Common use of Administration, Management, Facilities and Resources Clause in Contracts

Administration, Management, Facilities and Resources. ‌ The Contractor must maintain at all times during the term of this Contract adequate staffing, equipment, facilities, and resources sufficient to serve the needs of Members, as specified in this Contract, the RFQ, the Contractor’s Qualification, and in accordance with appropriate standards of both specialty and sub-specialty care. The Contractor must be responsible for the administration and management of all aspects of the Contractor and the performance of all covenants, conditions, and obligations imposed upon the Contractor pursuant to this Contract. No delegation of responsibility, whether by Subcontract or otherwise, will terminate or limit in any way the liability of the Contractor to the Division for the full performance of this Contract. The Contractor must have, at a minimum, the following personnel with comparable qualifications, as listed below, employed within ninety (90) days after the award of this Contract. Certain positions listed below are required to be located in the State of Mississippi. Should the Contractor wish to fill a position with an individual located outside of the state, any such request requires written approval by the Division. For the purposes of this section, “full-time” employment is considered at least forty (40) work hours per week and/or 2,080 work hours per year. Anything less is considered “part-time.” Employees designated herein as “full-time” must be hired with that work commitment expectation. Any other employees may be hired as full-time or part-time, at the Contractor’s discretion. 1.13.1 Key Personnel‌ Key Personnel are defined as positions listed in 1.13.1.1, Executive Positions, and 1.13.1.2, Administrative Positions, below. The Division must approve Key Personnel required to be located in Mississippi prior to assignment. The Division reserves the right to approve additional key positions as needed. Approvals must be submitted to the Division no later than fifteen (15) business days before the replacement’s start date. Key Personnel positions cannot be vacant for more than ninety (90) calendar days. The Contractor must notify the Division within five (5) business days of learning that any key position is vacant or anticipated to be vacant within the next thirty (30) calendar days. Prior to diverting any of the specified Key Personnel for any reason, the Contractor must notify the Division in writing and must submit justification (including proposed substitutions) in sufficient detail to permit evaluation of the impact on the delivery of covered services. These changes are to be reported when individuals either leave or are added to these positions.

Administration, Management, Facilities and Resources. ‌ The Contractor must shall maintain at all times during the term of this Contract adequate staffing, equipment, facilities, and resources sufficient to serve the needs of MembersEnrollees, as specified in this Contract, the RFQ, the Contractor’s QualificationRFP Proposal, and in accordance with appropriate standards of both specialty and sub-specialty care. The Contractor must shall be responsible for the administration and management of all aspects of the Contractor Plan and the performance of all of the covenants, conditions, conditions and obligations imposed upon the Contractor pursuant to this Contract. No delegation of responsibility, whether by Subcontract subcontract or otherwise, will shall terminate or limit in any way the liability of the Contractor to the Division for the full performance of this Contract. Medical management staffing shall be at a level that is sufficient to perform all necessary medical assessments and to meet all Mississippi Medicaid enrollees’ case management needs at all times. The Contractor must CCO shall have, at a minimum, the following key management personnel or persons with comparable qualifications, as listed below, employed within ninety (90) days after during the award term of this Contract. Certain positions listed below are required to be : Executive Positions: • Full time Chief Executive Officer, and/or Chief Operations Officer located in the State of Mississippi. Should the Contractor wish to fill a position with an individual • Chief Financial Officer • Chief Medical Officer located outside of the state, any such request requires written approval by the Divisionin Mississippi. For the purposes of this section, “full-time” employment is considered at least forty (40) work hours per week and/or 2,080 work hours per year. Anything less is considered “part-time.” Employees designated herein as “full-time” must be hired with that work commitment expectation. Any other employees may be hired as full-time or part-time, at the Contractor’s discretion. 