Department Oversight. TWIA shall provide a fully executed copy of this Agreement to the Department. The Insurer shall respond to any requests for information by the Department regarding the proposal or this Agreement. The Insurer and TWIA are, and shall remain, subject to all applicable laws of the State of Texas and the supervision, rules, regulations and orders of the Department.
Department Oversight. The Department reserves the right to review the Contractor’s policies and procedures and determine conditions for formal notification to the Department of situations involving quality of care. During the conduct of contract monitoring activities, the Department may assess the Contractor’s compliance with any requirements set forth in this Contract and in the documents referenced herein. The Department reserves the right to audit, formally and/or informally, for compliance with any term(s) of this Contract, for compliance with the laws and regulations of the Federal Government and the Commonwealth of Virginia, and for compliance in the implementation of any term(s) of this Contract. The right to audit under this section exists for ten (10) years from the final date of the contract period or from the date of completion of any audit, whichever is later. The Department shall be responsible for the administration of this Contract. Administration of the Contract shall be conducted in good faith within the resources of the State, but in the best interest of the members. The Department shall retain full authority for the administration of the Medicaid Program in accordance with the requirements of Federal and State laws and regulations. See Section 16.2 regarding conflicts between the Department’s administration of the Medicaid program and the Contractor’s policies and its subcontractor’s contracts. RESPONSIVENESS TO THE DEPARTMENT The Contractor must acknowledge receipt of the Department’s written, electronic, or telephonic requests for assistance, including case management evaluation requests and requests to change MCO (good cause as outlined in section 6.3.E of this Contract), involving members or providers as within one (1) business day in instances where the member’s health condition requires and in all other instances no later than two (2) business days of receipt of the request from the Department. The Contractor’s acknowledgement must include a planned date of resolution. A detailed resolution summary advising the Department of the Contractor’s action and resolution shall be rendered to the Department in the format requested. The Department’s requests for case management services and/or requests for the Contractor to contact the member/provider must occur within the time frame set forth by the Department. The Department’s urgent requests for assistance such as issues involving legislators, other governmental bodies, or as determined by the Department, must...
Department Oversight. Contractor acknowledges that pursuant to Section 10.02 of the Comprehensive Agreement, the Department has the right to oversee the Work, including the DB Work, and Contractor shall cooperate with Concessionaire and Department to facilitate the Department’s conduct of such oversight of the DB Work. If at any time Concessionaire fails to perform any of its obligations in any material respect under the Comprehensive Agreement, the Department, with written notice to Concessionaire given concurrently with the increase in the Department’s monitoring or as soon as practicable thereafter, is entitled, pursuant to Section 10.04(b) of the Comprehensive Agreement, to adequately and appropriately increase the level of its monitoring of the Project and Concessionaire’s compliance with its obligations pursuant to the Comprehensive Agreement, until such time as Concessionaire has demonstrated to the Department’s reasonable satisfaction that it will perform and is capable of performing such obligations. If such failure by Concessionaire to perform its obligations under the Comprehensive Agreement is a result of Contractor’s failure to perform its obligations hereunder, then Contractor (i) will, on behalf of Concessionaire, as required by Section 10.04(b) of the Comprehensive Agreement, compensate the Department for all “Allocable Costs” incurred by the Department as a result of such increased level of monitoring from and after the date on which such increased level of monitoring begins, not to exceed $2,000,000 in the aggregate; provided, that if the increased monitoring is due to a delay in achieving Substantial Completion or Final Acceptance, Contractor will compensate the Department (through Concessionaire) for such increased monitoring solely by payment of liquidated damages pursuant to Section 7.2, and (ii) as permitted by Section 10.04 (d) of the Comprehensive Agreement, may submit a cure plan to the Department (through Concessionaire) describing specific actions Contractor will undertake to improve its performance and avoid the need for increased monitoring, which the Department may accept or reject under the Comprehensive Agreement, and if the Department accepts a cure plan, the Department has agreed under the Comprehensive Agreement not to increase its monitoring or other oversight services unless Concessionaire (or Contractor for the purposes of this Agreement) fails to diligently pursue such cure plan. In addition, Contractor shall, on behalf of Concessionaire,...
