Exhibit 17.2 Reporting Requirements_02.10.2026.xlsx

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Attached to
Specialty Managed Care Plan
Solicitation number
41NHA-S3708
Issued by
Clark County, Fish Springs CDP, Nevada

About this file

This is a Reporting Requirements exhibit for a Specialty Managed Care Plan contract with the Nevada Health and Human Services Authority (NVHA). The document establishes comprehensive reporting obligations for the contractor across operational, clinical, financial, and compliance domains. The initial contract year runs from July 1, 2027, through December 31, 2027, with subsequent contract years following the calendar year (January 1 through December 31). The exhibit details 104 distinct reporting requirements, each specifying the report title, contract reference section, frequency of submission, and due dates. Reports range from one-time submissions such as Certificate of Authority and Evidence of Required Insurance Coverages due at contract signing and before execution, respectively, to ongoing requirements including weekly Enrollee Change of Status reports due every Monday and monthly Data Quality Reports due on the 15th of the following month. Key operational reports include Implementation Plans required biweekly within 30 days of selection and continuing until contract go-live, Provider Termination reports due weekly on Fridays, and Active Provider Lists due monthly within 10 days of month-end. All reports are subject to request by NVHA at any time, and extension requests require detailed email justification to mcreports@nvha.nv.gov with responses expected within 2 business days.

The reporting framework incorporates multiple federal and state regulatory authorities, including the Social Security Act (SSA), Code of Federal Regulations (42 CFR and 45 CFR), and Nevada Revised Statutes (NRS). Critical compliance reports include Fraud, Waste, and Abuse investigations and overpayments tracking (due monthly by the 10th business day after month-end), Financial statements including Balance Sheets and Statements of Revenue and Expenses (due annually by March 31 of the following year), and Medical Loss Ratio Reports (due by December 31 of the following contract year). Clinical and quality-related submissions encompass EPSDT Plans, Prior Authorization Reports, Care Management Program Descriptions, and Quality Assessment and Performance Improvement Program documentation. Certain reports are designated with templates (marked "Y" in template column) to ensure standardized submission formats. Select reports including the Policy and Procedures Manual, Medication Coverage Policies, Provider Directory, and Community Reinvestment Plans are posted online for public access. Financial and actuarial reports, including the Independent Audit Report and IBNR Certification, must be submitted by designated deadlines to support state oversight of contractor solvency and medical expense management.

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Reporting Requirements

Reporting Requirements Exhibit
ILLUSTRATIVE EXAMPLE; SUBJECT TO CHANGE. Updated January 2026
The table below outlines the reporting requirements included in the Specialty Managed Care Plan.
Unless otherwise indicated, "days" refers to calendar days. All reports are required upon request by NVHA in addition to the frequencies provided below.
Reporting requirements will be adjusted to accommodate the abbreviated first year of the contract term. The initial contract year will run from July 1, 2027, through December 31, 2027. Each subsequent year will follow a full calendar year, beginning January 1 and ending December 31.
If a report extension is needed, send a detailed email request with the reason for the extension to mcreports@nvha.nv.gov. MCQA will respond within 2 business days of receipt of the request.
Order in ContractReport No.Report TitleContract ReferenceTemplateInstructionsFrequencyDue Date(s)Related Federal LawRelated State AuthorityPosted Online?
1N/ACertificate of Authority2.2.2.NNOnceAt signing of contractSSA 1903(m)(1), 42 CFR 438.116(b)N/ANo
2N/AEvidence of Required Insurance Coverages2.3.1.NNOnceBefore contract executionN/AN/ANo
3N/AImplementation Plan2.6.2.NNBiweeklyWithin 30 days of selection for contract negotiations, and every 2 weeks thereafter until Contract go-liveN/AN/ANo
4N/APublic-Facing Materials2.16.1, 9.9.13.NNOn occurrencePrior to release of public materialsN/AN/ANo
5N/AData Quality and Governance Documents, including Data Dictionaries and Interface Control Documents2.17.13.D.NNQuarterly30 days after quarter-endN/AN/ANo
6N/AData Quality Report2.17.13.F.NNMonthly15th of the following monthN/AN/ANo
7N/AKey Personnel Organizational Chart3.1.1.A.NNOn occurrenceWithin 7 days of a significant change in personnelN/AN/ANo
8N/ANotification of Key Personnel Vacancies3.1.4.NNOn occurrenceWithin 7 days of vacancyN/AN/ANo
9N/ASubcontractor Agreement and Checklist3.2.3.YYOn occurrencePrior to subcontract executionSSA 1124(a)(2)(A)
42 CFR 455.105N/ANo
10608Subcontractor Deliverables Tracker3.2.3.YYUpon requestWithin 35 days from date of requestSSA 1124(a)(2)(A)
42 CFR 455.105N/ANo
11N/ASubcontractor Monitoring Report3.2.4.NNUpon requestWithin 35 days from date of request42 CFR 455.105N/ANo
12N/ANotification of Subcontractor Termination3.2.9.NNOn occurrenceWithin 7 days of notification to subcontractorN/AN/ANo
13N/APolicy and Procedures Manual3.3.4.B.NNOngoing60 days before contract go-live and within 7 days of the execution of any updatesN/AN/AYes
14N/AMarketing Materials3.3.6.
5.6.2.NNUpon request60 days prior to the MAC meeting at which materials will be reviewed;
Within 7 days of request42 CFR 438.104
42 CFR 457.1224N/ANo
15408Enrollee Change of Status4.1.7.A.YYWeeklyEvery Monday42 CFR 438.608(a)(3)
42 CFR 457.1285N/ANo
16408AEnrollee Change of Status Attestation4.1.7.C.YYMonthly15th of the following month42 CFR 438.608(a)(3)
42 CFR 457.1285N/ANo
17N/ABirths Report4.4.1.NNWeeklyEvery FridayN/AN/ANo
18N/AGood Cause Disenrollment - Contractor4.6.3.NNOn occurrencewithin 14 days of the request for disenrollment42 CFR 438.56(b)