1.13.1 Key Personnel‌ Key Personnel are defined as positions listed in 1.13.1.1, Executive Positions, and 1.13.1.2, • Chief Information Officer Administrative Positions, below: • Full time Provider Services Manager located in Mississippi. • Full time Member Services Manager located in Mississippi. • Quality Management Coordinator • Utilization Management Coordinator • Complaint/Grievance Coordinator • Claims Administrator • Other key personnel as identified by CCO. The Division must approve Key Personnel key personnel required to be located in Mississippi must be approved by the Division prior to assignment. The Division reserves the right to approve additional key positions as needed. Approvals must be submitted to the Division no later than fifteen (15) business days before the replacement’s start date. Key Personnel management positions cannot be vacant for more than ninety (90) calendar days. The Contractor must notify the Division within five (5) business days of learning that any key position is vacant or anticipated to be vacant within the next thirty (30) calendar days. Prior to diverting any of the specified Key Personnel key personnel for any reason, the Contractor must notify the Division in writing writing, and must shall submit justification (including proposed substitutions) in sufficient detail to permit evaluation of the impact on the delivery of covered services. These changes are to be reported when individuals either leave or are added to these key positions. The following are the minimum qualifications for staff and level of equipment: a. A designated Chief Executive Officer (Contract Officer), with decision-making authority, qualified by training and experience, to administer the day-to-day business activities conducted pursuant to this Contract; b. A Mississippi licensed physician to serve as Medical Director, who shall be responsible for all clinical decisions of the Plan, and who shall oversee and be responsible for the proper provision of Covered Services to Enrollees; c. A designated health care practitioner, qualified by training and experience, to serve as Quality Management Director; d. A designated person, qualified by training and experience, to be responsible for the Plan’s utilization control; e. A designated person, qualified by training and experience in the processing and resolution of complaints and grievances; f. A designated person, qualified by training and experience, to be responsible for the medical record system; g. A designated person, qualified by training and experience, to be responsible for data processing and the provision of accurate and timely reports to the Division; h. Designated staff, qualified by training and experience, to be responsible for ensuring that all Plan Providers, and all Outside Providers to whom Enrollees may be referred, are properly licensed in accordance with federal and state law and regulations; i. Designated staff, qualified by training and experience, to be responsible for Enrollee Services; j. Designated staff, qualified by training and experience, to be responsible for Provider Services and network development; k. Designated staff, qualified by training and experience, to be responsible for marketing or public relations; l. Sufficient support staff to conduct daily business in an orderly manner, as determined through management and medical reviews; and m. Telecommunications with sufficient local and toll free lines and a call distribution and monitoring system sufficient to meet the needs of the Enrollees and providers 24 hours per day for consultation or referrals. This includes making available 24 hours, seven (7) days per week access by telephone to (1) a live voice, i.e., an employee of the Contractor or answering service personnel who will immediately page an on call medical professional who can make referrals for non-emergency services or give information/authorization about accessing services or how to handle medical problems during non-office hours or (2) an answering machine or other electronic device which directs the Enrollee or providers to the telephone number to use to contact the after-hours medical professional.

