Readiness Review. Includes all plans to be implemented in one or more Service Areas on the anticipated Operational Start Date. At a minimum, the HMO shall, for each HMO Program:
Readiness Review. Prior to being eligible to accept Demonstration enrollments, each prospective Contractor selected to participate in the Demonstration must undergo a Readiness Review. The Readiness Review evaluates each prospective Contractor’s ability to comply with the Demonstration requirements, including but not limited to, the ability to quickly and accurately process claims and enrollment information, accept and transition new Enrollees, and provide adequate access to all Medicare and Medicaid-covered Covered Services that are Medically Necessary with Enrollee protections. Only Contractors passing the Readiness Review will participate in the Demonstration. At a minimum, each Readiness Review includes a desk review and a site visit to the prospective Contractor’s headquarters.
Readiness Review. Contractor shall submit its completed Cultural Competence plan to the Department at least two (2) weeks prior to the Department’s Readiness Review.
Readiness Review. Prior to being eligible to accept Demonstration enrollments, each prospective Contractor selected to participate in the Demonstration must undergo a Readiness Review. The Readiness Review evaluates each prospective Contractor’s ability to comply with the Demonstration requirements, including but not limited to, the ability to quickly and accurately process claims and enrollment information, accept and transition new Enrollees, and provide adequate access to all Medicare and Medicaid‑covered Medically Necessary Services. CMS and the EOHHS use the results to inform its decision of whether the prospective Contractor is ready to participate in the Demonstration. At a minimum, each Readiness Review includes a desk review and potentially a site visit to the prospective Contractor’s headquarters. Risk Corridor Percentage — For each Demonstration Year, the Contractor’s Total Adjusted Expenditures divided by the Adjusted Capitation Rate Revenue for the applicable Demonstration Year, rounded to the nearest one tenth of a percent. Self‑directed PCA — A model of service delivery in which the Enrollee, or the Enrollee’s designated surrogate, is the employer of record, and has decision‑making authority to hire, manage, schedule, and dismiss their PCA worker(s).
Readiness Review. The purpose of the readiness review is to confirm that the State is prepared to implement the Managed Fee-for-Service (MFFS) Financial Alignment Demonstration in accordance with the model as outlined in the MOU. The goal is to ensure the successful transition of Medicare-Medicaid enrollees into the Demonstration and to ensure the State has the necessary infrastructure and capacity to implement, monitor, and oversee the proposed model. CMS has conducted a readiness review and determined that the State has reached a level of readiness to implement the Demonstration. CMS and the State will finalize benchmarks for the Demonstration quality metrics for the retrospective performance payment, as described in Section IV.J.3.b.
Readiness Review. Readiness Review includes all activities that the MCO must complete prior to the Operational Start Date. At a minimum, the MCO must, for each MCO Program
Readiness Review. Readiness Review includes all plans to be implemented in one or more Service Areas on the anticipated Operational Start Date(s). At a minimum, the MCO must, for each MCO Program:
Readiness Review. The Department will, prior to the signing date, conduct a readiness review of the areas set forth in Section B.2.1 of the Appendices to generally assess the Contractor’s readiness to begin operations and issue a letter to the Contractor that conveys its findings and any changes required before contracting with the Department. Prior to the date of implementation of the MLTSS program covered by this contract, the Contractor shall demonstrate its ability to meet all requirements related to the MLTSS program. The Contractor shall participate in an MLTSS readiness review, which may include, but will not be limited to, desk and on-site reviews of documents provided by the Contractor, a walk-through of the Contractor’s operations, system demonstrations and systems connectivity testing, and interviews with Contractor’s staff Members. The scope of the MLTSS readiness review may include any and all requirements of the Agreement related to the MLTSS program, as determined by DMAHS. Based on the results of the review activities, DMAHS will issue a letter of findings and, if needed, will request an MLTSS corrective action plan from the Contractor. DMAHS will not enroll Members into the Contractor’s MLTSS program until such time as DMAHS has determined that the Contractor is able to meet all requirements related to the MLTSS program. If the Contractor is unable to demonstrate MLTSS readiness prior to its implementation, the Contractor shall cooperate with DMAHS to provide their MLTSS qualified Members with options counseling.
Readiness Review. A process that will evaluate each ICO’s ability to comply with the Demonstration requirements, including but not limited to, the ability to quickly and accurately process Claims and Enrollment information, accept and transition new Enrollees, and provide adequate access to all Medicare- and Medicaid‐covered Medically Necessary Services. CMS and MDHHS will use the results to inform the decision of whether the ICO is ready to participate in the Demonstration. At a minimum, the Readiness Review will include a desk review and a site visit to the ICO’s Michigan offices.
Readiness Review. If Contractor fails to satisfactorily pass the readiness review at least thirty (30) calendar days prior to scheduled member enrollment (or other deadline as may be established at the sole discretion of the State), the State may delay member enrollment and/or may require other remedies (including, but not limited to Contract termination), and Contractor shall be responsible for all costs incurred by the State as a result of such delay. In addition, for each business day that Contractor fails to submit readiness review processes beyond their expected due date, Contractor shall pay liquidated damages in the amount of five thousand, four hundred and fifty dollars ($5,450). Damages will be assessed each time the requirements are not met. In each instance that Contractor fails to submit substantially complete and accurate readiness review responses, Contractor shall pay liquidated damages in the amount of three thousand fifty dollars ($3,050).
