Common use of Organizational Structure Clause in Contracts

Organizational Structure. The Contractor shall establish, maintain and describe the interdepartmental structures and processes to support the operation and management of its One Care Plan line of business in a manner that fosters integration of physical and behavioral health service provision. The provision of all services shall be based on prevailing clinical knowledge and the study of data on the efficacy of treatment, when such data is available. The Contractor’s Behavioral Health Services and activities should be person‑centered, and oriented to recovery and rehabilitation from behavioral health conditions. On an annual basis, and on an ad hoc basis when changes occur or as directed by EOHHS, the Contractor shall submit to EOHHS an overall organizational chart that includes senior and mid‑level managers for the organization. The organizational chart must include the organizational staffing for Behavioral Health Services and activities. If such Behavioral Health Services and activities are provided by a First Tier, Downstream, or Related Entity the Contractor shall submit the organizational chart of the behavioral health First Tier, Downstream, or Related Entity which clearly demonstrates the relationship with the First Tier, Downstream, or Related Entity and the Contractor’s oversight of the First Tier, Downstream, or Related Entity. For all organizational charts, the Contractor shall indicate any staff vacancies and provide a timeline for when such vacancies are anticipated to be filled. For all employees, by functional area, the Contractor shall establish and maintain policies and procedures for managing staff retention and employee turnover. Such policies and procedures shall be provided to EOHHS upon request. For key management positions, including the Contractor’s Chief Executive Officer, if applicable, One Care Plan Executive Director, Chief Medical Officer/Medical Director, Pharmacy Director, Behavioral Health Clinical Director, Director of Long‑term Services and Supports, Accessibility and Accommodations Compliance Officer, Chief Financial Officer, Chief Operating Officer, Senior Manager of Clinical Services, Quality Manager, Claims Director, Information Technology (IT) Director, Compliance Officer, and designated “key contact,” the Contractor shall immediately notify CMS and EOHHS whenever the position becomes vacant and notify CMS and EOHHS when the position is filled and by whom; and The Contractor shall submit to EOHHS a listing of its board of directors as of the Contract Effective Date and an updated listing of its board of directors whenever any changes are made. Enrollment Activities Enrollment EOHHS will begin self‑selection (opt‑in) enrollment prior to the initiation of Passive Enrollment. During this period, Medicare‑Medicaid Beneficiaries eligible for the Demonstration may choose to enroll into a particular One Care plan. The first Effective Enrollment Date for this initial opt‑in period is scheduled for no earlier than January 1, 2022. Eligible Medicare‑Medicaid Beneficiaries who do not select a One Care plan or who do not opt out of the Demonstration will be assigned to a One Care plan during Passive Enrollment. EOHHS may conduct Passive Enrollment during the term of the Contract to assign eligible Medicare‑Medicaid Beneficiaries who do not select a One Care plan and who do not opt out of the Demonstration. Individuals who opt out of the Demonstration will not be included in Passive Enrollment for the remainder of the Demonstration. Individuals currently enrolled in PACE may not be passively enrolled into a One Care plan. EOHHS will provide notice of Passive Enrollments at least sixty (60) days prior to the effective dates to Eligible Beneficiaries, and will accept opt‑out requests prior to the effective date of enrollment. EOHHS will apply intelligent methodologies, to the extent approved by CMS, to assign Eligible Beneficiaries to a One Care plan. Such methodologies may include, but not be limited to, past provider relationships. CMS and EOHHS may stop Passive Enrollment to the Contractor if the Contractor does not meet reporting requirements necessary to maintain Passive Enrollment as set forth by CMS and EOHHS. Enrollments and disenrollments will be processed through the EOHHS customer service vendor, consistent with the Effective Enrollment Date requirements outlined in the Medicare‑Medicaid Plan Enrollment and Disenrollment Guidance. EOHHS or its vendor will then submit Passive Enrollment transactions at least sixty (60) days in advance of the effective date, to the CMS Medicare Advantage Prescription Drug (XXXX) enrollment system directly or via a third‑party CMS designates to receive such transactions, and MassHealth or its vendor will receive notification on the next Daily Transaction Reply Report. The Contractor will then receive enrollment transactions through the EOHHS customer service vendor. The Contractor will also use the third‑party CMS designates to submit additional enrollment‑related information to XXXx, and receive files from CMS. Enrollments received by the last calendar day of the month will be effective on the first calendar day of the following month. The Contractor is responsible for providing and paying for Covered Services as of the Effective Enrollment Date of each Enrollee, even if the Contractor is not notified of an Enrollee’s enrollment into the Contractor’s One Care Plan until after such Enrollee’s Effective Enrollment Date. The Contractor must have a mechanism for receiving timely information about all enrollments in the Contractor’s One Care Plan, including the Effective Enrollment Date, from CMS and MassHealth systems.

