1. Regulatory Affairs & Compliance Department
I. An anonymous telephone access for internal CalOptima staff, CalOptima delegates, members of the community, or CalOptima members to report non-compliance issues to RAC.
J. Professional responsible to serve as the focal point for compliance activities, reports directly to the CEO about activities of the compliance program. Silver Ho currently holds this position.
A. A narrative of steps taken to identify actions that will be implemented to correct issues of non-compliance. RAC may issue a CAP as part of the notice of non-compliance.
G. Specific guidelines for employees to follow and provides a process for proper decision-making. CalOptima employees are required to attest that they have receive, read, and understand the standards annually.
C. Audits administered by our federal and state regulators to ensure CalOptima's programs are meeting the regulatory and contractual requirements by our federal and state regulators. RAC is responsible for ensuring audit readiness, leading and facilitating the audits and ensuring deficiencies are remediated.
E. A group responsible for managing the process that enables business owners to develop, review, revise, or retire policies and procedures in response to standards, regulations and contractual obligations related to CalOptima's programs.
D. A department within the Department of Health & Human Services that is responsible for enforcing the rules and regulations under the Medicare and Medicaid laws, including what should be included in an effective Compliance program.
B. The fundamental requirements for having an effective Compliance program. The elements are reviewed in the 2016-2017 Compliance Handbook on the InfoNet.
H. Department within CalOptima that is comprised of two teams. The Medi-Cal team is responsible for the management of the Medi-Cal contract, and the Medicare team is responsible for the OneCare, PACE, and OneCare Connect contracts.
F. Form used to report issues of noncompliance as they relate to a violation in policy, regulation, or contractual requirements. The form can be found on the InfoNet or CalOptima website.
2. Request for Compliance Action (RCA)form
I. An anonymous telephone access for internal CalOptima staff, CalOptima delegates, members of the community, or CalOptima members to report non-compliance issues to RAC.
J. Professional responsible to serve as the focal point for compliance activities, reports directly to the CEO about activities of the compliance program. Silver Ho currently holds this position.
A. A narrative of steps taken to identify actions that will be implemented to correct issues of non-compliance. RAC may issue a CAP as part of the notice of non-compliance.
G. Specific guidelines for employees to follow and provides a process for proper decision-making. CalOptima employees are required to attest that they have receive, read, and understand the standards annually.
C. Audits administered by our federal and state regulators to ensure CalOptima's programs are meeting the regulatory and contractual requirements by our federal and state regulators. RAC is responsible for ensuring audit readiness, leading and facilitating the audits and ensuring deficiencies are remediated.
E. A group responsible for managing the process that enables business owners to develop, review, revise, or retire policies and procedures in response to standards, regulations and contractual obligations related to CalOptima's programs.
D. A department within the Department of Health & Human Services that is responsible for enforcing the rules and regulations under the Medicare and Medicaid laws, including what should be included in an effective Compliance program.
B. The fundamental requirements for having an effective Compliance program. The elements are reviewed in the 2016-2017 Compliance Handbook on the InfoNet.
H. Department within CalOptima that is comprised of two teams. The Medi-Cal team is responsible for the management of the Medi-Cal contract, and the Medicare team is responsible for the OneCare, PACE, and OneCare Connect contracts.
F. Form used to report issues of noncompliance as they relate to a violation in policy, regulation, or contractual requirements. The form can be found on the InfoNet or CalOptima website.
3. Corrective Action Plan (CAP)
I. An anonymous telephone access for internal CalOptima staff, CalOptima delegates, members of the community, or CalOptima members to report non-compliance issues to RAC.
J. Professional responsible to serve as the focal point for compliance activities, reports directly to the CEO about activities of the compliance program. Silver Ho currently holds this position.
A. A narrative of steps taken to identify actions that will be implemented to correct issues of non-compliance. RAC may issue a CAP as part of the notice of non-compliance.
G. Specific guidelines for employees to follow and provides a process for proper decision-making. CalOptima employees are required to attest that they have receive, read, and understand the standards annually.
