Common use of Readiness Review Clause in Contracts

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. 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 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 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 Contractor‘s headquarters. Risk Corridor Percentage — For each Demonstration Year, the Contractor’s 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 Self-directed PCA — A model of service delivery in which the Enrollee, or the Enrollee’s Enrollee‘s designated surrogate, is the employer of record, and has decision‑making decision- making authority to hire, manage, schedule, and dismiss their PCA worker(s).

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 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 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 decision-making authority to hire, manage, schedule, and dismiss their PCA worker(s).