Common use of Monitoring Process Clause in Contracts

Monitoring Process. a) The purpose of performance monitoring is to: (1) Determine the degree to which the program is accomplishing its goals and objectives; (2) Provide measurements of program results and effectiveness; (3) Evaluate efficiency in the allocation of resources; and (4) Assess compliance with the contract and applicable statutes and regulations. b) Failure to meet the thresholds established for Performance Indicators or other contract requirements constitutes breach of the contract and may result in the initiation of remedial action at the discretion of IDHW. c) IDHW will engage in ongoing contract monitoring, which may include performance monitoring of the Health Plan. This may include review of documentation as well as onsite monitoring at any operational facilities and business offices that handle any component of the Contract requirements. Documentation requested for the purposes of contract monitoring that is part of the Health Plan’s routine operations must be supplied to the contract monitor within three (3) business days of the request. Documentation that requires research, data collection, compilation of reports, or additional labor must be supplied to the contract monitor within ten (10) business days of the request or a mutually agreed upon date. d) During any type of performance monitoring, the Health Plan or any network provider or subcontractor will provide to IDHW any client’s treatment records, logbooks, staffing charts, time reports, claims data, administrative documents, complaints, grievances, and any other requested documents and data as requested when at the discretion of IDHW it is determined to be required to assess the performance of the Health Plan, a network provider or subcontractor. e) If monitoring activities are conducted at a provider location they will be conducted in a manner so as not to disrupt the provision of treatment to clients. f) Any monitoring performed may or may not be scheduled in advance, and may last for several days. g) The performance level of the Health Plan or a network provider or subcontractor may affect the frequency of the monitoring. h) IDHW reserves the right to monitor any aspect of the contract, not just those elements identified in the Performance Indicators or Contract Requirements. i) Additionally, if IDHW receives continual unresolved client or provider network complaints regarding service issues, IDHW will initiate a focused monitoring of that area, utilizing at least one of the performance criteria listed in this document. IDHW will then follow the reporting, cure period, and appeal process listed below. j) Areas in which performance deficiencies have been found may be followed continually, or subsequently re-examined as designated by IDHW. k) All monitoring is designed and will be performed in accordance with the following standards: (1) United States Code (2) Code of Federal Regulations (3) Idaho Code (4) Idaho Administrative Code (5) This Contract (6) Approved Medicaid waiver programs (7) National Accreditation Standards (8) Department of Health and Welfare Policies and Procedures l) General requirements applicable to all clients will typically be assessed via a randomly selected data review of approximately ten percent (10%) sample of client files at a provider location. Other requirements, relevant to a segment of the client population, may be reviewed using a higher percentage, up to one hundred percent (100%) of the records of a sub-population. Areas in which performance deficiencies have been found may be re-examined in the subsequent quarter or follow up period, as designated by IDHW, in order to gauge progress towards satisfactory performance.

Monitoring Process. a) The purpose of performance monitoring is to: (1) Determine the degree to which the program is accomplishing its goals and objectives; (2) Provide measurements of program results and effectiveness; (3) Evaluate efficiency in the allocation of resources; and (4) Assess compliance with the contract and applicable statutes and regulations. b) Failure to meet the thresholds established for Performance Indicators or other contract requirements constitutes breach of the contract and may result in the initiation of remedial action at the discretion of IDHW. c) IDHW will engage in ongoing contract monitoring, which and this may include performance monitoring of the Health Plan. This may include review of documentation as well as onsite monitoring at any operational facilities and business offices that handle any component of the Contract requirements. Documentation requested for the purposes of contract monitoring that is part of the Health Plan’s routine operations must be supplied to the contract monitor within three (3) business days of the request. Documentation that requires research, data collection, compilation of reports, or additional labor must be supplied to the contract monitor within ten (10) business days of the request or a mutually agreed upon date. d) During any type form of performance monitoring, the Health Plan or any network provider or subcontractor will provide to IDHW any client’s treatment records, logbooks, staffing charts, time reports, claims data, administrative documents, complaints, grievances, and any other requested documents and data as requested when at the discretion of IDHW it is determined to be required to assess the performance of the Health Plan, a network provider or subcontractor. e) If monitoring activities are conducted at a provider location they will be conducted in a manner so as not to disrupt the provision of treatment to clients. f) Any monitoring performed may or may not be scheduled in advance, and may last for several days. g) The performance level of the Health Plan or a network provider or subcontractor may affect the frequency of the monitoring. h) IDHW reserves the right to monitor any aspect of the contract, not just those elements identified in the Performance Indicators or Contract Requirements. i) Additionally, if IDHW receives continual unresolved client or provider network complaints regarding service issues, IDHW will initiate a focused monitoring of that area, utilizing at least one of the performance criteria listed in this document. IDHW will then follow the reporting, cure period, and appeal process listed below. j) Areas in which performance deficiencies have been found may be followed continually, or subsequently re-examined as designated by IDHW. k) All monitoring is designed and will be performed in accordance with the following standards: (1) United States Code (2) Code of Federal Regulations (3) Idaho Code (4) Idaho Administrative Code (5) This Contract (6) Approved Medicaid waiver programs (7) National Accreditation Standards (8) Department of Health and Welfare Policies and Procedures l) General requirements applicable to all clients will typically be assessed via a randomly selected data review of approximately ten percent (10%) sample of client files at a provider location. Other requirements, relevant to a segment of the client population, may be reviewed using a higher percentage, up to one hundred percent (100%) of the records of a sub-population. Areas in which performance deficiencies have been found may be re-examined in the subsequent quarter or follow up period, as designated by IDHW, in order to gauge progress towards satisfactory performance.