NCQA Accreditation. 2.15.5.1 The CONTRACTOR shall obtain NCQA accreditation by November 30, 2009 and shall maintain it thereafter. Any accreditation status granted by NCQA under the New Health Plan (NHP) program or the MCO Introductory Survey option will not be acknowledged by TENNCARE. Accreditation obtained under the NCQA Full Accreditation Survey or Multiple Product Survey options will be acknowledged by TENNCARE if the TennCare product is specifically included in the NCQA survey. TENNCARE will accept the use of the NCQA Corporate Survey process, to the extent deemed allowable by NCQA, in the accreditation of the CONTRACTOR. In order to ensure that the CONTRACTOR is making forward progress, TENNCARE shall require that the following information and/or benchmarks be met: NCQA Accreditation Survey Application Submitted and Pre Survey Fee paid December 15, 2007 Submit copy of signed NCQA Survey contract to TENNCARE January 15, 2008 Purchase NCQA ISS Tool for 2009 MCO Accreditation Survey August 15, 2008 Copy of signed contract with NCQA approved vendor to perform 2009 CAHPS surveys (Adult, Child and Children with Chronic Conditions to TENNCARE) November 15, 2008 Copy of signed contract with NCQA approved vendor to perform 2009 HEDIS Audit to TENNCARE (The CONTRACTOR must perform the complete Medicaid HEDIS Data Set with the exception of dental related measures) November 15, 2008 Notify TENNCARE of date for ISS Submission and NCQA On-site review January 15, 2009 HEDIS Baseline Assessment Tool completed and submitted to Contracted HEDIS Auditor, TENNCARE, and the EQRO February 15, 2009 Audited Medicaid HEDIS and CAHPS results submitted to NCQA and TENNCARE June 15, 2009 Finalize preparations for NCQA Survey (Final payment must be submitted to NCQA sixty (60) calendar days prior to submission of ISS) Notify TennCare of final payment within five (5) business days of submission to NCQA. Submission of ISS to NCQA Notify TennCare within five (5) business days of submission to NCQA. NCQA Survey Completed and copy of NCQA Final Report to TENNCARE: November 30, 2009 • Excellent, Commendable, or Accredited • Provisional — Corrective Action required to achieve status of Excellent, Commendable, or Accredited; resurvey within twelve ( 12) months. • Accreditation Denied — Results in termination of this Agreement. 2.15.5.2 If the CONTRACTOR consistently fails to meet the timelines as described above, the CONTRACTOR shall be considered to be in breach of the terms of this Agreement and may be subject to termination in accordance with Section 4.4 of this Agreement. 2.15.5.3 Failure to obtain NCQA accreditation by November 30, 2009 and maintain accreditation thereafter shall be considered a breach of this Agreement and shall result in termination of this Agreement in accordance with the terms set forth in Section 4.4 of this Agreement. Achievement of provisional accreditation status shall require a corrective action plan within thirty (30) calendar days of receipt of notification from NCQA and may result in termination of this Agreement in accordance with Section 4.4 of this Agreement.
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NCQA Accreditation. 2.15.5.1 2.15.6.1 The CONTRACTOR shall obtain NCQA accreditation by November 30, 2009 and shall maintain it thereafter. Any accreditation status granted by NCQA under the New Health Plan (NHP) program or the MCO Introductory Survey option will not be acknowledged by TENNCARE. Accreditation obtained under the NCQA Full Accreditation Survey or Multiple Product Survey options will be acknowledged by TENNCARE if the TennCare product is specifically included in the NCQA survey. TENNCARE will accept the use of the NCQA Corporate Survey process, to the extent deemed allowable by NCQA, in the accreditation of the CONTRACTOR. In order to ensure that the CONTRACTOR is making forward progress, TENNCARE shall require that the following information and/or benchmarks be met: NCQA Accreditation Survey Application Submitted and Pre Survey Fee paid December 15, 2007 Submit copy of signed NCQA Survey contract to TENNCARE January 15, 2008 Purchase NCQA ISS Tool for 2009 MCO Accreditation Survey August 15, 2008 Copy of signed contract with NCQA approved vendor to perform 2009 CAHPS surveys (Adult, Child and Children with Chronic Conditions to TENNCARE) November 15, 2008 Copy of signed contract with NCQA approved vendor to perform 2009 HEDIS Audit to TENNCARE (The CONTRACTOR must perform the complete Medicaid HEDIS Data Set with the exception of dental related measures) November 15, 2008 Notify TENNCARE of date for ISS Submission and NCQA On-site review January 15, 2009 HEDIS Baseline Assessment Tool completed and submitted to Contracted HEDIS Auditor, TENNCARE, and the EQRO February 15, 2009 Audited Medicaid HEDIS and CAHPS results submitted to NCQA and TENNCARE June 15, 2009 Finalize preparations for NCQA Survey (Final payment must be submitted to NCQA sixty (60) calendar days prior to submission of ISS) Notify TennCare of final payment within five (5) business days of submission to NCQA. Submission of ISS to NCQA Notify TennCare within five (5) business days of submission to NCQA. NCQA Survey Completed and copy of NCQA Final Report to TENNCARE: November 30, 2009 • Excellent, Commendable, or Accredited • Provisional — – Corrective Action required to achieve status of Excellent, Commendable, or Accredited; resurvey within twelve ( (12) months. • Accreditation Denied — – Results in termination of this Agreement.
2.15.5.2 2.15.6.2 If the CONTRACTOR consistently fails to meet the timelines as described above, the CONTRACTOR shall be considered to be in breach of the terms of this Agreement and may be subject to termination in accordance with Section 4.4 of this Agreement.
2.15.5.3 2.15.6.3 Failure to obtain NCQA accreditation by November 30, 2009 and maintain accreditation thereafter shall be considered a breach of this Agreement and shall result in termination of this Agreement in accordance with the terms set forth in Section 4.4 of this Agreement. Achievement of provisional accreditation status shall require a corrective action plan within thirty (30) calendar days of receipt of notification Final Report from NCQA and may result in termination of this Agreement in accordance with Section 4.4 of this Agreement.
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