Exhibit C-Reporting Documents and Schedules for MCOs (1).pdf
PDF 119 KB Posted
- Attached to
- MEDICAID MANAGED CARE RATE SETTING/PROGRAM ADMIN
- Solicitation number
- CRFP 0511 BMS2700000001 1
- Issued by
- Kanawha County, West Virginia
About this file
This document is an exhibit detailing reporting requirements for Managed Care Organizations (MCOs) serving the MHT and MHP programs under a contract with BMS (Benefits Management Services). The MCOs are required to submit comprehensive reports across multiple categories including quality reporting, provider reporting, financial reporting, federal reporting, and state-required reporting. Quality reporting submissions include quarterly MHT/MHP reports due within forty-five calendar days of quarter end, HEDIS data due by June 15th, QAPI annual evaluations due by June 15th, and CAHPS enrollee survey analyses due by August 15th. Provider reporting requirements encompass monthly electronic provider directory submissions, annual network adequacy reviews due by October 31st, and various specialized reports including provider satisfaction surveys, suspension and adverse enrollment action reports, and provider-preventable conditions reports. Financial reporting obligations include annual financial statements due by June 1st, quarterly Insurance Commissioner reports, and MLR calculations due eight months after fiscal year end. The contract also requires federal compliance reporting on topics including EPSDT services, hysterectomies and sterilizations, and various attestations related to communicable diseases, with submission deadlines ranging from monthly to annually depending on the report type.
Additional state-required reporting mandates MCOs to submit business continuity and disaster recovery plans within ten business days of written request, annual organizational charts and marketing plans by October 1st, and various compliance-related documents including FWA internal compliance plans, parity in mental health and substance use disorder benefits compliance plans, and data accuracy and completeness plans. MCOs must provide monthly mental health services access reports detailing approved and denied services with average wait times, SUD utilization and finance reports by the 10th of the following month, and PRTF and children's residential services demographic reports by the 15th of the following month. Claims aging reports and monthly member status reports are also required by the 15th of the following month. The exhibit establishes a structured reporting framework with specific due dates designed to ensure MCO compliance, quality assurance, financial accountability, and program integrity across all operational and clinical aspects of the managed care contracts.
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Text version
EXHIBIT C: SUMMARY OF MHT AND MHP MCO REPORTING
REQUIREMENTS
All MCO reports submitted under this Contract must reflect MHT and MHP program-related data only unless otherwise requested by BMS.
Reporting Requirement Timeframe
Monthly Quarterly Annually Other Due Date
Quarterly Reporting
MHT/MHP Quarterly Reporting
Template
X
Within forty-five (45) calendar days of end of quarter (by the 15th day of the second month following the end of the reporting period)
Quality Reporting
Written Description of PIPs and Results X On or before July 15th
PIP Progress Report X
Within one-hundred twenty
(120) days of end of quarter
HEDIS
X
On or before June 15th
(audited)
QAPI Annual Evaluation Report
Including Status and Results X On or before June 15th
QAPI CAP X
Within thirty (30) days of identification of systemic problem
CAHPS Enrollee Survey Analysis, Action Plan and Evaluation X
Annual analysis is due on or before August 15th.
Accreditation Review Report X Upon completion or change in status
Encounter Data X Within thirty (30) days of end of month
Adult and Child Core Quality Measures X On or before September 1st
Provider Reporting
Provider Network Data X
Electronic provider directories to be submitted to
BMS’ Enrollment Broker monthly
Reporting Requirement Timeframe
Monthly Quarterly Annually Other Due Date
Provider Network Adequacy X X X
• Full network - Annually by October 31st
• All Network changes by specialty – Quarterly, 45 days after end of the quarter
• PCP changes –fourteen
(14) days after the change
• Hospital changes – immediately
• Material changes of other providers affecting service delivery- fourteen (14) days after the change
Provider Satisfaction Survey X By June 30th of each contract year.
Suspension and Adverse Enrollment
Action Report (formerly the CAF
Suspension and PDC reports)
X By the 15th of the following month
Financial Reporting
Annual Financial Statements X On or before June 1st
Offices of the Insurance Commissioner
Reports – Quarterly and Annually X X
Concurrent with DOI submission
Third Party Liability Cases Not Pursued X
The 15th of each month (to include all events from the prior month)
Provider-Preventable Conditions X July 15th
PCP Payment Methodology X Upon request from BMS
Directed Payments Report X
45 days after each quarter, providing payment has been received from BMS.
MHT and MHP MLR Reports and
Calculations X
Eight (8) months after the end of the SFY
Recovery of All Overpayments Report
(included in the FWA Report) X By the 15th of the month
IMD Report X Submit on the 15th and 30th of each month
Hospital Paid Claims Report X 45 days after each quarter to
OAMR
Federal Reporting
Hysterectomies and Sterilizations X Submit attestation by
October 1st
EPSDT Services and Reporting X 45 days after each quarter
Other State Required Reporting
Business Continuity Plan X Within ten (10) business days of BMS written request
Disaster Recovery Plan X Within ten (10) business days of BMS written request
Information Security Plan X Within ten (10) business days of BMS written request
System Quality Assurance Plan X Within ten (10) business days of BMS written request
Sexually Transmitted Diseases X Submit attestation by
October 1st
Tuberculosis X Submit attestation by
October 1st
Communicable Diseases X Submit attestation by
October 1st
MCO Annual Report X On or before April 1st
Organization Chart X On or before October 1st
Marketing Plan X On or before October 1st
Subcontractor Monitoring Plan X Within ten (10) business days of BMS written request
Data Accuracy and Completeness Plan X On or before October 1st
Activities Summary, Analyses, and
Results of Provider/Beneficiary
Utilization to Detect FWA
X On or before June 15th
HB 4217 Report X On March 30th of each year
Alternative Payment Model Report X August 15th
FWA Reporting X By the 15th of the following month
Disclosure of Ownership Reporting X X
• Annually, on or before
July 1st;
• Upon request, within thirty-five (35) calendar days; or
• Upon change in ownership, within thirty-five (35) calendar days
FWA Internal Compliance Plan X On or before October 1st
Parity in Mental Health and Substance
Use Disorder (SUD) Benefits
Compliance Plan
X On or before June 30th
Claims Aging Report X By the 15th of the following month
Mental Health Services Access Report X
As defined in Section 10.1, the MCO shall provide a mental health service utilization report that provides data on the mental health services approved and denied by the MCO, as well as the average wait time between referral to mental health appointment.
SUD Utilization/Finance Report X By the 10th of the following month
PRTF and Children’s Residential
Services and Demographic Report X
By the 15th day of the following month
Monthly Member Status Report X By the 15th day of the following month
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