Common use of Oversight and Performance Evaluation Clause in Contracts

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;

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 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 beneficiarysupport system; (5) Finance, including medical loss ratio reporting; (6) Information systems, including encounter data reporting;