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 2
- Issued by
- Kanawha County, West Virginia
About this file
This document is an exhibit detailing reporting requirements for Managed Care Organizations (MCOs) providing MHT and MHP program services under a state contract administered by BMS (Bureau of Managed Services). The exhibit establishes a comprehensive framework of recurring reporting obligations across multiple categories including quality reporting, provider reporting, financial reporting, federal reporting, and state-required reporting. Quality reporting requirements include quarterly MHT/MHP reporting due within 45 days of quarter-end, HEDIS data due by June 15th, QAPI annual evaluations due by June 15th, and PIP progress reports due within 120 days of quarter-end. Provider reporting obligations encompass monthly electronic provider directory submissions, annual network adequacy reports due by October 31st, quarterly network change reports, immediate hospital change notifications, and provider satisfaction surveys due by June 30th. Financial reporting includes annual financial statements due by June 1st and quarterly Insurance Commissioner reports submitted concurrently with Department of Insurance submissions. The contract term and renewal options are not specified in this exhibit.
MCOs must submit encounter data within 30 days of month-end and adult/child core quality measures by September 1st. Federal reporting requirements include EPSDT services reporting due 45 days after each quarter, hysterectomies and sterilizations attestation due by October 1st, and hospital paid claims reports due 45 days after each quarter. Additional state-required reporting encompasses business continuity and disaster recovery plans, information security and system quality assurance plans (all due within 10 business days of request), MCO annual reports due by April 1st, organization charts and marketing plans due by October 1st, and fraud/waste/abuse monitoring reports due by June 15th. Monthly reports required include third-party liability cases not pursued (15th of following month), IMD reports (15th and 30th of each month), claims aging reports (15th of following month), member status reports (15th of following month), and SUD utilization/finance reports (10th of following month). The document does not address pricing, set-asides, incumbents, funding sources, or contract award information.
View the file
Other files
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
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
File details come from the government source that posted it. Updated .