Organizational Structure. The Contractor shall establish, maintain and describe the interdepartmental structures and processes to support the operation and management of its One Care Plan ICO line of business in a manner that fosters integration of physical and behavioral health service provision. The provision of all services shall be based on prevailing clinical knowledge and the study of data on the efficacy of treatment, when such data is available. The Contractor’s Behavioral Health Services and activities should be person‑centeredperson-centered, and oriented to recovery and rehabilitation from behavioral health conditions. On an annual basis, and on an ad hoc basis when changes occur or as directed by EOHHS, the Contractor shall submit to EOHHS an overall organizational chart that includes senior and mid‑level mid-level managers for the organization. The organizational chart must include the organizational staffing for Behavioral Health Services and activities. If such Behavioral Health Services and activities are provided by a First Tier, Downstream, Downstream or Related Entity the Contractor shall submit the organizational chart of the behavioral health First Tier, Downstream, Downstream or Related Entity which clearly demonstrates the relationship with the First Tier, Downstream, Downstream or Related Entity and the Contractor’s oversight of the First Tier, Downstream, Downstream or Related Entity. For all organizational charts, the Contractor shall indicate any staff vacancies and provide a timeline for when such vacancies are anticipated to be filled. For all employees, by functional area, the Contractor shall establish and maintain policies and procedures for managing staff retention and employee turnover. Such policies and procedures shall be provided to EOHHS upon request. For key management positions, including the Contractor’s Chief Executive Officerchief executive officer, if applicable, One Care Plan Executive Directorplan executive director, Chief Medical Officerchief medical officer/Medical Directormedical director, Pharmacy Directorpharmacy director, Behavioral Health Clinical Directorbehavioral health clinical director, Director director of Long‑term Services long term services and Supportssupports, Accessibility and Accommodations Compliance OfficerADA compliance director, Chief Financial Officerchief financial officer, Chief Operating Officerchief operating officer, Senior Manager senior manager of Clinical Servicesclinical services, Quality Managerquality manager, Claims Directorclaims director, Information Technology information technology (IT) Directordirector, Compliance Officercompliance officer, and designated “key contact,” , the Contractor shall immediately notify CMS and EOHHS whenever the position becomes vacant and notify CMS and EOHHS when the position is filled and by whom; and The Contractor shall submit to EOHHS a listing of its board of directors as of the Contract Effective Date and an updated listing of its board of directors whenever any changes are made. Enrollment Activities Enrollment EOHHS will begin self‑selection (opt‑in) enrollment prior to the initiation of Passive Enrollment. During this period, Medicare‑Medicaid Beneficiaries eligible for the Demonstration may choose to enroll into a particular One Care plan. The first Effective Enrollment Date for this initial opt‑in period is scheduled for no earlier than January 1, 2022. Eligible Medicare‑Medicaid Beneficiaries who do not select a One Care plan or who do not opt out of the Demonstration will be assigned to a One Care plan during Passive Enrollment. EOHHS may conduct Passive Enrollment during the term of the Contract to assign eligible Medicare‑Medicaid Beneficiaries who do not select a One Care plan and who do not opt out of the Demonstration. Individuals who opt out of the Demonstration will not be included in Passive Enrollment for the remainder of the Demonstration. Individuals currently enrolled in PACE may not be passively enrolled into a One Care plan. EOHHS will provide notice of Passive Enrollments at least sixty (60) days prior to the effective dates to Eligible Beneficiaries, and will accept opt‑out requests prior to the effective date of enrollment. EOHHS will apply intelligent methodologies, to the extent approved by CMS, to assign Eligible Beneficiaries to a One Care plan. Such methodologies may include, but not be limited to, past provider relationships. CMS and EOHHS may stop Passive Enrollment to the Contractor if the Contractor does not meet reporting requirements necessary to maintain Passive Enrollment