42 CFR 457.1201(m)

42 CFR 457.1212N/ANo
19437EPSDT Plan5.3.5.D.NNAnnually60 days prior to each contract yearSSA 1905(r)
42 CFR 441 Subpart BN/ANo
20N/AProof of Laboratory Service Provider CLIA Certification5.3.10.A.NNUpon requestAs indicated in the request42 CFR 493N/ANo
21N/AMedication Coverage Policies5.3.11.D.7.NNOngoing30 days before go-live and 30 days before any change42 CFR 438.10(i), 42 CFR 457.1207N/AYes
22422Pharmacy Lock-In Report5.3.11.I.3.YYQuarterly10 days after the quarter endN/AMSM Chapter 1200No
23N/ADrug Utilization Review (DUR) Program Report5.3.11.L.1.A.
5.3.11.M.2.NNAnnuallyJune 1SSA 1927(g)

42 CFR 438.3(s)

42 CFR 456 Subpart KN/ANo
24113Pharmacy Supplemental Rebate Agreement5.3.11.N.1.
5.3.12.F.6.YYAnnuallyJuly 1N/ANRS 422.4025(8)
NRS 422.4053No
25114Pharmacy Supplemental Rebate Detail5.3.11.N.1.
5.3.12.F.6.NYQuarterly90 days after quarter-endN/ANRS 422.4053
NRS 422.4056(1)(b)No
26N/APharmacy Benefit Manager (PBM) Report5.3.12.B.NYAnnuallyBy December 1 of each contract yearN/AN/ANo
27N/APharmacy Benefit Manager (PBM) Administrative Fee Formula5.3.12.DNNAnnually90 days before the start of each contract yearN/AN/ANo
28115Pharmacy Audit of Internal Controls - SOC-15.3.11.O.
5.3.12.F.1.NNAnnuallyJune 15th of every yearN/ANRS 422.4056No
29N/APharmacy Rebate Claim Errors Data5.3.12.B.

5.3.12.D.

5.3.12.F.6.NNN/AN/AN/AN/ANo
30N/APharmacy Rebate Providers Data5.3.12.B.

5.3.12.D.

5.3.12.F.6.NNN/AN/AN/AN/ANo
31N/APharmacy Rebate Medical Data5.3.12.B.

5.3.12.D.

