Common use of Readiness Review of Health Plan Clause in Contracts

Readiness Review of Health Plan. The state must assess plan readiness in Greater Arizona in accordance with the requirements of 42 CFR 438. Readiness reviews will include, but are not limited to, documentation and confirmation of adequate capacity, access to care outside of the network, access to care for enrollees with special health care needs, and cultural considerations. The state will also notify CMS of its intent to conduct a readiness review 30 days in advance of the review and provide CMS the opportunity to observe the readiness review. The state will submit to CMS for review by September 1, 2015, a copy of its readiness review report of the health plan(s) selected to provide the integrated services to the SMI population to ensure the selected health plan’s provider network, both in terms of primary and specialty care providers, is adequate and would not result in access to care issues for the affected population.