Common use of General Reporting Requirements Clause in Contracts

General Reporting Requirements. The Contractor shall: Submit to EOHHS all applicable MassHealth reporting requirements in compliance with 42 C.F.R. § 438.602-606; Submit to CMS applicable reporting requirements in compliance with 42 C.F.R. § 422.516, 42 C.F.R. § 423.514 and 42 C.F.R. § 438 et. seq.; Submit to EOHHS all applicable MMP reporting requirements; Submit to CMS and EOHHS all required reports and data in accordance with the specifications, templates and time frames described in this Contract; In accordance with the timelines, definitions, formats and instructions contained herein or as specified by EOHHS, provide the following information. Where practicable, EOHHS shall consult with the Contractor to establish time frames and formats and detailed specifications reasonably acceptable to both parties; Provide all information required under this Contract, including but not limited to, the requirements of this section, Appendix D, or other information related to the performance of its or its first-tier, downstream, or related entities’ responsibilities hereunder or under the subcontracts as reasonably requested by CMS or EOHHS; Provide any information in its or its First Tier, Downstream or Related Entities’ possession sufficient to permit EOHHS to comply with 42 C.F.R. § 438; and Provide any data from its or its first-tier, downstream or related entities’ clinical systems, authorization systems, claims systems, medical record reviews, Network Management visits, and Enrollee and family input. Upon request, participate in work groups led by EOHHS to develop reporting specifications and to adopt the reporting models formulated by these work groups and approved by EOHHS, pursuant to the timeline established by EOHHS; Upon request, provide EOHHS with the original data sets used by the Contractor in the development of any required reporting or ad-hoc reporting in accordance with the time frames and formats established by EOHHS; Upon request, submit to CMS and EOHHS any internal reports that the Contractor uses for internal management. Such reports shall include, but not be limited to, internal reports that analyze the medical/ loss ratio, financial stability, or other areas where standard compliance reports indicate a problem in performance; Report HEDIS, HOS, and CAHPS data, as well as measures related to Long-Term Services and Supports. HEDIS, HOS, and CAHPS measures will be reported consistent with Medicare requirements for HEDIS, plus additional Medicaid measures required by EOHHS. All existing Part D metrics will be collected as well. Such measures shall include a combined set of core measures that the Contractor must report to CMS and EOHHS; Pursuant to 42 C.F.R. § 438.6(f)(2)(ii), comply with any reporting requirements on Provider Preventable Conditions in the form and frequency as may be specified by EOHHS; The Contractor shall, at the direction of EOHHS, require its PCPs who are not MassHealth Primary Care Clinicians (PCCs) to complete a practice infrastructure survey provided by EOHHS; and Provide to CMS and EOHHS, in a form and format approved by CMS and EOHHS and in accordance with the timeframes established by CMS and EOHHS, all reports, data or other information CMS and EOHHS determine are necessary for compliance with the provisions of the Affordable Care Act of 2010, Subtitle F, Medicaid Prescription Drug Coverage, and applicable implementing regulations and interpretive guidance. Information Management and Information Systems General The Contractor shall:

General Reporting Requirements. The Contractor shall provide the reports described in Appendix N according to the specified timeframes. Furthermore, the Contractor shall: Submit to EOHHS all applicable MassHealth reporting requirements in compliance with 42 C.F.R. § 438.602-606438.602‑606; Submit to CMS applicable reporting requirements in compliance with 42 C.F.R. § 422.516, 42 C.F.R. § 423.514 and 42 C.F.R. § 438 et. seq.; Submit to CMS, and EOHHS as directed, all applicable MMP reporting requirements; Submit to CMS and EOHHS all required reports and data in accordance with the specifications, templates and time frames described in this Contract; In accordance with the timelines, definitions, formats and instructions contained herein or as specified by EOHHS, provide the following information. Where practicable, EOHHS shall consult with the Contractor to establish time frames and formats and detailed specifications reasonably acceptable to both parties; Provide all information required under this Contract, including but not limited to, the requirements of this section, Appendix D, or other information related to the performance of its or its first-tierfirst‑tier, downstream, or related entities’ responsibilities hereunder or under the subcontracts as reasonably requested by CMS or EOHHS; Provide any information in its or its First Tier, Downstream Downstream, or Related Entities’ possession sufficient to permit EOHHS to comply with 42 C.F.R. § 438; and Provide any data from its or its first-tierfirst‑tier, downstream or related entities’ clinical systems, authorization systems, claims systems, medical record reviews, Network Management visits, and Enrollee and family input. Upon request, participate in work groups led by EOHHS to develop reporting specifications and to adopt the reporting models formulated by these work groups and approved by EOHHS, pursuant to the timeline established by EOHHS; Upon request, provide EOHHS with the original data sets used by the Contractor in the development of any required reporting or ad-hoc ad‑hoc reporting in accordance with the time frames and formats established by EOHHS; Upon request, submit to CMS and EOHHS any internal reports that the Contractor uses for internal management. Such reports shall include, but not be limited to, internal reports that analyze the medical/ loss ratio, financial stability, or other areas where standard compliance reports indicate a problem in performance; Report HEDIS, HOS, and CAHPS data, as well as measures related to Long-Term Services and SupportsLTSS. HEDIS, HOS, and CAHPS measures will be reported consistent with Medicare requirements for HEDISrequirements, plus additional Medicaid measures required by EOHHS. All existing Part D metrics will be collected This includes, but is not limited to, reporting data for certain HEDIS measures, such as well. Such measures shall Breast Cancer Screening and Controlling High Blood Pressure, in accordance with additional stratification requirements as directed by EOHHS, minimally to include a combined set of core measures that the Contractor must report to CMS race, ethnicity, and EOHHSlanguage; Pursuant to 42 C.F.R. § 438.6(f)(2)(ii438.3(g), comply with any reporting requirements on Provider Preventable Conditions in the form and frequency as may be specified by EOHHS; The Contractor shall, at the direction of EOHHS, require its PCPs who are not MassHealth Primary Care Clinicians (PCCs) to complete a practice infrastructure survey provided by EOHHS; and Provide to CMS and EOHHS, in a form and format approved by CMS and EOHHS and in accordance with the timeframes established by CMS and EOHHS, all reports, data or other information CMS and EOHHS determine are necessary for compliance with the provisions of the Affordable Care Act of 2010, Subtitle F, Medicaid Prescription Drug Coverage, and applicable implementing regulations and interpretive guidance. Information Management Data, documentation, or information the Contractor submits to the State must be certified by either the Contractor’s Chief Executive Officer (CEO), Chief Financial Officer (CFO) or an individual who reports directly to the CEO or CFO with delegated authority to sign so the CEO or CFO is ultimately responsible for the certification. The certification, pursuant to 42 C.F.R. §§ 438.604(a), 438.606, and Information Systems General 438.608(d)(3), must be submitted concurrently with the submission of data, and must attest that, based on best information, knowledge, and belief, the data are accurate, complete, and truthful. The Contractor shall:must provide and require its First Tier, Downstream, and Related Entities to provide any information required for the implementation and operation of Electronic Visit Verification (EVV) to ensure that the Contractor’s EVV systems comply with the requirements outlined in Section 12006 of the 21st Century Cures Act (codified as 42 USC 1396b(l)) and as directed by EOHHS and CMS.