5.3.12.F.6.YYN/AN/AN/AN/ANo
32N/AMental Health Parity and Addiction Equity Act (MHPAEA) Compliance Analysis5.5.6.
5.11.4.C.YYAnnually90 days before the start of each contract year42 CFR 438 Subpart KNRS 687.B.404No
33N/AValue Added Benefit Services Fact Sheet5.6.1.NNUpon requestWithin 7 days of request;
60 days prior to the MAC meeting at which materials will be reviewedN/AN/AYes
34N/AValue added Benefit Services Usage5.6.1.NNUpon requestWithin 7 days of requestN/AN/ANo
35808Enrollee Gifts and Incentives Attestation5.6.3.NNOn occurrenceJune 15th of each year for the next contract year;
Within 7 business days of changeN/AN/ANo
36N/ANotification of Nursing Facility Stay >180 days5.7.1.J.1.NNOn occurrenceBy the 175th day of an NF stayN/AMSM 3603.4DNo
37N/ANotification of Swing Bed Stay >45 days5.7.2.NNOn occurrenceBy the 40th day of a swing bed stayN/AMSM 3603.4ENo
38N/APrior Authorization Report5.8.2.N.YNAnnuallyBy March 31st of the following year42 CFR 438.210(f)N/AYes
39N/ANotification of transfer to FFS or a Standard MCO during a hospitalization5.10.5.NNOn occurrenceAs soon as the transition is knownN/AN/ANo
40440UM Program Description and Work Plan5.11.2.NNAnnuallyBy March 31st of each contract yearN/AN/AYes
41430Care Management Program Description6.3.1.NNOn occurrenceWithin 90 days of contract execution and by March 31 of each contract year thereafter42 CFR 438(b)N/ANo
42N/AProcesses and Protocols to support and monitor Targeted Case Management (TCM)6.3.2.I.NYOn occurrenceTBD42 CFR 438(b)N/ANo
43N/ADeclined CME-Provided TCM Report6.6.4.YYMonthlyTBDN/AN/ANo
44N/ACare Management Program Status Report6.12.1.YYTBDTBDN/AN/ANo
45N/ANon-Renewal of Provider Contracts7.6.11NNOn occurrenceWithin 5 business daysN/ANRS 687.B.692No
46N/AStandard Participating Provider Agreement7.8.2.NNOn occurrenceAs part of Readiness Review and upon request within 5 business daysN/AN/ANo
47N/ANotification of Unexpected Change in Provider Network7.9.5.NNOn occurrenceWithin 1 business day of changeN/AN/ANo
48N/ANotification of Substantial Change in Provider Network7.9.6.NNOn occurrenceWithin 1 business day of becoming aware of change and no later than 5 business days of known changeN/AN/ANo
49302Provider Termination7.9.8.A.YYWeeklyFridaysN/AN/ANo
50303Active Provider List7.9.8.C.YYMonthly10 days after month end42 CFR 438.206
42 CFR 438.608(b)N/ANo
51304Comparison List7.9.8.C.NNOn occurrenceN/A42 CFR 438.206
42 CFR 438.608(b)N/ANo
52402Network Adequacy7.10.2.G.

7.10.4.B.

7.10.5.A.

7.10.6.B.

7.10.6.C. Y Y Quarterly 30 days before go-live and within 30 days after quarter-end 42 CFR 438.68

42 CFR 438.207

42 CFR 457.1230N/ANo
53427Single Case Agreement7.13.2.YYMonthlyBy the 10th of the following monthN/AN/ANo
54N/AAccess Improvement7.14.2.A.NNAnnuallyBy March 31st of each yearN/AN/AYes
55802Provider Call Center Performance Standard Attestation7.15.2.C.YYMonthlyBy the 10th of the following monthN/AN/ANo
56N/ACalendar of Provider Trainings7.17.2.NNOngoing30 days before go-live and within 7 days of any updatesN/AN/AYes
57501Appeals and Grievances7.22.5.
YYQuarterly
Annually30 days after quarter-end;
30 days after year-end42 CFR 438.416, 457.1260(h)NRS 422.306No
58414Clean Claims8.1.6.YYMonthly15th of the following month42 CFR 447.45(d)
42 CFR 447.46NRS 695C.185No
59N/ANotification of Changes to Claims Processing Software System8.1.11.NNOn occurrenceNo later than 30 days prior to changeN/AN/ANo
60210Third Party Liability8.2.4.YYMonthly30 days after month-end42 CFR 433 Subpart D, 42 CFR 447.20N/ANo
61213TPL Subrogation8.2.11.A.yyMonthly30 days after month-end42 CFR 433 Subpart D, 42 CFR 447.20N/ANo
62311Provider Preventable Conditions8.3.2.YYMonthlyBy the 10th business day after each month-end42 CFR 438.3(g)
42 CFR 447.26N/ANo
63N/APhysician Incentive Plans8.6.NNUpon requestWithin 7 days of requestSSA 1876

