Oversight and Performance Evaluation Clause Samples

The Oversight and Performance Evaluation clause establishes a framework for monitoring and assessing the performance of parties involved in an agreement. Typically, it outlines the methods and frequency of evaluations, such as regular progress reports, audits, or performance reviews, and may specify the criteria or benchmarks to be used. This clause ensures accountability and helps identify issues early, thereby promoting compliance with contractual obligations and supporting continuous improvement throughout the duration of the contract.
Oversight and Performance Evaluation. AHS will be responsible for oversight of the managed care-like model acting as a non-risk PIHP, ensuring compliance with state and federal statutes, regulations, special terms and conditions, waiver, and expenditure authority. AHS shall be responsible for evaluation, interpretation and enforcement of findings issued by the external quality review organization. AHS will ensure that the views of beneficiaries, individuals representing beneficiaries and other stakeholders are solicited during any modifications to the design, implementation and oversight of the State’s managed Long-Term Services and Supports. AHS will implement procedures for monitoring all aspects of the managed care program, including DVHA’s performance in at least the following areas: 1. Administration and management; 2. Appeal and grievance systems; 3. Claims management; 4. Enrollee materials and customer services, including the activities of the beneficiarysupport system; 5. Finance, including medical loss ratio reporting; 6. Information systems, including encounter data reporting; 7. Marketing; 8. Medical management, including utilization management and case management; 9. Program integrity; 10. Provider network management, including provider directory standards; 11. Availability and accessibility of services, including network adequacystandards; 12. Quality improvement; 13. Areas related to the delivery of LTSS not otherwise included above; and 14. All other provisions of the contract, as appropriate. AHS will use data collected from its monitoring activities to improve the performance of its managed care program, including at a minimum: 1. Enrollment and disenrollment trends; 2. Enrollee grievance and appeal logs; 3. Provider complaint and appeal logs; 4. Findings from the State’s External Quality Review process; 5. Results from any enrollee or provider satisfaction survey conducted by AHS or DVHA; 6. Performance on required quality measures; 7. Medical management committee reports and minutes; 8. DVHA’s annual quality improvement plan; 9. Financial and encounter data; 10. The medical loss ratio summary reports required by § 438.8; 11. Customer service performance data submitted by DVHA and performance data submitted by the beneficiary support system; and 12. Any other data related to the provision of LTSS not otherwise included above. AHS shall at its discretion do the following: Define measurable performance standards for DVHA and its subcontractors in all of the following areas: • S...
View SourceView Similar (2)
Oversight and Performance Evaluation. AHS will be responsible for oversight of the managed care-like model acting as a non-risk PIHP, ensuring compliance with state and federal statutes, regulations, special terms and conditions, waiver, and expenditure authority. AHS shall be responsible for evaluation, interpretation and enforcement of findings issued by the external quality review organization. AHS will ensure that the views of beneficiaries, individuals representing beneficiaries and other stakeholders are solicited during any modifications to the design, implementation and oversight of the State’s managed Long Term Services and Supports. AHS will implement procedures for monitoring all aspects of the managed care program, including DVHA’s performance in at least the following areas: (1) Administration and management; (2) Appeal and grievance systems; (3) Claims management; (4) Enrollee materials and customer services, including the activities of the beneficiary support system; (5) Finance, including medical loss ratio reporting; (6) Information systems, including encounter data reporting;
View SourceView Similar (2)
Oversight and Performance Evaluation. ‌ (a) AHS will be responsible for oversight of DVHA as the managed care-like model acting as a non-risk PIHP, ensuring compliance with state and federal statutes, regulations, special terms and conditions, waiver, and expenditure authority. (b) AHS will ensure compliance with 42 CFR 438.66 by ensuring its Medicaid compliance policies and procedures continue to provide for a formal, documented process for comprehensive program integrity oversight of DVHA. (c) In accordance with 42 CFR 438.66, AHS will implement procedures for monitoring all aspects of the managed care program, including ▇▇▇▇’s performance in at least the following areas: (i) Administration and management; (ii) Appeal and grievance systems; (iii) Claims management; (iv) Beneficiary materials and customer services, including the activities of the beneficiary support system; (v) Finance, including medical loss ratio reporting; (vi) Information systems, including encounter data reporting; (vii) Marketing; (viii) Medical management, including utilization management and case standards;‌ adequacy standards; above; and‌ (ix) Program integrity; (x) Provider network management, including provider directory (xi) Availability and accessibility of services, including network (xii) Quality improvement; (xiii) Areas related to the delivery of LTSS not otherwise included (xiv) All other provisions of the contract, as appropriate. (d) The External Quality Review Organization (EQRO) shall perform an annual, external independent review of the quality outcomes, timeliness of, and access to, the services covered under this IGA. AHS shall contract with an EQRO in order to obtain independent monitoring of DVHA’s Quality Management Program. AHS shall be responsible for the evaluation, interpretation, and enforcement of findings issued by the EQRO. (e) In its role as single state agency, AHS will ensure a managed LTSS plan for a comprehensive care model is developed that promotes the integration of home and community-based services, institutional, acute, primary, and behavioral health care. (f) AHS must meet the managed care quality strategy requirements at 42 CFR
View Source
Oversight and Performance Evaluation. ‌ (a) AHS will be responsible for oversight of DVHA as the managed care-like model acting as a non-risk PIHP, ensuring compliance with state and federal statutes, regulations, special terms and conditions, waiver, and expenditure authority. (b) AHS will ensure compliance with 42 CFR 438.66 by ensuring its Medicaid compliance policies and procedures continue to provide for a formal, documented process for comprehensive program integrity oversight of DVHA. (c) In accordance with 42 CFR 438.66, AHS will implement procedures for monitoring all aspects of the managed care program, including ▇▇▇▇’s performance in at least the following areas: (i) Administration and management; (ii) Appeal and grievance systems; (iii) Claims management; (iv) Beneficiary materials and customer services, including the activities of the beneficiary support system; (v) Finance, including medical loss ratio reporting; (vi) Information systems, including encounter data reporting; (vii) Marketing; (viii) Medical management, including utilization management and case management; (ix) Program integrity; (x) Provider network management, including provider directory standards; (xi) Availability and accessibility of services, including network adequacy standards; (xii) Quality improvement; (xiii) Areas related to the delivery of LTSS not otherwise included above; and (xiv) All other provisions of the contract, as appropriate.
View Source