as set forth by CMS and EOHHS. Enrollments and disenrollments will be processed through the EOHHS customer service vendor, consistent with the Effective Enrollment Date requirements outlined in the Medicare‑Medicaid Plan Enrollment and Disenrollment Guidance. EOHHS or its vendor will then submit Passive Enrollment transactions at least sixty (60) days in advance of the effective date, to the CMS Medicare Advantage Prescription Drug (XXXX) enrollment system directly or via a third‑party CMS designates to receive such transactions, and MassHealth or its vendor will receive notification on the next Daily Transaction Reply Report. The Contractor will then receive enrollment transactions through the EOHHS customer service vendor. The Contractor will also use the third‑party CMS designates to submit additional enrollment‑related information to XXXx, and receive files from CMS. Enrollments received by the last calendar day of the month will be effective on the first calendar day of the following month. The Contractor is responsible for providing and paying for Covered Services as of the Effective Enrollment Date of each Enrollee, even if the Contractor is not notified of an Enrollee’s enrollment into the Contractor’s One Care Plan until after such Enrollee’s Effective Enrollment Date. The Contractor must have a mechanism for receiving timely information about all enrollments in the Contractor’s One Care Plan, including the Effective Enrollment Date, from CMS and MassHealth systems.

Organizational Structure. The Contractor shall establish, maintain and describe the interdepartmental structures and processes to support the operation and management of its One Care Plan line of business in a manner that fosters integration of physical and behavioral health service provision. The provision of all services shall be based on prevailing clinical knowledge and the study of data on the efficacy of treatment, when such data is available. The Contractor’s Contractor‘s Behavioral Health Services and activities should be person‑centeredperson- centered, and oriented to recovery and rehabilitation from behavioral health conditions. On an annual basis, and on an ad hoc basis when changes occur or as directed by EOHHS, the Contractor shall submit to EOHHS an overall organizational chart that includes senior and mid‑level mid-level managers for the organization. The organizational chart must include the organizational staffing for Behavioral Health Services and activities. If such Behavioral Health Services and activities are provided by a First Tier, Downstream, or Related Entity the Contractor shall submit the organizational chart of the behavioral health First Tier, Downstream, or Related Entity which clearly demonstrates the relationship with the First Tier, Downstream, or Related Entity and the Contractor’s Contractor‘s oversight of the First Tier, Downstream, or Related Entity. For all organizational charts, the Contractor shall indicate any staff vacancies and provide a timeline for when such vacancies are anticipated to be filled. For all employees, by functional area, the Contractor shall establish and maintain policies and procedures for managing staff retention and employee turnover. Such policies and procedures shall be provided to EOHHS upon request. For key management positions, including the Contractor’s Chief Executive OfficerContractor‘s chief executive officer, if applicable, One Care Plan Executive Directorplan executive director, Chief Medical Officerchief medical officer/Medical Directormedical director, Pharmacy Directorpharmacy director, Behavioral Health Clinical Directorbehavioral health clinical director, Director director of Long‑term Services long-term services and Supportssupports, Accessibility and Accommodations Compliance OfficerADA compliance director, Chief Financial Officerchief financial officer, Chief Operating Officerchief operating officer, Senior Manager senior manager of Clinical Servicesclinical services, Quality Managerquality manager, Claims Directorclaims director, Information Technology information technology (IT) Directordirector, Compliance Officercompliance officer, and designated “key contact,” , the Contractor shall immediately notify CMS and EOHHS whenever the position becomes vacant and notify CMS and EOHHS when the position is filled and by whom; and The Contractor shall submit to EOHHS a listing of its board of directors as of the Contract Effective Date and an updated listing of its board of directors whenever any changes are made. Enrollment Activities Enrollment EOHHS will begin self‑selection