42 CFR 422.210

42 CFR 438.3(i) 42 CFR 438.10(f)(3)

N/ANo
64N/AAnnual Payment Analysis8.11.4.NNAnnuallyBy March 31st of each contract year42 CFR 438.207(b)(3)N/AYes
65801Enrollee Services Department Performance Standards Attestation9.8.5.B.YYMonthlyBy the 10th of the following monthN/AN/ANo
66N/AEnrollee Handbook9.10.1.NNAnnuallyPrior to the Contract start date and 90 days prior to the start of each contract year42 CFR 438.10(c)(4)(ii)

42 CFR 438.10(g)(1)

42 CFR 457.1207

45 CFR 147.200(a)N/AYes
67N/AEnrollee Newsletters9.11.NNTwice AnnuallyBy June 30th and December 31st of each contract yearN/AN/AYes
68N/AProvider Directory9.13.NNOngoing30 days prior to go-live, quarterly for paper directories and on the Contractor's website within 30 calendar days of any change42 CFR 438.10(h)(4)
42 CFR 457.1207N/AYes
69N/ASpecialty Managed Care Plan Monitoring Requirements10.1.2.NYTBDTBD42 CFR 438N/ANo
70N/AQuality Assessment and Performance Improvement (QAPI) Program10.2.2.C
10.3.NYAnnually and OngoingWithin 30 days of request42 CFR 438.330

42 CFR 438.109(c)(3)

42 CFR 438.340

42.CFR 441.730(a)

441.302(h)N/AYes
71N/APerformance Improvement Project (PIP) Report10.3.4.D.NNAnnuallyBy June 30 of each contract year42 CFR 438.330N/ANo
72702Critical Incident Report10.10.2.YYOn occurrenceWithin 1 business day of discoveryN/AN/ANo
73423Population Health Annual Strategy10.12.1.
10.12.2.NNAnnuallyWithin 90 days of contract execution and by January 31 of each contract year thereafterN/AN/ANo
74404Cultural Competency Plan (CCP) Report10.13.2.C.
10.13.5.NNAnnuallyBy June 30th of each contract year42 CFR 438.206(c)(2)
42 CFR 457.1230(a)NRS 422.2734No
75315Compliance Review Tool11.2.1.
11.2.2.YYAnnuallyBy June 30th of each contract year42 CFR 438.608
42 CFR 457.1285N/ANo
76316Attachment A Goals and Objectives11.2.1.
11.2.2.YYAnnuallyBy June 30th of each contract year42 CFR 438.608
42 CFR 457.1285N/ANo
77306Embezzlement and Theft Report11.2.5.YYOn occurrence5 days after identification42 CFR 438.608
42 CFR 457.1285N/ANo
78307FWA Provider Referral Report11.5.3.YYOn occurrenceCAF Referrals: Within 10 business days after determination;
Non-CAF Referrals: Within 10 business days after opening an investigation42 CFR 438.608(a)(7)
42 CFR 457.1285N/ANo
79317Credible Allegation of Fraud11.5.3.YYOn occurrenceWithin 10 days of discovery42 CFR 438.608(a)(7)
42 CFR 457.1285N/ANo
80318Overpayments Recovered11.5.3.

11.10.1.

