Common use of Operational/Policy Developments/Issues Clause in Contracts

Operational/Policy Developments/Issues. Identify all significant program developments/issues/problems that have occurred in the current quarter, including but not limited to: approval and contracting with new plans; benefit changes; legislative activity; Healthy Behaviors program benefits by health plan and participation rates; network adequacy including customer service reporting; complaints, grievances and appeals; reporting on managed care plans critical incidents, efforts to promote alignment or integration for Medicare-Medicaid eligible individuals. Provide a summary of the types of complaints or problems consumers identified about the program in the current quarter. Include any trends discovered, the resolution of complaints, and any actions taken or to be taken to prevent other occurrences. Identify and address any appeals related to medical necessity under the EPSDT benefit.