Policies and Procedures for Core Functions Clause Samples
The "Policies and Procedures for Core Functions" clause establishes the requirement for an organization or party to develop, maintain, and follow documented policies and procedures governing its essential operations. In practice, this means the party must create clear guidelines and step-by-step processes for activities such as data management, security, or service delivery, and ensure that staff are trained to adhere to these standards. The core purpose of this clause is to promote consistency, accountability, and compliance in performing key functions, thereby reducing operational risks and ensuring reliable outcomes.
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Policies and Procedures for Core Functions. The Contractor shall develop, maintain, and provide to EOHHS upon request, policies and procedures for all core functions necessary to effectively and efficiently manage the MassHealth population and meet the requirements outlined in this Contract. All policies and procedures requiring EOHHS approval shall be documented and shall include the dates of approval by EOHHS. These policies and procedures shall include, but are not limited to, the following topics:
a. Response to violations of Enrollees’ privacy rights by staff, Providers or subcontractors;
b. Non-discrimination of MassHealth Enrollees;
c. Non-restriction of Providers advising or advocating on an Enrollee’s behalf;
d. Appeal rights for certain minors who under the law may consent to medical procedures without parental consent;
e. Enrollee cooperation with those providing health care services;
f. Marketing activities that apply to the Plan, Providers and subcontractors as well as the Contractor’s procedures for monitoring these activities;
g. Cost-sharing by Enrollees;
h. Advance directives;
i. Assisting Enrollees in understanding their benefits and how to access them;
j. Access and availability standards;
k. Enrollees’ right to be free from restraint or seclusion used as a means of coercion or retaliation;
l. The provision of Culturally and Linguistically Appropriate Services; m. Practice guidelines in quality measurement and improvement activities;
Policies and Procedures for Core Functions. 2.3.2.8.1. The Contractor shall develop, maintain, and provide to EOHHS upon request, policies and procedures for all core functions necessary to manage the One Care eligible and enrolled population effectively and efficiently and meet the requirements outlined in this Contract. All policies and procedures requiring EOHHS approval shall be documented and shall include the dates of approval by EOHHS.
2.3.2.8.2. These policies and procedures shall include, but are not limited to, the following topics:
2.3.2.8.2.1. Response to violations of Enrollees' privacy rights by staff, Providers, or Material Subcontractors;
2.3.2.8.2.2. Non-discrimination of Enrollees;
2.3.2.8.2.3. Non-restriction of Providers advising or advocating on an Enrollee's behalf;
2.3.2.8.2.4. Enrollee cooperation with those providing health care services;
2.3.2.8.2.5. Marketing activities that apply to the Contractor, Providers, and Material Subcontractors, including both Medicare and Medicaid activities, as well as the Contractor's procedures for monitoring these activities;
2.3.2.8.2.6. Cost-sharing by Enrollees; 2.3.2.8.2.7. Advance directives;
Policies and Procedures for Core Functions. The Contractor shall develop, maintain, and provide to EOHHS upon request, policies and procedures for all core functions necessary to manage the MassHealth population effectively and efficiently and meet the requirements outlined in this Contract. All policies and procedures requiring EOHHS approval shall be documented and shall include the dates of approval by EOHHS. These policies and procedures shall include, but are not limited to, the following topics:
a. Response to violations of Enrollees’ privacy rights by staff or Subcontractors;
b. Non-discrimination of MassHealth Enrollees;
c. Enrollee cooperation with those providing health care services;
d. Marketing activities and the Contractor’s procedures for monitoring these activities;
e. Advance Directives;
f. Assisting Enrollees in understanding their benefits and how to access them;
g. Enrollees’ right to be free from restraint or seclusion used as a means of coercion or retaliation;
h. The provision of Culturally and Linguistically Appropriate Services;
i. Practice guidelines in quality measurement and improvement activities;
j. Handling of complaints/Grievances sent directly to EOHHS;
k. Process used to monitor PCP and Subcontractor implementation of amendments and improvements;
l. Retention of medical records;
m. Engagement and coordination with BH CPs and LTSS CPs, as described in Section 2.4.E;
n. Care Management;
o. Public health emergencies; and p. Risk stratification.
D. Readiness Review Overview
1. Contract Readiness Workplan
a. No later than five business days following the Contract Effective Date, or other date as specified by EOHHS, the Contractor shall submit to EOHHS, for its review and approval, a workplan which shall be used by EOHHS to monitor the Contractor’s progress toward achieving Contract readiness, as detailed in Section 2.5.D below, in accordance with timelines specified by EOHHS. The workplan shall:
1) Address all of the items listed in Section 2.5.D.3, at a minimum;
2) List each task, the date by which it will be completed, how it will be completed, and the documentation that will be provided to EOHHS as evidence that the task has been completed.
b. EOHHS may, in its discretion, modify or reject any such workplan, in whole or in part;
c. The Contractor shall modify its workplan as specified by EOHHS and resubmit for approval.
2. EOHHS will conduct a Readiness Review of the Contractor that may include, at a minimum, one on-site review, as determined appropriate by EOHHS. Thi...
Policies and Procedures for Core Functions. 2.3.2.7.1. The Contractor shall develop, maintain, and provide to EOHHS upon request, policies and procedures for all core functions necessary to manage the SCO eligible and enrolled population effectively and efficiently and meet the requirements outlined in this Contract. All policies and procedures requiring EOHHS approval shall be documented and shall include the dates of approval by EOHHS.
2.3.2.7.2. These policies and procedures shall include, but are not limited to, the following topics:
2.3.2.7.2.1. Response to violations of Enrollees' privacy rights by staff, Providers or Material Subcontractors;
2.3.2.7.2.2. Non-discrimination of Enrollees; 2.
3.2.7.2.3. Non-restriction of Providers advising or advocating on an Enrollee's behalf;