Common use of General Oversight Clause in Contracts

General Oversight. During the second 6 (six) month period, data collection and direct contact with the Qualified Hospital will continue on a monthly or as-needed basis. If the data collected during the first year of implementation suggests that a 90% accuracy rate for PE determinations and/or timely submissions of full Medicaid applications for PE approvals is not an achievable standard for Qualified Hospital, discussions will be held with Qualified Hospital’s assigned staff regarding any additional training, necessary corrective actions, or possible alternate standard that could be applied if the 90% standard could not be met due to circumstances beyond the Qualified Hospital’s control. However, DOM is not required to accommodate Qualified Hospital’s habitual failure to meet required performance standards. While DOM will make reasonable efforts to provide assistance and accommodations in meeting the standards required herein, this assistance shall not be permanent. If Qualified Hospital continues to fail to meet required standards, even after DOM’s subsequent efforts, DOM will pursue all remedies allowed under this MOU. DOM shall specifically consider termination of Qualified Hospital’s PE authority. Effective with the second year of participation in the PE program, the performance standards provided above will increase and remain at 95%. The possibility of an alternate standard assigned for a pre-determined amount of time will be discussed as a correction action measure if at any time the Qualified Hospital falls below the 95% standard due to circumstances beyond their control. Feedback and direct contact with Qualified Hospital’s assigned staff will continue on an as-needed basis and data will be shared monthly regarding adherence to the performance measures. PE-ELIGIBLE MEDICAID COVERAGE GROUPS: Children up to Age nineteen (19) years, Pregnant Women, Parents or Caretaker Relatives, Former ▇▇▇▇▇▇ Care Children in DHS ▇▇▇▇▇▇ Care at Age eighteen (18) years, and Certain Individuals Needing Breast or Cervical Cancer Treatment (Qualified Hospital must be a CDC screener). PE PERIODS: PE begins on the date the Qualified Hospital determines an individual is presumptively eligible. PE ends at the end of the month following the month the PE determination is made by the Qualified Hospital. If a full Medicaid application is submitted to DOM within the PE period, the PE period ends on the day in which the eligibility decision is made by DOM. DOM has limited the number of PE periods to no more than one (1) PE period within two (2) calendar years. However, pregnant women are limited to one (1) PE determination per pregnancy. INCOME QUALIFICATIONS: PE determinations are to be made in accordance with MAGI Household Income – refer to training material.

General Oversight. During the second 6 (six) month period, data collection and direct contact with the Qualified Hospital will continue on a monthly or as-needed basis. If the data collected during the first year of implementation suggests that a 90% accuracy rate for PE determinations and/or timely submissions of full Medicaid applications for PE approvals is not an achievable standard for Qualified Hospital, discussions will be held with Qualified Hospital’s assigned staff regarding any additional training, necessary corrective actions, or possible alternate standard that could be applied if the 90% standard could not be met due to circumstances beyond the Qualified Hospital’s control. However, DOM is not required to accommodate Qualified Hospital’s habitual failure to meet required performance standards. While DOM will make reasonable efforts to provide assistance and accommodations in meeting the standards required herein, this assistance shall not be permanent. If Qualified Hospital continues to fail to meet required standards, even after DOM’s subsequent efforts, DOM ▇▇▇ will pursue all remedies allowed under this MOU. DOM shall specifically consider termination of Qualified Hospital’s PE authority. Effective with the second year of participation in the PE program, the performance standards provided above will increase and remain at 95%. The possibility of an alternate standard assigned for a pre-determined amount of time will be discussed as a correction action measure if at any time the Qualified Hospital falls below the 95% standard due to circumstances beyond their control. Feedback and direct contact with Qualified Hospital’s assigned staff will continue on an as-needed basis and data will be shared monthly regarding adherence to the performance measures. PE-ELIGIBLE MEDICAID COVERAGE GROUPS: Children up to Age nineteen (19) years, Pregnant Women, Parents or Caretaker Relatives, Former ▇▇▇▇▇▇ Care Children in DHS ▇▇▇▇▇▇ Care at Age eighteen (18) years, and Certain Individuals Needing Breast or Cervical Cancer Treatment (Qualified Hospital must be a CDC screener). PE PERIODS: PE begins on the date the Qualified Hospital determines an individual is presumptively eligible. PE ends at the end of the month following the month the PE determination is made by the Qualified Hospital. If a full Medicaid application is submitted to DOM within the PE period, the PE period ends on the day in which the eligibility decision is made by DOM. DOM has limited the number of PE periods to no more than one (1) PE period within two (2) calendar years. However, pregnant women are limited to one (1) PE determination per pregnancy. INCOME QUALIFICATIONS: PE determinations are to be made in accordance with MAGI Household Income – refer to training material.