C. Audits administered by our federal and state regulators to ensure CalOptima's programs are meeting the regulatory and contractual requirements by our federal and state regulators. RAC is responsible for ensuring audit readiness, leading and facilitating the audits and ensuring deficiencies are remediated.
E. A group responsible for managing the process that enables business owners to develop, review, revise, or retire policies and procedures in response to standards, regulations and contractual obligations related to CalOptima's programs.
D. A department within the Department of Health & Human Services that is responsible for enforcing the rules and regulations under the Medicare and Medicaid laws, including what should be included in an effective Compliance program.
B. The fundamental requirements for having an effective Compliance program. The elements are reviewed in the 2016-2017 Compliance Handbook on the InfoNet.
H. Department within CalOptima that is comprised of two teams. The Medi-Cal team is responsible for the management of the Medi-Cal contract, and the Medicare team is responsible for the OneCare, PACE, and OneCare Connect contracts.
F. Form used to report issues of noncompliance as they relate to a violation in policy, regulation, or contractual requirements. The form can be found on the InfoNet or CalOptima website.
4. Compliance and Ethics Hotline
I. An anonymous telephone access for internal CalOptima staff, CalOptima delegates, members of the community, or CalOptima members to report non-compliance issues to RAC.
J. Professional responsible to serve as the focal point for compliance activities, reports directly to the CEO about activities of the compliance program. Silver Ho currently holds this position.
A. A narrative of steps taken to identify actions that will be implemented to correct issues of non-compliance. RAC may issue a CAP as part of the notice of non-compliance.
G. Specific guidelines for employees to follow and provides a process for proper decision-making. CalOptima employees are required to attest that they have receive, read, and understand the standards annually.
C. Audits administered by our federal and state regulators to ensure CalOptima's programs are meeting the regulatory and contractual requirements by our federal and state regulators. RAC is responsible for ensuring audit readiness, leading and facilitating the audits and ensuring deficiencies are remediated.
E. A group responsible for managing the process that enables business owners to develop, review, revise, or retire policies and procedures in response to standards, regulations and contractual obligations related to CalOptima's programs.
D. A department within the Department of Health & Human Services that is responsible for enforcing the rules and regulations under the Medicare and Medicaid laws, including what should be included in an effective Compliance program.
B. The fundamental requirements for having an effective Compliance program. The elements are reviewed in the 2016-2017 Compliance Handbook on the InfoNet.
H. Department within CalOptima that is comprised of two teams. The Medi-Cal team is responsible for the management of the Medi-Cal contract, and the Medicare team is responsible for the OneCare, PACE, and OneCare Connect contracts.
F. Form used to report issues of noncompliance as they relate to a violation in policy, regulation, or contractual requirements. The form can be found on the InfoNet or CalOptima website.
5. Code of Conduct
I. An anonymous telephone access for internal CalOptima staff, CalOptima delegates, members of the community, or CalOptima members to report non-compliance issues to RAC.
J. Professional responsible to serve as the focal point for compliance activities, reports directly to the CEO about activities of the compliance program. Silver Ho currently holds this position.
A. A narrative of steps taken to identify actions that will be implemented to correct issues of non-compliance. RAC may issue a CAP as part of the notice of non-compliance.
G. Specific guidelines for employees to follow and provides a process for proper decision-making. CalOptima employees are required to attest that they have receive, read, and understand the standards annually.
C. Audits administered by our federal and state regulators to ensure CalOptima's programs are meeting the regulatory and contractual requirements by our federal and state regulators. RAC is responsible for ensuring audit readiness, leading and facilitating the audits and ensuring deficiencies are remediated.
E. A group responsible for managing the process that enables business owners to develop, review, revise, or retire policies and procedures in response to standards, regulations and contractual obligations related to CalOptima's programs.
D. A department within the Department of Health & Human Services that is responsible for enforcing the rules and regulations under the Medicare and Medicaid laws, including what should be included in an effective Compliance program.
B. The fundamental requirements for having an effective Compliance program. The elements are reviewed in the 2016-2017 Compliance Handbook on the InfoNet.