Related to Oversight and Performance Evaluation

  • Portfolio Expense and Performance Data The Trust shall provide such data regarding each Portfolio’s expense ratios and investment performance as the Company shall reasonably request, to facilitate the registration and sale of the Variable Contracts. Without limiting the generality of the forgoing, the Trust shall provide the following Portfolio expense and performance data on a timely basis to facilitate the Company’s preparation of its annually updated registration statement for the Variable Contracts (and as otherwise reasonably requested by the Company), but in no event later than 10 calendar days after the close of each Portfolio’s fiscal year: (a) The gross “Annual Portfolio Company Expenses” for each Portfolio calculated in accordance with Item 3 of Form N-1A, before any expense reimbursements or fee waiver arrangements (and in accordance with (i) Instruction 16 to Item 4 of Form N-4, and (ii) Instruction 4(a) to Item 4 of Form N-6); (b) The net “Annual Portfolio Company Expenses” (aka “Total Annual Fund Operating Expenses”) for each Portfolio calculated in accordance with Item 3 of Form N-1A, that include any expense reimbursements or fee waiver arrangements (and in accordance with (i) Instruction 17 to Item 4 of Form N-4, (ii) Instruction 4 to Item 17 of Form N-4, (iii) Instruction 4(b) to Item 4 of Form N-6, and (iv) Instruction 4 to Item 18 of Form N-6), and the period for which the expense reimbursements or fee waiver arrangement is expected to continue and whether it can be terminated by the Portfolio (or Fund); and (c) The “Average Annual Total Returns” for each Portfolio (before taxes) as calculated pursuant to Item 4(b)(2)(iii) of Form N-1A (for the 1, 5, and 10 year periods, and in accordance with (i) Instruction 7 to Item 17 of Form N-4, and (ii) Instruction 7 to Item 18 of Form N-6).

  • Payment and Performance Bond Prior to the execution of this Contract, City may require Contractor to post a payment and performance bond (Bond). The Bond shall guarantee Contractor’s faithful performance of this Contract and assure payment to contractors, subcontractors, and to persons furnishing goods and/or services under this Contract.

  • Payment and Performance Bonds A payment bond and performance is required for a public works contract involving expenditure in excess of twenty-five thousand dollars ($25,000) and no work can be commenced prior to both bonds being approved the County. The Contractor shall furnish, at time of signing the Contract, one surety bond which shall protect the laborers and material men and shall be for $60,000, in accordance with Section 9554 of the Civil Code, and one surety bond in the amount of $60,000, guaranteeing the faithful performance of the Contract. If at any time the value of the total task orders is expected to exceed $60,000, the Contractor shall furnish, in a manner acceptable to the County, evidence that the Contractor is bonded to the expected total value of outstanding task orders for both the faithful performance and laborers and material men bonds. Contractor shall not be entitled to, nor shall County authorize, task orders when the total outstanding value of the task orders under this contract exceeds the bond values for which the County is an obligee. Said bonds to be approved by the office of the County Counsel and the County Executive Office of Orange County. Such bonds shall be the forms provided in these specifications and issued and executed by an admitted surety insurer (authorized to transact surety insurance in California). (e.g., if the bonds are issued through a surplus line broker, both the surplus line broker and the insurer with whom he is doing business for purposes of this project must be licensed in California to issue such bonds.) The faithful performance bond shall be issued by a Surety company with a minimum insurance rating of A- (Secure Best’s Rating) and VIII (Financial Size Category) as determined by the most current edition of the Best’s Key Rating Guide/Property-Casualty/United States or ▇▇▇▇▇▇.▇▇▇. The Surety Company must also be authorized to write in California by the Department of the Treasury, and must be listed on the most current edition of the Department of Treasury’s Listing of Approved Securities. If any surety upon any bond furnished in connection with this Contract becomes unacceptable to the County, or if any such surety fails to furnish reports as to his financial condition from time to time as requested by OC Public Works, the Contractor shall promptly furnish such additional security as may be required by OC Public Works or the Board of Supervisors from time to time to protect the interests of the County and of persons supplying labor or materials in the prosecution of the Work contemplated by this Contract. If the County increases the total Contract amount the Contractor is to provide a new bond for the new total Contract amount or a bond for the difference.

  • Continuity of Service and Performance Unless otherwise agreed in writing, the Parties shall continue to provide service and honor all other commitments under this Agreement during the course of a Dispute with respect to all matters not subject to such Dispute.

  • Quarterly Contractor Performance Reporting Customers shall complete a Contractor Performance Survey (Exhibit I) for each Contractor on a Quarterly basis. Customers will electronically submit the completed Contractor Performance Survey(s) to the Department Contract Manager no later than the due date indicated in Contract Exhibit D, Section 17, Additional Special Contract Conditions. The completed Contractor Performance Survey(s) will be used by the Department as a performance-reporting tool to measure the performance of Contractors. The Department reserves the right to modify the Contractor Performance Survey document and introduce additional performance-reporting tools as they are developed, including online tools (e.g. tools within MyFloridaMarketPlace or on the Department's website).