Common use of Inspection and Monitoring Clause in Contracts

Inspection and Monitoring. Pursuant to the requirements of 42 CFR § 438.6, the Division, CMS and other authorized federal or State personnel or the authorized representatives of these parties including, without limitation, any employee, agent, or contractor of the Division, CMS, the Fiscal Agent, the Division's Program Integrity Unit and the State Medicaid Fraud Control Unit, shall have the right to monitor and inspect the operations of the Contractor and any subcontractor or supplier for compliance with the provisions of this contract and all applicable federal and State law and regulations, with or without notice, at any time during the term of this contract. Such monitoring activities shall include, but are not limited to, on-site inspections of all service locations and health care facilities; auditing and/or review of all records developed under this contract including periodic medical audits, grievances, enrollments, disenrollment’s, termination, utilization and financial records, reviewing management systems and procedures developed under this contract and review of any other areas of materials relevant to or pertaining to this contract. Because of the importance of having accurate service utilization data for program management, utilization review and evaluation purposes, emphasis will be placed on case record validation during periodic monitoring visits to project sites. The Division shall prepare a report of its findings and recommendations and require the Contractor to develop corrective action plan to address any deficiencies.

Inspection and Monitoring. Pursuant to the requirements of 42 CFR § 438.6, the Division, CMS and other authorized federal or State personnel or the authorized representatives of these parties including, without limitation, any employee, agent, or contractor Contractor of the Division, CMS, the Fiscal Agent, the Division's Program Integrity Unit and the State Medicaid Fraud Control Unit, shall have the right to monitor and inspect the operations of the Contractor and any subcontractor or supplier for compliance with the provisions of this contract and all applicable federal and State law and regulations, with or without notice, at any time during the term of this contract. Such monitoring activities shall include, but are not limited to, on-site inspections of all service locations and health care facilities; auditing and/or review of all records developed under this contract including periodic medical audits, grievances, enrollments, disenrollment’s, termination, utilization and financial records, reviewing management systems and procedures developed under this contract and review of any other areas of materials relevant to or pertaining to this contract. Because of the importance of having accurate service utilization data for program management, utilization review and evaluation purposes, emphasis will be placed on case record validation during periodic monitoring visits to project sites. The Division shall prepare a report of its findings and recommendations and require the Contractor to develop corrective action plan to address any deficiencies.

Inspection and Monitoring. Pursuant to the requirements of 42 CFR § 438.6, the Division, CMS and other authorized federal or State personnel or the authorized representatives of these parties including, without limitation, any employee, agent, or contractor of the Division, CMS, the Fiscal Agent, the Division's Program Integrity Unit and the State Medicaid Fraud Control Unit, shall have the right to monitor and inspect the operations of the Contractor and any subcontractor or supplier for compliance with the provisions of this contract and all applicable federal and State law and regulations, with or without notice, at any time during the term of this contract. Such monitoring activities shall include, but are not limited to, on-site inspections of all service locations and health care facilities; auditing and/or review of all records developed under this contract including periodic medical audits, grievances, enrollments, disenrollment’s, termination, utilization and financial records, reviewing management systems and procedures developed under this contract and review of any other areas of materials relevant to or pertaining to this contract. Because of the importance of having accurate service utilization data for program management, utilization review and evaluation purposes, emphasis will be placed on case record validation during periodic monitoring visits to project sites. The Division shall prepare a report of its findings and recommendations and require the Contractor to develop corrective action plan to address any deficiencies.