H. Department within CalOptima that is comprised of two teams. The Medi-Cal team is responsible for the management of the Medi-Cal contract, and the Medicare team is responsible for the OneCare, PACE, and OneCare Connect contracts.
F. Form used to report issues of noncompliance as they relate to a violation in policy, regulation, or contractual requirements. The form can be found on the InfoNet or CalOptima website.
6. Regulatory Audits
I. An anonymous telephone access for internal CalOptima staff, CalOptima delegates, members of the community, or CalOptima members to report non-compliance issues to RAC.
J. Professional responsible to serve as the focal point for compliance activities, reports directly to the CEO about activities of the compliance program. Silver Ho currently holds this position.
A. A narrative of steps taken to identify actions that will be implemented to correct issues of non-compliance. RAC may issue a CAP as part of the notice of non-compliance.
G. Specific guidelines for employees to follow and provides a process for proper decision-making. CalOptima employees are required to attest that they have receive, read, and understand the standards annually.
C. Audits administered by our federal and state regulators to ensure CalOptima's programs are meeting the regulatory and contractual requirements by our federal and state regulators. RAC is responsible for ensuring audit readiness, leading and facilitating the audits and ensuring deficiencies are remediated.
E. A group responsible for managing the process that enables business owners to develop, review, revise, or retire policies and procedures in response to standards, regulations and contractual obligations related to CalOptima's programs.
D. A department within the Department of Health & Human Services that is responsible for enforcing the rules and regulations under the Medicare and Medicaid laws, including what should be included in an effective Compliance program.
B. The fundamental requirements for having an effective Compliance program. The elements are reviewed in the 2016-2017 Compliance Handbook on the InfoNet.
H. Department within CalOptima that is comprised of two teams. The Medi-Cal team is responsible for the management of the Medi-Cal contract, and the Medicare team is responsible for the OneCare, PACE, and OneCare Connect contracts.
F. Form used to report issues of noncompliance as they relate to a violation in policy, regulation, or contractual requirements. The form can be found on the InfoNet or CalOptima website.
7. Policies & Procedures Team
I. An anonymous telephone access for internal CalOptima staff, CalOptima delegates, members of the community, or CalOptima members to report non-compliance issues to RAC.
J. Professional responsible to serve as the focal point for compliance activities, reports directly to the CEO about activities of the compliance program. Silver Ho currently holds this position.
A. A narrative of steps taken to identify actions that will be implemented to correct issues of non-compliance. RAC may issue a CAP as part of the notice of non-compliance.
G. Specific guidelines for employees to follow and provides a process for proper decision-making. CalOptima employees are required to attest that they have receive, read, and understand the standards annually.
C. Audits administered by our federal and state regulators to ensure CalOptima's programs are meeting the regulatory and contractual requirements by our federal and state regulators. RAC is responsible for ensuring audit readiness, leading and facilitating the audits and ensuring deficiencies are remediated.
E. A group responsible for managing the process that enables business owners to develop, review, revise, or retire policies and procedures in response to standards, regulations and contractual obligations related to CalOptima's programs.
D. A department within the Department of Health & Human Services that is responsible for enforcing the rules and regulations under the Medicare and Medicaid laws, including what should be included in an effective Compliance program.
B. The fundamental requirements for having an effective Compliance program. The elements are reviewed in the 2016-2017 Compliance Handbook on the InfoNet.
H. Department within CalOptima that is comprised of two teams. The Medi-Cal team is responsible for the management of the Medi-Cal contract, and the Medicare team is responsible for the OneCare, PACE, and OneCare Connect contracts.
F. Form used to report issues of noncompliance as they relate to a violation in policy, regulation, or contractual requirements. The form can be found on the InfoNet or CalOptima website.
8. Office of Inspector General (OIG)
I. An anonymous telephone access for internal CalOptima staff, CalOptima delegates, members of the community, or CalOptima members to report non-compliance issues to RAC.