Administration, Management, Facilities and Resources. ‌ The Contractor must shall maintain at all times during the term of this Contract adequate staffing, equipment, facilities, and resources sufficient to serve the needs of MembersEnrollees, as specified in this Contract, the RFQ, the Contractor’s QualificationRFP Proposal, and in accordance with appropriate standards of both specialty and sub-specialty care. The Contractor must shall be responsible for the administration and management of all aspects of the Contractor Plan and the performance of all of the covenants, conditions, conditions and obligations imposed upon the Contractor pursuant to this Contract. No delegation of responsibility, whether by Subcontract subcontract or otherwise, will shall terminate or limit in any way the liability of the Contractor to the Division for the full performance of this Contract. Medical management staffing shall be at a level that is sufficient to perform all necessary medical assessments and to meet all Mississippi Medicaid enrollees’ case management needs at all times. The Contractor must CCO shall have, at a minimum, the following key management personnel or persons with comparable qualifications, as listed below, employed within ninety (90) days after during the award term of this Contract. Certain positions listed below are required to be : Executive Positions:  Full time Chief Executive Officer, and/or Chief Operations Officer located in the State of Mississippi. Should the Contractor wish to fill a position with an individual  Chief Financial Officer  Chief Medical Officer located outside of the state, any such request requires written approval by the Divisionin Mississippi. For the purposes of this section, “full-time” employment is considered at least forty (40) work hours per week and/or 2,080 work hours per year. Anything less is considered “part-time.” Employees designated herein as “full-time” must be hired with that work commitment expectation. Any other employees may be hired as full-time or part-time, at the Contractor’s discretion. 1.13.1 Key Personnel‌ Key Personnel are defined as positions listed in 1.13.1.1, Executive Positions, and 1.13.1.2,  Chief Information Officer Administrative Positions, below:  Full time Provider Services Manager located in Mississippi.  Full time Member Services Manager located in Mississippi.  Quality Management Coordinator  Utilization Management Coordinator  Complaint/Grievance Coordinator  Claims Administrator  Other key personnel as identified by CCO. The Division must approve Key Personnel key personnel required to be located in Mississippi must be approved by the Division prior to assignment. The Division reserves the right to approve additional key positions as needed. Approvals must be submitted to the Division no later than fifteen (15) business days before the replacement’s start date. Key Personnel management positions cannot be vacant for more than ninety (90) calendar days. The Contractor must notify the Division within five (5) business days of learning that any key position is vacant or anticipated to be vacant within the next thirty (30) calendar days. Prior to diverting any of the specified Key Personnel key personnel for any reason, the Contractor must notify the Division in writing writing, and must shall submit justification (including proposed substitutions) in sufficient detail to permit evaluation of the impact on the delivery of covered services. These changes are to be reported when individuals either leave or are added to these key positions. The following are the minimum qualifications for staff and level of equipment: a. A designated Chief Executive Officer (Contract Officer), with decision-making authority, qualified by training and experience, to administer the day-to-day business activities conducted pursuant to this Contract; b. A Mississippi licensed physician to serve as Medical Director, who shall be responsible for all clinical decisions of the Plan, and who shall oversee and be responsible for the proper provision of Covered Services to Enrollees; c. A designated health care practitioner, qualified by training and experience, to serve as Quality Management Director; d. A designated person, qualified by training and experience, to be responsible for the Plan’s utilization control; e. A designated person, qualified by training and experience in the processing and resolution of complaints and grievances; f. A designated person, qualified by training and experience, to be responsible for the medical record system; g. A designated person, qualified by training and experience, to be responsible for data processing and the provision of accurate and timely reports to the Division; h. Designated staff, qualified by training and experience, to be responsible for ensuring that all Plan Providers, and all Outside Providers to whom Enrollees may be referred, are properly licensed in accordance with federal and state law and regulations; i. Designated staff, qualified by training and experience, to be responsible for Enrollee Services; j. Designated staff, qualified by training and experience, to be responsible for Provider Services and network development; k. Designated staff, qualified by training and experience, to be responsible for marketing or public relations; l. Sufficient support staff to conduct daily business in an orderly manner, as determined through management and medical reviews; and m. Telecommunications with sufficient local and toll free lines and a call distribution and monitoring system sufficient to meet the needs of the Enrollees and providers 24 hours per day for consultation or referrals. This includes making available 24 hours, seven (7) days per week access by telephone to (1) a live voice, i.e., an employee of the Contractor or answering service personnel who will immediately page an on call medical professional who can make referrals for non-emergency services or give information/authorization about accessing services or how to handle medical problems during non-office hours or (2) an answering machine or other electronic device which directs the Enrollee or providers to the telephone number to use to contact the after-hours medical professional.