Department Oversight. The Contractor and its subcontractor(s) agree to make available to the Department upon request, data, clinical and other records and reports for review of quality of care, access and utilization issues including but not limited to EQRO, HEDIS, Encounter Data Validation, and other related activities. The Contractor must submit a plan, as determined by the Department, and within time frames established by the Department, to resolve any performance or quality of care deficiencies identified by the Department's ongoing monitoring activities and any independent assessments or evaluations requested by the Department. The Contractor must obtain advance written approval from the Department before releasing or sharing data, correspondence and/or improvements from the Department regarding the Contractor's internal QM and UM programs with any of the other HealthChoices PH-MCOs or any external entity. The Contractor must obtain advance written approval from the Department before participating in or providing letters of support for QM or UM data studies and/or any data related external research projects related to HealthChoices with any entity.
Department Oversight. 12. CHC-MCO Cooperation with Research and Evaluation DD. Mergers, Acquisitions, Xxxx, Insignia, Logo and Product Name 1. Mergers and Acquisitions .................................................................
Department Oversight. The CHC-MCO and its subcontractor(s) and Network Providers will make available to the Department upon request, data, clinical and other records and reports for review of quality of care, access and utilization issues, including, but not limited to, activities related to EQR, HEDIS, Encounter Data validation, and other related activities. The CHC-MCO must submit a plan, in accordance with the timeframes established by the Department, to resolve any performance or quality of care deficiencies identified through ongoing monitoring activities and any independent assessments or evaluations requested by the Department. The CHC-MCO must obtain advance written approval from the Department before releasing or sharing data, correspondence and/or improvements from the Department regarding the CHC-MCO’s internal QM and UM programs with any of the other CHC-MCOs or any external entity. The CHC-MCO must obtain advance written approval from the Department before participating in or providing letters of support for QM or UM data studies and/or any data related external research projects related to CHC with any entity.
Department Oversight. The Department reserves the right to review the Contractor’s policies and procedures and determine conditions for formal notification to the Department of situations involving quality of care. During the conduct of contract monitoring activities, the Department may assess the Contractor’s compliance with any requirements set forth in this Contract and in the documents referenced herein. The Department reserves the right to audit, formally and/or informally, for compliance with any term(s) of this Contract, for compliance with the laws and regulations of the Federal Government and the Commonwealth of Virginia, and for compliance in the implementation of any term(s) of this Contract. The right to audit under this section exists for ten (10) years from the final date of the contract period or from the date of completion of any audit, whichever is later. Records must be maintained in a searchable electronic format. The Department shall be responsible for the administration of this Contract. Administration of the Contract shall be conducted in good faith within the resources of the State, but in the best interest of the members. The Department shall retain full authority for the administration of the Medicaid and FAMIS programs in accordance with the requirements of Federal and State laws and regulations. See Section 16.2 regarding conflicts between the Department’s administration of the Medicaid program and the Contractor’s policies and its subcontractor’s contracts.
Department Oversight. Each Department will designate a Records Manager within that department to assist the Records Administrator with implementing this Policy. These Records Managers are responsible for: Ensuring that the records of their respective departments are retained for the periods of time specified in the Records Retention Schedule; Assisting in the maintenance of an accurate and complete inventory of that Department’s stored records; Coordinating with the Records Administrator to oversee the destruction of records in accordance with the Records Retention Schedule; Completing audits every two years in conjunction with the Records Administrator in order to ensure department records are in compliance with this policy.
Department Oversight. The PH-MCO and its Subcontractor(s) will make available to the Department upon request, data, clinical and other records and reports for review of quality of care, access and utilization issues including but not limited to activities related to External Quality Review, HEDIS, Encounter Data validation, and other related activities. The PH-MCO must submit a plan, in accordance with the time frames established by the Department, to resolve any performance or quality of care deficiencies identified through ongoing monitoring activities and any independent assessments or evaluations requested by the Department. The PH-MCO must obtain advance written approval from the Department before releasing or sharing data, correspondence and/or improvements from the Department regarding the PH-MCO’s internal QM and UM programs with any of the other HealthChoices PH-MCOs or any external entity. The PH-MCO must obtain advance written approval from the Department before participating in or providing letters of support for QM or UM data studies and/or any data related external research projects related to HealthChoices with any entity.
Department Oversight. CITIZENS shall provide a fully executed copy of this Agreement to the Department. The Carrier shall respond to any requests for information by the Department regarding the proposal or this Agreement. The Carrier and CITIZENS are, and shall remain, subject to all applicable laws of the State of Florida and the supervision, rules, regulations and orders of the Department.
