OPERATIONS PHASE REQUIREMENTS Sample Clauses

OPERATIONS PHASE REQUIREMENTS. Revision 1.5 January 1, 2007 Revised version of the Attachment B-1, Section 8, that includes provisions applicable to MCOs participating in the STAR and STAR+PLUS Program.
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OPERATIONS PHASE REQUIREMENTS. 8-14 8.1 General Scope of Work....................................................................................8-14
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OPERATIONS PHASE REQUIREMENTS. This Section describes Scope of Work requirements for the Operations Phase of the Contract.
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OPERATIONS PHASE REQUIREMENTS. This Section is designed to provide HMOs with sufficient information to understand the HMOs' responsibilities. This Section describes scope of work requirements for the Operations Phase of the Contract.
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OPERATIONS PHASE REQUIREMENTS. This Section is designed to provide HMOs with sufficient information to understand the HMOs' responsibilities. This Section describes scope of work requirements for the Operations Phase of the Contract. Section 8.1 includes the general scope of work that applies to the STAR, STAR+PLUS, CHIP, and CHIP Perinatal HMO Programs. Section 8.2 includes the additional Medicaid scope of work that applies only to the STAR and STAR+PLUS HMOs. Section 8.3 includes the additional scope of work that applies only to STAR+PLUS HMOs. Section 8.4 includes the additional scope of work that applies only to CHIP HMOs. Section 8.5 includes the additional scope of work that applies only to CHIP Perinatal HMOs. The Section does not include detailed information on the STAR, STAR+PLUS, CHIP, and CHIP Perinatal HMO Program requirements, such as the time frame and format for all reporting requirements. HHSC has included this information in the Uniform Managed Care Contract Terms and Conditions (Attachment A) and the Uniform Managed Care Manual. HHSC reserves the right to modify these documents as it deems necessary using the procedures set forth in the Uniform Managed Care Contract Terms and Conditions.
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OPERATIONS PHASE REQUIREMENTS. This Section describes Scope of Work requirements for the Operations Phase of the Contract. Section 8.1 includes the general Scope of Work that applies to all MCO Programs (STAR, STAR+PLUS, and CHIP). Section 8.2 includes the additional Medicaid Scope of Work that applies only to the STAR and STAR+PLUS MCOs. Section 8.3 includes the additional Scope of Work that applies only to STAR+PLUS MCOs. Section 8.4 includes the additional CHIP Scope of Work that applies only to CHIP MCOs. The CHIP Perinatal Program is a CHIP subprogram. CHIP Program requirements apply to the CHIP Perinatal Program, unless the Contract otherwise indicates. Additional information regarding the STAR, STAR+PLUS, and CHIP Program requirements, such as reporting timeframes and formats is included in Attachment A, "Uniform Managed Care Contract Terms and Conditions," and the Uniform Managed Care Manual. HHSC reserves the right to modify these documents as it deems necessary using the procedures set forth in the Attachment A, “Uniform Managed Care Contract Terms and Conditions.”
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OPERATIONS PHASE REQUIREMENTS. 8-14 8.1 General Scope of Work ...................................................................................... 8-14 8.1.1 Administration and Contract Management ................................................ 8-14 8.1.2 Covered Services ...................................................................................... 8-16 8.1.3 Access to Care .......................................................................................... 8-19 8.1.4 Provider Network ....................................................................................... 8-25 8.1.5 Member Services ....................................................................................... 8-37 8.1.6 Marketing and Prohibited Practices ........................................................... 8-45 8.1.7 Quality Assessment and Performance Improvement ................................ 8-45 8.1.8 Utilization Management ............................................................................. 8-49 8.1.9 Early Childhood Intervention (ECI) ............................................................ 8-51 8.1.10 Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) - Specific Requirements .................................................................. 8-52 8.1.11 Coordination with Texas Department of Family and Protective Services .. 8-53 8.1.12 Services for People with Special Health Care Needs ................................ 8-54 8.1.13 Service Management for Certain Populations ........................................... 8-56 8.1.14 Disease Management (DM) ....................................................................... 8-57 8.1.15 Behavioral Health (BH) Network and Services .......................................... 8-58 8.1.16 Financial Requirements for Covered Services .......................................... 8-62 8.1.17 Accounting and Financial Reporting Requirements ................................... 8-62 8.1.18 Management Information System Requirements ...................................... 8-68 8.1.19 Fraud and Abuse ....................................................................................... 8-75 8.1.20 General Reporting Requirements .............................................................. 8-78 8.1.21 Pharmacy Services .................................................................................... 8-82
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OPERATIONS PHASE REQUIREMENTS. This Section is designed to provide HMOs with sufficient information to understand the HMOs’ responsibilities. This Section describes scope of work requirements for the Operations Phase of the Contract. Section 8.1 includes the general scope of work that applies to both the STAR and CHIP HMO Programs. Section 8.2 includes the additional Medicaid scope of work that applies only to STAR HMOs. Section 8.3 includes the additional scope of work that applies only to CHIP HMOs. The Section does not include detailed information on the STAR and CHIP HMO Program requirements, such as the time frame and format for all reporting requirements. HHSC has included this information in the Uniform Managed Care Contract Terms and Conditions (Attachment A) and the Uniform Managed Care Manual. HHSC reserves the right to modify these documents as it deems necessary using the procedures set forth in the Uniform Managed Care Contract Terms and Conditions.
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Related to OPERATIONS PHASE REQUIREMENTS

  • License Requirements The Hotel’s alcoholic beverage license requires that the Hotel shall: (i) request proper identification (photo ID) of any person of questionable age and refuse alcoholic beverage service if the person is either under age or proper identification cannot be produced, and (ii) refuse alcoholic beverage service to any person who, in the Hotel’s judgment, appears to be intoxicated; and (iii) instruct its personnel to avoid encouraging patrons to consume alcoholic beverages (commonly referred to as “over-pouring”).

  • Project Requirements 1. Project must conform to regulations under 24 CFR Part 92, commonly known as the HOME Regulations.

  • Procurement Requirements If the Sponsor has, or is required to have, a procurement process that follows applicable state and/or federal law or procurement rules and principles, it must be followed, documented, and retained. If no such process exists, the Sponsor must follow these minimum procedures: 1) Publish a notice to the public requesting bids/proposals for the project; 2) Specify in the notice the date for submittal of bids/proposals; 3) Specify in the notice the general procedure and criteria for selection; and 4) Sponsor must contract or hire from within its bid pool. If bids are unacceptable the process needs to be repeated until a suitable bid is selected. 5) Comply with the same legal standards regarding unlawful discrimination based upon race, gender, ethnicity, sex, or sex-orientation that are applicable to state agencies in selecting a bidder or proposer. Alternatively, Sponsor may choose a bid from a bidding cooperative if authorized to do so. This procedure creates no rights for the benefit of third parties, including any proposers, and may not be enforced or subject to review of any kind or manner by any entity other than the RCO. Sponsors may be required to certify to the RCO that they have followed any applicable state and/or federal procedures or the above minimum procedure where state or federal procedures do not apply.

  • Operating Requirements Any operating and technical requirements that may be applicable due to Regional Transmission Organization, Independent System Operator, control area, or the Connecting Transmission Owner’s requirements, including those set forth in the Small Generator Interconnection Agreement. Operating Requirements shall include Applicable Reliability Standards.

  • Time Requirements The Independent Contractor will not be required to follow or establish a regular or daily work schedule, but shall devote during the term of this Agreement the time, energy and skill as necessary to perform the services of this engagement and shall, periodically or at any time upon the request of the Company, submit information as to the amount of time worked and scope of work performed.