Orange County NC Website
Browse       Search
12 | Page <br /> <br />See Section 12 of the Standard Terms and Conditions (Reporting Requirements ), for <br />supplemental details and instructions. Failure to submit any of the required reports in the <br />CMS-designated template by the time and manner determined by CMS could result in <br />corrective action, pursuant to Section 25 of this document (Corrective Action and <br />Termination ). <br /> <br />15. Transformed Medicaid Statistical Information System (T-MSIS) Requirements. <br />The universe of Medicaid and CHIP claims and encounter data for each state is submitted <br />monthly by the state Medicaid agency (or its contractor) to CMS’s T-MSIS in accordance <br />with CMS guidance . Unless otherwise stipulated, the InCK evaluation contractor will access <br />data via T -MSIS for the Recipient’s InCK-attributed population and comparison group. The <br />timely submission of complete and accurate Medicaid and CHIP claims and encounter data <br />via T -MSIS or directly to CMS, if requested, is a prerequisite for continued funding. <br />A. The Recipient must meet or exceed targets for all Outcome Based Assessment Criteria. <br />Non-compliance status occurs when one or more OBA criteria remain unmet. If the <br />Recipient falls into non-compliance status, it must alert the PO within five (5) business <br />Days of the date the Recipient became aware of its non-compliant status. CMS will <br />periodically audit T-MSIS records to ensure the Recipient meets compliance. If the <br />Recipient does not comply with T-MSIS data quality expectations, the Recipient must <br />demonstrate they have delivered a compliance plan to CMS within 30 days, as required <br />for continued enhanced system maintenance and operations funding. <br />B. When T-MSIS data quality expectations remain unmet after 6 months from creation of <br />the compliance pla n, the Recipient will be asked to submit claims and encounter data <br />directly to CMS through the InCK Reusable Framework, within 90 Days of being <br />notified by CMS. <br /> <br />16. M ilestones. The Recipient shall achieve the Operational and Performance Measure <br />Milestones described in NOFO Section F 5.1.1., as well as any additional milestones <br />identified by the Recipient and approved by CMS in the Recipient’s Operational Plan . The <br />Recipient shall protect the confidentiality of all model-related information that identifies <br />individuals, in accordance with all applicable federal laws, regulations , and polic ies . CMS <br />reserves the right to revise Operational and Performance Milestones based upon agency <br />needs , an individual Recipient’s Implementation P lan , and unforeseen circumsta nces that <br />arise during the model pre-implementation and implementation periods . <br /> <br />CMS may require the Recipient to provide additional information regarding its milestone <br />progress at any time during the project period as follow -up to reports described in Section <br />12 of the Standard Terms and Conditions (Reporting Requirements ). Failure to achieve any <br />of the applicable milestones in accordance with the stated schedule could result in corrective <br />action pursuant to Section 25 of this document (Corrective Action and Termination). <br /> <br />DocuSign Envelope ID: 7832B0E4-F34E-430E-A3C2-1A6A14F29307