self-selection (opt‑inopt-in) enrollment prior to the initiation of Passive Enrollment. During this period, Medicare‑Medicaid Medicare- Medicaid Beneficiaries eligible for the Demonstration may choose to enroll into a particular One Care plan. The first Effective Enrollment Date for this initial opt‑in opt-in period is scheduled for no earlier than January 1, 2022. Eligible Medicare‑Medicaid Medicare-Medicaid Beneficiaries who do not select a One Care plan or who do not opt out of the Demonstration will be assigned to a One Care plan during Passive Enrollment. EOHHS may conduct Passive Enrollment during the term of the Contract to assign eligible Medicare‑Medicaid Medicare-Medicaid Beneficiaries who do not select a One Care plan and who do not opt out of the Demonstration. Individuals who opt out of the Demonstration will not be included in Passive Enrollment for the remainder of the Demonstration. Individuals currently enrolled in PACE may not be passively enrolled into a One Care plan. EOHHS will provide notice of Passive Enrollments at least sixty (60) days prior to the effective dates to Eligible Beneficiaries, and will accept opt‑out opt-out requests prior to the effective date of enrollment. EOHHS will apply intelligent methodologies, to the extent approved by CMS, to assign Eligible Beneficiaries to a One Care plan. Such methodologies may include, but not be limited to, past provider relationships. CMS and EOHHS may stop Passive Enrollment to the Contractor if the Contractor does not meet reporting requirements necessary to maintain Passive Enrollment as set forth by CMS and EOHHS. Enrollments and disenrollments will be processed through the EOHHS customer service vendor, consistent with the Effective Enrollment Date requirements outlined in the Medicare‑Medicaid Medicare-Medicaid Plan Enrollment and Disenrollment Guidance. EOHHS or its vendor will then submit Passive Enrollment transactions at least sixty (60) days in advance of the effective date, to the CMS Medicare Advantage Prescription Drug (XXXX) enrollment system directly or via a third‑party third-party CMS designates to receive such transactions, and MassHealth or its vendor will receive notification on the next Daily Transaction Reply Report. The Contractor will then receive enrollment transactions through the EOHHS customer service vendor. The Contractor will also use the third‑party third-party CMS designates to submit additional enrollment‑related enrollment-related information to XXXx, and receive files from CMS. Enrollments received by the last calendar day of the month will be effective on the first calendar day of the following month. The Contractor is responsible for providing and paying for Covered Services as of the Effective Enrollment Date of each Enrollee, even if the Contractor is not notified of an Enrollee’s Enrollee‘s enrollment into the Contractor’s Contractor‘s One Care Plan until after such Enrollee’s Enrollee‘s Effective Enrollment Date. The Contractor must have a mechanism for receiving timely information about all enrollments in the Contractor’s Contractor‘s One Care Plan, including the Effective Enrollment Date, from CMS and MassHealth systems.

Organizational Structure. The Contractor shall establish, maintain and describe the interdepartmental structures and processes to support the operation and management of its One Care Plan line of business in a manner that fosters integration of physical and behavioral health service provision. The provision of all services shall be based on prevailing clinical knowledge and the study of data on the efficacy of treatment, when such data is available. The Contractor’s Behavioral Health Services and activities should be person‑centered, and oriented to recovery and rehabilitation from behavioral health conditions. On an annual basis, and on an ad hoc basis when changes occur or as directed by EOHHS, the Contractor shall submit to EOHHS an overall organizational chart that includes senior and mid‑level managers for the organization. The organizational chart must include the organizational staffing for Behavioral Health Services and activities. If such Behavioral Health Services and activities are provided by a First Tier, Downstream, or Related Entity the Contractor shall submit the organizational chart of the behavioral health First Tier, Downstream, or Related Entity which clearly demonstrates the relationship with the First Tier, Downstream, or Related Entity and the Contractor’s oversight of the First Tier, Downstream, or Related Entity. For all organizational charts, the Contractor shall indicate any