General Reporting Requirements. The Contractor shall provide the reports described in Appendix N according to the specified timeframes. Furthermore, the Contractor shall: Submit to EOHHS all applicable MassHealth reporting requirements in compliance with 42 C.F.R. § 438.602-606438.602‑606; Submit to CMS applicable reporting requirements in compliance with 42 C.F.R. § 422.516, 42 C.F.R. § 423.514 and 42 C.F.R. § 438 et. seq.; Submit to EOHHS all applicable MMP reporting requirements; Submit to CMS and EOHHS all required reports and data in accordance with the specifications, templates and time frames described in this Contract; In accordance with the timelines, definitions, formats and instructions contained herein or as specified by EOHHS, provide the following information. Where practicable, EOHHS shall consult with the Contractor to establish time frames and formats and detailed specifications reasonably acceptable to both parties; Provide all information required under this Contract, including but not limited to, the requirements of this section, Appendix D, or other information related to the performance of its or its first-tierfirst‑tier, downstream, or related entities’ responsibilities hereunder or under the subcontracts as reasonably requested by CMS or EOHHS; Provide any information in its or its First Tier, Downstream Downstream, or Related Entities’ possession sufficient to permit EOHHS to comply with 42 C.F.R. § 438; and Provide any data from its or its first-tierfirst‑tier, downstream or related entities’ clinical systems, authorization systems, claims systems, medical record reviews, Network Management visits, and Enrollee and family input. Upon request, participate in work groups led by EOHHS to develop reporting specifications and to adopt the reporting models formulated by these work groups and approved by EOHHS, pursuant to the timeline established by EOHHS; Upon request, provide EOHHS with the original data sets used by the Contractor in the development of any required reporting or ad-hoc ad‑hoc reporting in accordance with the time frames and formats established by EOHHS; Upon request, submit to CMS and EOHHS any internal reports that the Contractor uses for internal management. Such reports shall include, but not be limited to, internal reports that analyze the medical/ loss ratio, financial stability, or other areas where standard compliance reports indicate a problem in performance; Report HEDIS, HOS, and CAHPS data, as well as measures related to Long-Term Services and SupportsLTSS. HEDIS, HOS, and CAHPS measures will be reported consistent with Medicare requirements for HEDIS, plus additional Medicaid measures required by EOHHS. All existing Part D metrics will be collected as well. Such measures shall include a combined set of core measures that the Contractor must report to CMS and EOHHS; Pursuant to 42 C.F.R. § 438.6(f)(2)(ii438.3(g), comply with any reporting requirements on Provider Preventable Conditions in the form and frequency as may be specified by EOHHS; The Contractor shall, at the direction of EOHHS, require its PCPs who are not MassHealth Primary Care Clinicians (PCCs) to complete a practice infrastructure survey provided by EOHHS; and Provide to CMS and EOHHS, in a form and format approved by CMS and EOHHS and in accordance with the timeframes established by CMS and EOHHS, all reports, data or other information CMS and EOHHS determine are necessary for compliance with the provisions of the Affordable Care Act of 2010, Subtitle F, Medicaid Prescription Drug Coverage, and applicable implementing regulations and interpretive guidance. Information Management Data, documentation, or information the Contractor submits to the State must be certified by either the Contractor’s Chief Executive Officer (CEO), Chief Financial Officer (CFO) or an individual who reports directly to the CEO or CFO with delegated authority to sign so the CEO or CFO is ultimately responsible for the certification. The certification, pursuant to 42 C.F.R. §§ 438.604(a), 438.606, and Information Systems General 438.608(d)(3), must be submitted concurrently with the submission of data, and must attest that, based on best information, knowledge, and belief, the data are accurate, complete, and truthful. The Contractor shall:must provide and require its First Tier, Downstream, and Related Entities to provide any information required for the implementation and operation of Electronic Visit Verification (EVV) to ensure that the Contractor’s EVV systems comply with the requirements outlined in Section 12006 of the 21st Century Cures Act (codified as 42 USC 1396b(l)) and as directed by EOHHS and CMS.