Common use of OPERATIONS PHASE REQUIREMENTS Clause in Contracts

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

OPERATIONS PHASE REQUIREMENTS. 8-14 4 8.1 General Scope of Work ...................................................................................... Work........................................................................................8-14 4 8.1.1 Administration and Contract Management ................................................ Management..................................................8-14 4 8.1.2 Covered Services ...................................................................................... Services........................................................................................8-16 6 8.1.3 Access to Care .......................................................................................... Care............................................................................................8-19 9 8.1.4 Provider Network ....................................................................................... Network.......................................................................................8-25 13 8.1.5 Member Services ....................................................................................... Services.......................................................................................8-37 24 8.1.6 Marketing and Prohibited Practices ........................................................... Practices...........................................................8-45 31 8.1.7 Quality Assessment and Performance Improvement ................................ Improvement................................8-45 32 8.1.8 Utilization Management ............................................................................. Management.............................................................................8-49 36 8.1.9 Early Childhood Intervention (ECI) ............................................................ ECI)............................................................8-51 37 8.1.10 Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) - Specific Requirements .................................................................. Requirements..................................................................8-52 39 8.1.11 Coordination with Texas Department of Family and Protective Services .. Services..8-53 39 8.1.12 Services for People with Special Health Care Needs ................................ Needs................................8-54 40 8.1.13 Service Management for Certain Populations ........................................... Populations...........................................8-56 42 8.1.14 Disease Management (DM) ....................................................................... DM)/Health Home Services..................................8-57 43 8.1.15 Behavioral Health (BH) Network and Services .......................................... Services..........................................8-58 45 8.1.16 Financial Requirements for Covered Services .......................................... Services..........................................8-62 48 8.1.17 Accounting and Financial Reporting Requirements ................................... Requirements...................................8-62 49 8.1.18 Management Information System Requirements ...................................... Requirements......................................8-68 55 8.1.19 Fraud and Abuse ....................................................................................... Abuse.......................................................................................8-75 61 8.1.20 General Reporting Requirements .............................................................. Requirements..............................................................8-78 62 8.1.21 Pharmacy Services .................................................................................... Services....................................................................................8-8266