staff vacancies and provide a timeline for when such vacancies are anticipated to be filled. For all employees, by functional area, the Contractor shall establish and maintain policies and procedures for managing staff retention and employee turnover. Such policies and procedures shall be provided to EOHHS upon request. For key management positions, including the Contractor’s Chief Executive Officerchief executive officer, if applicable, One Care Plan Executive Directorplan executive director, Chief Medical Officerchief medical officer/Medical Directormedical director, Pharmacy Directorpharmacy director, Behavioral Health Clinical Directorbehavioral health clinical director, Director director of Long‑term Services long‑term services and Supportssupports, Accessibility and Accommodations Compliance OfficerADA compliance director, Chief Financial Officerchief financial officer, Chief Operating Officerchief operating officer, Senior Manager senior manager of Clinical Servicesclinical services, Quality Managerquality manager, Claims Directorclaims director, Information Technology information technology (IT) Directordirector, Compliance Officercompliance officer, and designated “key contact,” , the Contractor shall immediately notify CMS and EOHHS whenever the position becomes vacant and notify CMS and EOHHS when the position is filled and by whom; and The Contractor shall submit to EOHHS a listing of its board of directors as of the Contract Effective Date and an updated listing of its board of directors whenever any changes are made. Enrollment Activities Enrollment EOHHS will begin self‑selection (opt‑in) enrollment prior to the initiation of Passive Enrollment. During this period, Medicare‑Medicaid Beneficiaries eligible for the Demonstration may choose to enroll into a particular One Care plan. The first Effective Enrollment Date for this initial opt‑in period is scheduled for no earlier than January 1, 2022. Eligible Medicare‑Medicaid Beneficiaries who do not select a One Care plan or who do not opt out of the Demonstration will be assigned to a One Care plan during Passive Enrollment. EOHHS may conduct Passive Enrollment during the term of the Contract to assign eligible Medicare‑Medicaid Beneficiaries who do not select a One Care plan and who do not opt out of the Demonstration. Individuals who opt out of the Demonstration will not be included in Passive Enrollment for the remainder of the Demonstration. Individuals currently enrolled in PACE may not be passively enrolled into a One Care plan. EOHHS will provide notice of Passive Enrollments at least sixty (60) days prior to the effective dates to Eligible Beneficiaries, and will accept opt‑out requests prior to the effective date of enrollment. EOHHS will apply intelligent methodologies, to the extent approved by CMS, to assign Eligible Beneficiaries to a One Care plan. Such methodologies may include, but not be limited to, past provider relationships. CMS and EOHHS may stop Passive Enrollment to the Contractor if the Contractor does not meet reporting requirements necessary to maintain Passive Enrollment as set forth by CMS and EOHHS. Enrollments and disenrollments will be processed through the EOHHS customer service vendor, consistent with the Effective Enrollment Date requirements outlined in the Medicare‑Medicaid Plan Enrollment and Disenrollment Guidance. EOHHS or its vendor will then submit Passive Enrollment transactions at least sixty (60) days in advance of the effective date, to the CMS Medicare Advantage Prescription Drug (XXXX) enrollment system directly or via a third‑party CMS designates to receive such transactions, and MassHealth or its vendor will receive notification on the next Daily Transaction Reply Report. The Contractor will then receive enrollment transactions through the EOHHS customer service vendor. The Contractor will also use the third‑party CMS designates to submit additional enrollment‑related information to XXXx, and receive files from CMS. Enrollments received by the last calendar day of the month will be effective on the first calendar day of the following month. The Contractor is responsible for providing and paying for Covered Services as of the Effective Enrollment Date of each Enrollee, even if the Contractor is not notified of an Enrollee’s enrollment into the Contractor’s One Care Plan until after such Enrollee’s Effective Enrollment Date. The Contractor must have a mechanism for receiving timely information about all enrollments in the Contractor’s One Care Plan, including the Effective Enrollment Date, from CMS and MassHealth systems.

