the
Approval of Department. If the Contractor fails to properly report a case of suspected fraud or abuse before the suspected fraud or abuse is identified by the Commonwealth, its designees, the United States or private parties acting on behalf of the United States, any portion of the fraud or abuse recovered by the Commonwealth or designees shall be retained by the Commonwealth or its designees. If the Department performs or contracts with an entity that performs audits of claims paid by the Contractor and identifies an overpayment, then the Department shall send notice to the provider and collect and retain any overpayment. The Contractor shall, as requested by the Department, recoup on any outstanding overpayments owed by the provider if the provider has exhausted all appeals and fails to pay within sixty (60) days.
Approval of Department. The Contractor shall provide information to any Enrollee upon request about any Physician Incentive Plan and/or any payments to Provider made pursuant to an incentive arrangement under this Section to a provider as required by applicable state or federal law. If a Contractor includes a Physician Incentive Plan, the activities included shall comply with requirements set forth in 42 C.F.R. 422.208 and 42 C.F.R. 422.210. The Contractor shall report disclosures to the Department for Physician Incentive Plans including the following:
