Common use of Other Reporting Requirements Clause in Contracts

Other Reporting Requirements. The MCO must provide the STATE and CMS with the following information in a format and time frame determined by the STATE and CMS. The MCO shall submit information to the effect that no change has occurred since the prior year for reports which require an annual update and where no change has occurred since the prior year. With any new report required under this section, the STATE will provide the MCO the technical specifications for the report at least sixty (60) days prior to the effective date of when the report is to be submitted, unless the STATE determines that a shorter time period is necessary. This provision does not apply to ad hoc reports requested by the STATE. Enrollment and Marketing Materials. Enrollment and Marketing Materials and plans as outlined in this Contract. Service Delivery Plan. Any substantive changes in the Service Delivery Plan previously submitted with the MCO’s Request for Proposal (RFP) response to the most recent MHCP procurement shall be provided by the MCO to the STATE thirty (30) days prior to any changes made by the MCO. The STATE must approve all changes to the MCO’s Service Delivery Plan. Care Coordination and Case Management Systems: By September 15th of the Contract Year, the MCO must provide an updated description of the Case Management System for MSC+ and Care Coordination system for MSHO using a Delegate Review Reporting template developed jointly by the STATE and MCOs. This description shall include, but will not be limited to: A document describing how MSHO care coordination and MSC+ case management is being provided for community, EW and nursing home members by county and population group including whether it is provided through contracts with local agencies or tribes, clinic or provider care systems, community agencies, health plan staff or other arrangements or through a combination of such arrangements; The most recent SNP model of care as submitted to CMS, unless already submitted to the STATE and there has been no change since the submission; Lists and descriptions of entities providing Care Coordination and Case Management contractors, duties of such entities or subcontractors, contracting and delegation arrangements; A description of Care Coordination and/or Case Management screening and assessment tools, timelines and follow up processes; A description of use of protocols for management of chronic conditions including procedures for communication with clinics and physicians; A description of use of Nurse Practitioners in the care of Nursing Facility residents if applicable; A description of the MCO’s oversight and training of subcontractors and Care Coordinators /Case Managers, qualifications, caseloads /ratios of Care Coordinators /Case Managers and evaluation of care coordination performance as required in 6.1.4(A)(6) and 6.1.5(B)(17) below; and Changes and updated descriptions, if any, must be included in Care system, County Care Coordination system and County Case Management system audit reports provided annually by September 15th. If there are no changes in each of the reports, the MCO will provide notice of the lack of change. The results of the annual review of care system subcontractors, county care coordination and case management systems as required in 9.3.7 below. Documentation of Care Management/ Case Management/ Care Coordination Plans. The MCO shall maintain documentation sufficient to support its Care Management/ Case Management/ Care Coordination responsibilities set forth in sections 6.1.4 and 6.1.5, and for Elderly Waiver services set forth in section 6.1.14. Upon request of the STATE, the MCO shall provide the STATE or its designee access to a random sampling of Care Management/Case Management/Care Coordination care plans of MCO Enrollees. Provider Network Information. The MCO will submit to the STATE a complete listing of its Provider network in accordance with the specifications outlined in the STATE’s provider network template posted on the STATE’s website. The MCO will submit its entire Provider network on the fifth of every month to the STATE’s provider data repository. The MCO will work with the STATE to ensure that its monthly Provider network data submission is complete, accurate, and timely and will resolve any issues necessary to successfully submit the data. For MSHO, contracted Home and Community-Based Services, and Nursing Facility providers; and providers of Medicare and Medicaid services must be included. Upon request by the STATE and with at least sixty (60) days’ notice, the MCO will provide information about the qualifications of mental health and chemical dependency Providers. Financial Information. Financial and other information as specified by the STATE to determine the MCO’s financial and risk capability, and for MSHO, all financial information required under applicable provisions of 42 CFR §422.516 and any other information necessary for the administration or evaluation of the Medicare program. The MCO shall provide to the STATE the information outlined in Minnesota Statutes, §256B.69, subd. 9c in a format and manner specified by the STATE in accordance with STATE guidelines developed in consultation with the MCO. The MCO will submit the information on a quarterly basis consistent with the instructions included in the STATE’s financial reporting template. The fourth quarter report shall also include audited financial statements, parent company audited financial statements, an income statement reconciliation report, and any other documentation necessary to reconcile the detailed reports to the audited financial statements. In the event a report is published or released based on data provided under this section, the STATE shall provide the report to the MCO fifteen (15) days prior to the publication or release of the report. The MCO shall have fifteen (15) days to review the report and provide comments to the STATE.

Other Reporting Requirements. The MCO must provide the STATE and CMS with the following information in a format and time frame determined by the STATE and CMS. The MCO shall submit information to the effect that no change has occurred since the prior year for reports which require an annual update and where no change has occurred since the prior year. year.‌ With any new report required under this section, the STATE will provide the MCO the technical specifications for the report at least sixty (60) 60 days prior to the effective date of when the report is to be submitted, unless the STATE State determines that a shorter time period is necessary. This provision does not apply to ad hoc reports requested by the STATE. Birth of Child to an Enrollee. The MCO may report to the STATE or the Local Agency the birth of any Child to an Enrollee on a form approved by the STATE, as soon as reasonably possible after the MCO knows of the birth. Enrollment and Marketing Materials. Enrollment and Marketing Materials and plans as outlined described in this Contract. Service Delivery Plan. Any substantive changes in the Service Delivery Plan previously submitted with the MCO’s Request for Proposal (RFP) response to the most recent MHCP procurement shall be provided by the MCO to the STATE thirty (30) days prior to any changes made by the MCO. The STATE must approve all changes to the MCO’s Service Delivery Plan. Care Coordination Management and Case Management Systems: By . The MCO will provide to the STATE descriptions of changes in Care Management and Case Management systems annually by September 15th of the Contract Yeareach year. Descriptions must include, the MCO must provide an updated description but not be limited to a copy of the Case Management System for MSC+ SNP Model of Care as submitted to CMS and Care Coordination system for MSHO using the results of the annual review of case management systems. The MCO may use a Delegate Review Reporting delegate review reporting template developed jointly by the STATE and MCOs. This description shall include, but will not be limited to: A document describing how MSHO managed care coordination and MSC+ case management is being provided for community, EW and nursing home members by county and population group including whether it is provided through contracts with local agencies or tribes, clinic or provider care systems, community agencies, health plan staff or other arrangements or through a combination of such arrangements; The most recent SNP model of care as submitted to CMS, unless already submitted to the STATE and there has been no change since the submission; Lists and descriptions of entities providing Care Coordination and Case Management contractors, duties of such entities or subcontractors, contracting and delegation arrangements; A description of Care Coordination and/or Case Management screening and assessment tools, timelines and follow up processes; A description of use of protocols for management of chronic conditions including procedures for communication with clinics and physicians; A description of use of Nurse Practitioners in the care of Nursing Facility residents if applicable; A description of the MCO’s oversight and training of subcontractors and Care Coordinators /Case Managers, qualifications, caseloads /ratios of Care Coordinators /Case Managers and evaluation of care coordination performance organizations as required in 6.1.4(A)(6) and 6.1.5(B)(17) section 9.3.8 below; and Changes and updated descriptions, if any, must be included in Care system, County Care Coordination system and County Case Management system audit reports provided annually by September 15th. If there are no changes in each of the reports, the MCO will provide notice of the lack of change. The results of the annual review of care system subcontractors, county care coordination and case management systems as required in 9.3.7 below. Documentation of Care Management/ Case Management/ Care Coordination Plans. The MCO shall maintain documentation sufficient to support its Care Management/ Case Management/ Care Coordination responsibilities set forth in sections 6.1.4 and 6.1.5, and for Elderly Waiver services set forth in section 6.1.14. Upon request of the STATE, the MCO shall provide the STATE or its designee access to a random sampling of Care Management/Case Management/Care Coordination care plans of MCO Enrollees. Provider Network Information. The MCO will submit to the STATE a complete listing of its Provider network in accordance with the specifications outlined in the STATE’s provider network template posted on the STATE’s website. The MCO will submit its entire Provider network on the fifth of every month to the STATE’s provider data repository. The MCO will work with the STATE to ensure that its monthly Provider network data submission is complete, accurate, and timely and will resolve any issues necessary to successfully submit the data. For MSHO, contracted Home and Community-Based Services, and Nursing Facility providers; and providers of Medicare and Medicaid services must be included. Upon request by the STATE and with at least sixty (60) days’ notice, the MCO will provide information about the qualifications of mental health and chemical dependency Providers. Financial Information. Financial and other information as specified by the STATE to determine the MCO’s financial and risk capability, and for MSHO, all financial information required under applicable provisions of 42 CFR §422.516 and any other information necessary for the administration or evaluation of the Medicare program. The MCO shall provide to the STATE the information outlined in Minnesota Statutes, §256B.69, subd. 9c in a format and manner specified by the STATE in accordance with STATE guidelines developed in consultation with the MCO. The MCO will submit the information on a quarterly basis consistent with the instructions included in the STATE’s financial reporting template. The fourth quarter report shall also include audited financial statements, parent company audited financial statements, an income statement reconciliation report, and any other documentation necessary to reconcile the detailed reports to the audited financial statements. In the event a report is published or released based on data provided under this section, the STATE shall provide the report to the MCO fifteen (15) days prior to the publication or release of the report. The MCO shall have fifteen (15) days to review the report and provide comments to the STATE.

Other Reporting Requirements. The MCO must provide the STATE and CMS with the following information in a format and time frame determined by the STATE and CMS. The MCO shall submit information to the effect that no change has occurred since the prior year for reports which require an annual update and where no change has occurred since the prior year. year.‌ With any new report required under this section, the STATE will provide the MCO the technical specifications for the report at least sixty (60) days prior to the effective date of when the report is to be submitted, unless the STATE determines that a shorter time period is necessary. This provision does not apply to ad hoc reports requested by the STATE. Enrollment and Marketing Materials. Enrollment and Marketing Materials and plans as outlined in this Contract. Service Delivery Plan. Any substantive changes in the Service Delivery Plan previously submitted with the MCO’s Request for Proposal (RFP) response to the most recent MHCP procurement shall be provided by the MCO to the STATE thirty (30) days prior to any changes made by the MCO. The STATE must approve all changes to the MCO’s Service Delivery Plan. Care Coordination and Case Management Systems: By September 15th of the Contract Year, the MCO must provide an updated description of the Case Management System for MSC+ and Care Coordination system for MSHO using a Delegate Review Reporting template developed jointly by the STATE and MCOs. This description shall include, but will not be limited to: A document describing how MSHO care coordination and MSC+ case management is being provided for community, EW and nursing home members by county and population group including whether it is provided through contracts with local agencies or tribes, clinic or provider care systems, community agencies, health plan staff or other arrangements or through a combination of such arrangements; The most recent SNP model of care as submitted to CMS, unless already submitted to the STATE and there has been no change since the submission; Lists and descriptions of entities providing Care Coordination and Case Management contractors, duties of such entities or subcontractors, contracting and delegation arrangements; A description of Care Coordination and/or Case Management screening and assessment tools, timelines and follow up processes; A description of use of protocols for management of chronic conditions including procedures for communication with clinics and physicians; A description of use of Nurse Practitioners in the care of Nursing Facility residents if applicable; A description of the MCO’s oversight and training of subcontractors and Care Coordinators /Case Managers, qualifications, caseloads /ratios of Care Coordinators /Case Managers and evaluation of care coordination performance as required in 6.1.4(A)(6) and 6.1.5(B)(17) below; and Changes and updated descriptions, if any, must be included in Care system, County Care Coordination system and County Case Management system audit reports provided annually by September 15th. If there are no changes in each of the reports, the MCO will provide notice of the lack of change. The results of the annual review of care system subcontractors, county care coordination and case management systems as required in 9.3.7 below. Documentation of Care Management/ Case Management/ Care Coordination Plans. The MCO shall maintain documentation sufficient to support its Care Management/ Case Management/ Care Coordination responsibilities set forth in sections 6.1.4 and 6.1.5, and for Elderly Waiver services set forth in section 6.1.146.1.5. Upon request of the STATE, the MCO shall provide the STATE or its designee access to a random sampling of Care Management/Case Management/Care Coordination care plans of MCO Enrollees. Provider Network Information. The MCO will submit to the STATE a complete listing of its Provider network in accordance with the specifications outlined in the STATE’s provider network template posted on the STATE’s website. The MCO will submit its entire Provider network on the fifth of every month to the STATE’s provider data repository. The MCO will work with the STATE to ensure that its monthly Provider network data submission is complete, accurate, and timely and will resolve any issues necessary to successfully submit the data. For MSHO, contracted Home and Community-Based Services, and Nursing Facility providers; and providers of Medicare and Medicaid services must be included. Upon request by the STATE and with at least sixty (60) days’ notice, the MCO will provide information about the qualifications of mental health and chemical dependency Providers. Financial Information. Financial and other information as specified by the STATE to determine the MCO’s financial and risk capability, and for MSHO, all financial information required under applicable provisions of 42 CFR §422.516 and any other information necessary for the administration or evaluation of the Medicare program. The MCO shall provide to the STATE the information outlined in Minnesota Statutes, §256B.69, subd. 9c in a format and manner specified by the STATE in accordance with STATE guidelines developed in consultation with the MCO. The MCO will submit the information on a quarterly basis consistent with the instructions included in the STATE’s financial reporting template. The fourth quarter report shall also include audited financial statements, parent company audited financial statements, an income statement reconciliation report, and any other documentation necessary to reconcile the detailed reports to the audited financial statements. In the event a report is published or released based on data provided under this section, the STATE shall provide the report to the MCO fifteen (15) days prior to the publication or release of the report. The MCO shall have fifteen (15) days to review the report and provide comments to the STATE.

Other Reporting Requirements. The MCO must provide the STATE and CMS with the following information in a format and time frame determined by the STATE and CMS. The MCO shall submit information to the effect that no change has occurred since the prior year for reports which require an annual update and where no change has occurred since the prior year. With any new report required under this section, the STATE will provide the MCO the technical specifications for the report at least sixty (60) 60 days prior to the effective date of when the report is to be submitted, unless the STATE State determines that a shorter time period is necessary. This provision does not apply to ad hoc reports requested by the STATE. Birth of Child to an Enrollee. The MCO may report to the STATE or the Local Agency the birth of any Child to an Enrollee on a form approved by the STATE, as soon as reasonably possible after the MCO knows of the birth. Enrollment and Marketing Materials. Enrollment and Marketing Materials and plans as outlined described in this Contract. Service Delivery Plan. Any substantive changes in the Service Delivery Plan previously submitted with the MCO’s Request for Proposal (RFP) response to the most recent MHCP procurement shall be provided by the MCO to the STATE thirty (30) days prior to any changes made by the MCO. The STATE must approve all changes to the MCO’s Service Delivery Plan. Care Coordination Management and Case Management Systems: By . The MCO will provide to the STATE descriptions of changes in Care Management and Case Management systems annually by September 15th of the Contract Yeareach year. Descriptions must include, the MCO must provide an updated description but not be limited to a copy of the Case Management System for MSC+ SNP Model of Care as submitted to CMS and Care Coordination system for MSHO using the results of the annual review of case management systems. The MCO may use a Delegate Review Reporting delegate review reporting template developed jointly by the STATE and MCOs. This description shall include, but will not be limited to: A document describing how MSHO managed care coordination and MSC+ case management is being provided for community, EW and nursing home members by county and population group including whether it is provided through contracts with local agencies or tribes, clinic or provider care systems, community agencies, health plan staff or other arrangements or through a combination of such arrangements; The most recent SNP model of care as submitted to CMS, unless already submitted to the STATE and there has been no change since the submission; Lists and descriptions of entities providing Care Coordination and Case Management contractors, duties of such entities or subcontractors, contracting and delegation arrangements; A description of Care Coordination and/or Case Management screening and assessment tools, timelines and follow up processes; A description of use of protocols for management of chronic conditions including procedures for communication with clinics and physicians; A description of use of Nurse Practitioners in the care of Nursing Facility residents if applicable; A description of the MCO’s oversight and training of subcontractors and Care Coordinators /Case Managers, qualifications, caseloads /ratios of Care Coordinators /Case Managers and evaluation of care coordination performance organizations as required in 6.1.4(A)(6) and 6.1.5(B)(17) section 9.3.8 below; and Changes and updated descriptions, if any, must be included in Care system, County Care Coordination system and County Case Management system audit reports provided annually by September 15th. If there are no changes in each of the reports, the MCO will provide notice of the lack of change. The results of the annual review of care system subcontractors, county care coordination and case management systems as required in 9.3.7 below. Documentation of Care Management/ Case Management/ Care Coordination Plans. The MCO shall maintain documentation sufficient to support its Care Management/ Case Management/ Care Coordination responsibilities set forth in sections 6.1.4 and 6.1.5, and for Elderly Waiver services set forth in section 6.1.14. Upon request of the STATE, the MCO shall provide the STATE or its designee access to a random sampling of Care Management/Case Management/Care Coordination care plans of MCO Enrollees. Provider Network Information. The MCO will submit to the STATE a complete listing of its Provider network in accordance with the specifications outlined in the STATE’s provider network template posted on the STATE’s website. The MCO will submit its entire Provider network on the fifth of every month to the STATE’s provider data repository. The MCO will work with the STATE to ensure that its monthly Provider network data submission is complete, accurate, and timely and will resolve any issues necessary to successfully submit the data. For MSHO, contracted Home and Community-Based Services, and Nursing Facility providers; and providers of Medicare and Medicaid services must be included. Upon request by the STATE and with at least sixty (60) days’ notice, the MCO will provide information about the qualifications of mental health and chemical dependency Providers. Financial Information. Financial and other information as specified by the STATE to determine the MCO’s financial and risk capability, and for MSHO, all financial information required under applicable provisions of 42 CFR §422.516 and any other information necessary for the administration or evaluation of the Medicare program. The MCO shall provide to the STATE the information outlined in Minnesota Statutes, §256B.69, subd. 9c in a format and manner specified by the STATE in accordance with STATE guidelines developed in consultation with the MCO. The MCO will submit the information on a quarterly basis consistent with the instructions included in the STATE’s financial reporting template. The fourth quarter report shall also include audited financial statements, parent company audited financial statements, an income statement reconciliation report, and any other documentation necessary to reconcile the detailed reports to the audited financial statements. In the event a report is published or released based on data provided under this section, the STATE shall provide the report to the MCO fifteen (15) days prior to the publication or release of the report. The MCO shall have fifteen (15) days to review the report and provide comments to the STATE.