Administration, Management, Facilities and Resources. ‌ The Contractor must shall maintain at all times during the term of this Contract adequate staffing, equipment, facilities, and resources sufficient to serve the needs of MembersEnrollees, as specified in this Contract, the RFQ, the Contractor’s QualificationRFP Proposal, and in accordance with appropriate standards of both specialty and sub-specialty care. The Contractor must shall be responsible for the administration and management of all aspects of the Contractor Plan and the performance of all of the covenants, conditions, conditions and obligations imposed upon the Contractor pursuant to this Contract. No delegation of responsibility, whether by Subcontract subcontract or otherwise, will shall terminate or limit in any way the liability of the Contractor to the Division for the full performance of this Contract. The Contractor must have, Medical management staffing shall be at a minimum, level that is sufficient to perform all necessary medical assessments and to meet all Mississippi Medicaid enrollees’ case management needs at all times. The CCO shall have at a minimum the following key management personnel or persons with comparable qualifications, as listed below, employed within ninety (90) days after during the award term of this Contract. Certain positions listed below are required to be : Executive Positions: • Full time Chief Executive Officer, and/or Chief Operations Officer located in the State of Mississippi. Should the Contractor wish to fill a position with an individual Mississippi • Chief Financial Officer • Chief Medical Officer located outside of the state, any such request requires written approval by the Division. For the purposes of this section, “full-time” employment is considered at least forty (40) work hours per week and/or 2,080 work hours per year. Anything less is considered “part-time.” Employees designated herein as “full-time” must be hired with that work commitment expectation. Any other employees may be hired as full-time or part-time, at the Contractor’s discretion. 1.13.1 Key Personnel‌ Key Personnel are defined as positions listed in 1.13.1.1, Executive Positions, and 1.13.1.2, Mississippi • Chief Information Officer Administrative Positions, below. : • Full time Provider Services Manager located in Mississippi • Full time Member Services Manager located in Mississippi • Quality Management Coordinator • Utilization Management Coordinator • Maternal Health/EPSDT Coordinator • Complaint/Grievance Coordinator • Claims Administrator • Other key personnel as identified by CCO The Division must approve Key Personnel positions required to be located in Mississippi must be approved by the Division prior to assignment. The Division reserves the right to approve additional key positions as needed. Approvals must be submitted to the Division no later than fifteen (15) business days before the replacement’s start date. Key Personnel management positions cannot be vacant for more than ninety (90) calendar days. The Contractor must notify the Division within five (5) business days of learning that any key position is vacant or anticipated to be vacant within the next thirty (30) calendar 90 days. Prior to diverting any of the specified Key Personnel key personnel for any reason, the Contractor must notify the Division in writing writing, and must shall submit justification (including proposed substitutions) in sufficient detail to permit evaluation of the impact on the delivery of covered services. These changes are to be reported when individuals either leave or are added to these key positions.. The following are the minimum qualifications for staff and level of equipment: a. a designated Chief Executive Officer (Contract Officer), with decision-making authority, qualified by training and experience, to administer the day-to-day business activities conducted pursuant to this Contract; b. a Mississippi licensed physician to serve as Medical Director, who shall be responsible for all clinical decisions of the Plan, and who shall oversee and be responsible for the proper provision of Covered Services to Enrollees;

Administration, Management, Facilities and Resources. ‌ The Contractor must shall maintain at all times during the term of this Contract adequate staffing, equipment, facilities, and resources sufficient to serve the needs of MembersEnrollees, as specified in this Contract, the RFQ, the Contractor’s QualificationRFP Proposal, and in accordance with appropriate standards of both specialty and sub-specialty care. The Contractor must shall be responsible for the administration and management of all aspects of the Contractor Plan and the performance of all of the covenants, conditions, conditions and obligations imposed upon the Contractor pursuant to this Contract. No delegation of responsibility, whether by Subcontract subcontract or otherwise, will shall terminate or limit in any way the liability of the Contractor to the Division for the full performance of this Contract. Medical management staffing shall be at a level that is sufficient to perform all necessary medical assessments and to meet all Mississippi Medicaid enrollees’ case management needs at all times. The Contractor must shall have, at a minimum, the following key management personnel or persons with comparable qualifications, as listed below, employed within ninety (90) days after during the award term of this Contract. Certain positions listed below are required to be : Executive Positions:  Full time Chief Executive Officer, and/or Chief Operations Officer located in the State of Mississippi. Should the Contractor wish to fill a position with an individual  Chief Financial Officer  Chief Medical Officer located outside of the state, any such request requires written approval by the Divisionin Mississippi. For the purposes of this section, “full-time” employment is considered at least forty (40) work hours per week and/or 2,080 work hours per year. Anything less is considered “part-time.” Employees designated herein as “full-time” must be hired with that work commitment expectation. Any other employees may be hired as full-time or part-time, at the Contractor’s discretion. 1.13.1 Key Personnel‌ Key Personnel are defined as positions listed in 1.13.1.1, Executive Positions, and 1.13.1.2,  Chief Information Officer Administrative Positions, below:  Full time Provider Services Manager located in Mississippi.  Full time Member Services Manager located in Mississippi.  Quality Management Coordinator  Utilization Management Coordinator  Complaint/Grievance Coordinator  Claims Administrator  Other key personnel as identified by Contractor. The Division must approve Key Personnel key personnel required to be located in Mississippi must be approved by the Division prior to assignment. The Division reserves the right to approve additional key positions as needed. Approvals must be submitted to the Division no later than fifteen (15) business days before the replacement’s start date. Key Personnel management positions cannot be vacant for more than ninety (90) calendar days. The Contractor must notify the Division within five (5) business days of learning that any key position is vacant or anticipated to be vacant within the next thirty (30) calendar days. Prior to diverting any of the specified Key Personnel key personnel for any reason, the Contractor must notify the Division in writing writing, and must shall submit justification (including proposed substitutions) in sufficient detail to permit evaluation of the impact on the delivery of covered services. These changes are to be reported when individuals either leave or are added to these key positions. The following are the minimum qualifications for staff and level of equipment: a. A designated Chief Executive Officer (Contract Officer), with decision-making authority, qualified by training and experience, to administer the day-to-day business activities conducted pursuant to this Contract; b. A Mississippi licensed physician to serve as Medical Director, who shall be responsible for all clinical decisions of the Plan, and who shall oversee and be responsible for the proper provision of Covered Services to Enrollees; c. A designated health care practitioner, qualified by training and experience, to serve as Quality Management Director; d. A designated person, qualified by training and experience, to be responsible for the Plan’s utilization control; e. A designated person, qualified by training and experience in the processing and resolution of complaints and grievances; f. A designated person, qualified by training and experience, to be responsible for the medical record system; g. A designated person, qualified by training and experience, to be responsible for data processing and the provision of accurate and timely reports to the Division; h. Designated staff, qualified by training and experience, to be responsible for ensuring that all Plan Providers, and all Outside Providers to whom Enrollees may be referred, are properly licensed in accordance with federal and state law and regulations; i. Designated staff, qualified by training and experience, to be responsible for Enrollee Services; j. Designated staff, qualified by training and experience, to be responsible for Provider Services and network development; k. Designated staff, qualified by training and experience, to be responsible for marketing or public relations; l. Sufficient support staff to conduct daily business in an orderly manner, as determined through management and medical reviews; and m. Telecommunications with sufficient local and toll free lines and a call distribution and monitoring system sufficient to meet the needs of the Enrollees and providers 24 hours per day for consultation or referrals. This includes making available 24 hours, seven (7) days per week access by telephone to (1) a live voice, i.e., an employee of the Contractor or answering service personnel who will immediately page an on call medical professional who can make referrals for non-emergency services or give information/authorization about accessing services or how to handle medical problems during non-office hours or (2) an answering machine or other electronic device which directs the Enrollee or providers to the telephone number to use to contact the after-hours medical professional.