Organizational Structure. The Contractor shall establish, maintain and describe the interdepartmental structures and processes to support the operation and management of its One Care Plan line of business in a manner that fosters integration of physical and behavioral health service provision. The provision of all services shall be based on prevailing clinical knowledge and the study of data on the efficacy of treatment, when such data is available. The Contractor’s Behavioral Health Services and activities should be person‑centeredperson-centered, and oriented to recovery and rehabilitation from behavioral health conditions. On an annual basis, and on an ad hoc basis when changes occur or as directed by EOHHS, the Contractor shall submit to EOHHS an overall organizational chart that includes senior and mid‑level mid-level managers for the organization. The organizational chart must include the organizational staffing for Behavioral Health Services and activities. If such Behavioral Health Services and activities are provided by a First Tier, Downstream, or Related Entity the Contractor shall submit the organizational chart of the behavioral health First Tier, Downstream, or Related Entity which clearly demonstrates the relationship with the First Tier, Downstream, or Related Entity and the Contractor’s oversight of the First Tier, Downstream, or Related Entity. For all organizational charts, the Contractor shall indicate any staff vacancies and provide a timeline for when such vacancies are anticipated to be filled. For all employees, by functional area, the Contractor shall establish and maintain policies and procedures for managing staff retention and employee turnover. Such policies and procedures shall be provided to EOHHS upon request. For key management positions, including the Contractor’s Chief Executive Officerchief executive officer, if applicable, One Care Plan Executive Directorplan executive director, Chief Medical Officerchief medical officer/Medical Directormedical director, Pharmacy Directorpharmacy director, Behavioral Health Clinical Directorbehavioral health clinical director, Director director of Long‑term Services long term services and Supportssupports, Accessibility and Accommodations Compliance OfficerADA compliance director, Chief Financial Officerchief financial officer, Chief Operating Officerchief operating officer, Senior Manager senior manager of Clinical Servicesclinical services, Quality Managerquality manager, Claims Directorclaims director, Information Technology information technology (IT) Directordirector, Compliance Officercompliance officer, and designated “key contact,” , the Contractor shall immediately notify CMS and EOHHS whenever the position becomes vacant and notify CMS and EOHHS when the position is filled and by whom; and The Contractor shall submit to EOHHS a listing of its board of directors as of the Contract Effective Date and an updated listing of its board of directors whenever any changes are made. Enrollment Activities Enrollment EOHHS will begin self‑selection self-selection (opt‑inopt-in) enrollment prior to the initiation of Passive Enrollment. During this period, Medicare‑Medicaid Medicare-Medicaid Beneficiaries eligible for the Demonstration may choose to enroll into a particular One Care plan. The first Effective Enrollment Date for this initial opt‑in opt-in period is scheduled for no earlier than January October 1, 20222013. Eligible Medicare‑Medicaid Medicare-Medicaid Beneficiaries who do not select a One Care plan or who do not opt out of the Demonstration will be assigned to a One Care plan during Passive Enrollment. EOHHS may conduct Passive Enrollment during the term of the Contract to assign eligible Medicare‑Medicaid Medicare-Medicaid Beneficiaries who do not select a One Care plan and who do not opt out of the Demonstration. Individuals who opt out of the Demonstration will not be included in Passive Enrollment for the remainder of the Demonstration. Individuals currently enrolled in PACE may not be passively enrolled into a One Care plan. EOHHS will provide notice of Passive Enrollments at least sixty (60) days prior to the effective dates to Eligible Beneficiaries, and will accept opt‑out opt-out requests prior to the effective date of enrollment. EOHHS will apply intelligent methodologies, to the extent approved by CMS, to assign Eligible Beneficiaries to a One Care plan. Such methodologies may include, but not be limited to, past provider relationships. CMS and EOHHS may stop Passive Enrollment to the Contractor if the Contractor does not meet reporting requirements necessary to maintain Passive Enrollment as set forth by CMS and EOHHS. Enrollments and disenrollments will be processed through the EOHHS customer service vendor, consistent with the Effective Enrollment Date requirements outlined in the Medicare‑Medicaid Medicare-Medicaid Plan Enrollment and Disenrollment Guidance. EOHHS or its vendor will then submit Passive Enrollment transactions at least sixty (60) days in advance of the effective date, to the CMS Medicare Advantage Prescription Drug (XXXX) enrollment system directly or via a third‑party third-party CMS designates to receive such transactions, and MassHealth or its vendor will receive notification on the next Daily Transaction Reply Report. The Contractor will then receive enrollment transactions through the EOHHS customer service vendor. The Contractor will also use the third‑party third-party CMS designates to submit additional enrollment‑related enrollment-related information to XXXx, and receive files from CMS. Enrollments received by the last calendar day of the month will be effective on the first calendar day of the following month. The Contractor is responsible for providing and paying for Covered Services as of the Effective Enrollment Date of each Enrollee, even if the Contractor is not notified of an Enrollee’s enrollment into the Contractor’s One Care Plan until after such Enrollee’s Effective Enrollment Date. The Contractor must have a mechanism for receiving timely information about all enrollments in the Contractor’s One Care Plan, including the Effective Enrollment Date, from CMS and MassHealth systems.