Common use of Department Oversight Clause in Contracts

Department Oversight. The Department reserves the right to review the Contractor’s policies and procedures and determine conditions for formal notification to the Department of situations involving quality of care. During the conduct of contract monitoring activities, the Department may assess the Contractor’s compliance with any requirements set forth in this Contract and in the documents referenced herein. The Department reserves the right to audit, formally and/or informally, for compliance with any term(s) of this Contract, for compliance with the laws and regulations of the Federal Government and the Commonwealth of Virginia, and for compliance in the implementation of any term(s) of this Contract. The right to audit under this section exists for ten (10) years from the final date of the contract period or from the date of completion of any audit, whichever is later. The Department shall be responsible for the administration of this Contract. Administration of the Contract shall be conducted in good faith within the resources of the State, but in the best interest of the members. The Department shall retain full authority for the administration of the Medicaid Program in accordance with the requirements of Federal and State laws and regulations. See Section 16.2 regarding conflicts between the Department’s administration of the Medicaid program and the Contractor’s policies and its subcontractor’s contracts. RESPONSIVENESS TO THE DEPARTMENT The Contractor must acknowledge receipt of the Department’s written, electronic, or telephonic requests for assistance, including case management evaluation requests and requests to change MCO (good cause as outlined in section 6.3.E of this Contract), involving members or providers as within one (1) business day in instances where the member’s health condition requires and in all other instances no later than two (2) business days of receipt of the request from the Department. The Contractor’s acknowledgement must include a planned date of resolution. A detailed resolution summary advising the Department of the Contractor’s action and resolution shall be rendered to the Department in the format requested. The Department’s requests for case management services and/or requests for the Contractor to contact the member/provider must occur within the time frame set forth by the Department. The Department’s urgent requests for assistance such as issues involving legislators, other governmental bodies, or as determined by the Department, must be given priority by the Contractor and completed in accordance with the instructions from the Department. The Department shall provide guidance with respect to any necessary deadlines and resolution requirements, including dates of resolution. A resolution summary, as described by the Department, shall be submitted to the Department.