11.10.4

8.3.2. Y Y Annually By March 31 of the following contract year 42 CFR 438.608(d)

42 CFR 457.1285

42 CFR 447.26N/ANo
81308FWA Recipient Referral Report11.5.3.YYOn occurrenceCAF Referrals: Within 10 business days after determination;
Non-CAF Referrals: Within 10 business days after opening an investigation42 CFR 438.608(a)(7)
42 CFR 457.1285N/ANo
82309Provider Investigations List11.10.1.YYMonthlyBy the 10th business day after each month-end42 CFR 438.608,
42 CFR 457.1285N/ANo
83310Recipient Investigations List11.10.1.YYMonthlyBy the 10th business day after each month-end42 CFR 438.608,
42 CFR 457.1285N/ANo
84312Fraud, Waste, Abuse (FWA) Overpayments Report11.10.2.
11.10.3.YYMonthlyBy the 10th business day after each month-end42 CFR 438.608
42 CFR 457.1285N/ANo
85313Overpayments Related to Administrative Errors Report11.10.2.
11.10.3.YYMonthlyBy the 10th business day after each month-end42 CFR 438.608
N/ANo
86305Contractor Disclosures11.13.1.

11.13.2.

11.13.3.

15.2.1. Y Y On occurrence TBD 42 CFR 438.608(c)(2)

42 CFR 457.1285

42 CFR 455.100-104(b) SSA 1903(m)(2)(A)(viii) SSA 1124(a)(2)(A)

SSA 1903(m)(4)(A)-(B)N/ANo
87109Independent Audit Report (CPA)12.3.2.NYAnnuallyBy April 30th of each contract year42 CFR 438.3(m)
42 CFR 457.1285N/ANo
88105Balance Sheet - Assets, Liabilities, and Equities12.3.3.YYAnnuallyBy March 31st of the following year42 CFR 438.3(m), 42 CFR 457.1285N/ANo
89106Statement of Revenue, Expenses and Equity12.3.3.YYAnnually90 days after each calendar year-end42 CFR 438.3(m), 42 CFR 457.1285N/ANo
90N/AIBNR Certification12.4.1.NNAnnuallyBy June 30th of each contract yearN/AN/ANo
91108Medical Loss Ratio (MLR) Report12.5.1.
12.5.4.YYAnnuallyBy December 31st of the following contract year42 CFR 438.8,
42 CFR 457.1203(f)N/ANo
92N/ACost Containment and Cost Avoidance Initiatives Report12.6.1.NNOn occurrence60 days before contract go-live and within 7 days of the execution of any updatesN/AN/ANo
93111Community Reinvestment Plan12.7.4.NNAnnuallyBy March 1st of each contract yearN/AN/AYes
94112Community Reinvestment Expenditure12.7.4.YYAnnuallyBy March 1st of each contract yearN/AN/AYes
95N/AService-Specific Encounter Data13.3.8.
13.3.9.NNOn occurrence90 days from receipt of encounter from a provider42 CFR 438.604(a)(1)

42 CFR 438.606

42 CFR 438.818N/ANo
96N/AEncounter Response File
(aka Encounter Reporting Form (ERF))13.3.13.H.NNOn occurrenceWithin 60 days of receipt of the rejected encounter fileN/AN/ANo
97314Certification of Data, Documentation, and Information13.4.1.YYMonthlyBy the 10th business day after each month-end42 CFR 438.604

42 CFR 438.606

42 CFR 457.1201

42 CFR 457.1285N/ANo
98424IMD 15-Day Report14.2.7.D.1.YYMonthly15th of the following monthSSA 1905(a)(30)(B)N/ANo
99204Maternity Kick Payment - SOBRA Request14.3.4.YYOn occurrenceWithin 180 days of a qualifying delivery42 CFR 438.6(b)(1)N/ANo
100206Stop Loss Payment Request14.5.2.YYOn occurrenceWithin 90 days from the date of payment exceeding $500,000, with an additional 45 days allowed for claims from out-of-state providers42 CFR 438.6(b)(1)N/ANo
101205Disputed/Retroactive Capitation Request14.6.1.YYMonthlyBetween 45-225 days after the end of the month the payment was supposed to coverN/AMSM 3603.25.BNo
102207Excess Capitation Report14.7.1.A.
14.7.1.B.YYQuarterly15 days after quarter-end42 CFR 438.608(c)(3)N/ANo
103N/ACorrective Action Plans (CAPs)16.2.3.NNOn occurrenceWithin 21 days of request from stateN/AN/ANo
104N/ATermination Transition Plan16.5.3.B.1.NNOn occurrence90 days prior to the contract termination dateN/AN/ANo

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