J. Professional responsible to serve as the focal point for compliance activities, reports directly to the CEO about activities of the compliance program. Silver Ho currently holds this position.
A. A narrative of steps taken to identify actions that will be implemented to correct issues of non-compliance. RAC may issue a CAP as part of the notice of non-compliance.
G. Specific guidelines for employees to follow and provides a process for proper decision-making. CalOptima employees are required to attest that they have receive, read, and understand the standards annually.
C. Audits administered by our federal and state regulators to ensure CalOptima's programs are meeting the regulatory and contractual requirements by our federal and state regulators. RAC is responsible for ensuring audit readiness, leading and facilitating the audits and ensuring deficiencies are remediated.
E. A group responsible for managing the process that enables business owners to develop, review, revise, or retire policies and procedures in response to standards, regulations and contractual obligations related to CalOptima's programs.
D. A department within the Department of Health & Human Services that is responsible for enforcing the rules and regulations under the Medicare and Medicaid laws, including what should be included in an effective Compliance program.
B. The fundamental requirements for having an effective Compliance program. The elements are reviewed in the 2016-2017 Compliance Handbook on the InfoNet.
H. Department within CalOptima that is comprised of two teams. The Medi-Cal team is responsible for the management of the Medi-Cal contract, and the Medicare team is responsible for the OneCare, PACE, and OneCare Connect contracts.
F. Form used to report issues of noncompliance as they relate to a violation in policy, regulation, or contractual requirements. The form can be found on the InfoNet or CalOptima website.
9. Seven Elements of the Compliance Program
I. An anonymous telephone access for internal CalOptima staff, CalOptima delegates, members of the community, or CalOptima members to report non-compliance issues to RAC.
J. Professional responsible to serve as the focal point for compliance activities, reports directly to the CEO about activities of the compliance program. Silver Ho currently holds this position.
A. A narrative of steps taken to identify actions that will be implemented to correct issues of non-compliance. RAC may issue a CAP as part of the notice of non-compliance.
G. Specific guidelines for employees to follow and provides a process for proper decision-making. CalOptima employees are required to attest that they have receive, read, and understand the standards annually.
C. Audits administered by our federal and state regulators to ensure CalOptima's programs are meeting the regulatory and contractual requirements by our federal and state regulators. RAC is responsible for ensuring audit readiness, leading and facilitating the audits and ensuring deficiencies are remediated.
E. A group responsible for managing the process that enables business owners to develop, review, revise, or retire policies and procedures in response to standards, regulations and contractual obligations related to CalOptima's programs.
D. A department within the Department of Health & Human Services that is responsible for enforcing the rules and regulations under the Medicare and Medicaid laws, including what should be included in an effective Compliance program.
B. The fundamental requirements for having an effective Compliance program. The elements are reviewed in the 2016-2017 Compliance Handbook on the InfoNet.
H. Department within CalOptima that is comprised of two teams. The Medi-Cal team is responsible for the management of the Medi-Cal contract, and the Medicare team is responsible for the OneCare, PACE, and OneCare Connect contracts.
F. Form used to report issues of noncompliance as they relate to a violation in policy, regulation, or contractual requirements. The form can be found on the InfoNet or CalOptima website.
10. Compliance Officer
I. An anonymous telephone access for internal CalOptima staff, CalOptima delegates, members of the community, or CalOptima members to report non-compliance issues to RAC.
J. Professional responsible to serve as the focal point for compliance activities, reports directly to the CEO about activities of the compliance program. Silver Ho currently holds this position.
A. A narrative of steps taken to identify actions that will be implemented to correct issues of non-compliance. RAC may issue a CAP as part of the notice of non-compliance.
G. Specific guidelines for employees to follow and provides a process for proper decision-making. CalOptima employees are required to attest that they have receive, read, and understand the standards annually.
C. Audits administered by our federal and state regulators to ensure CalOptima's programs are meeting the regulatory and contractual requirements by our federal and state regulators. RAC is responsible for ensuring audit readiness, leading and facilitating the audits and ensuring deficiencies are remediated.
E. A group responsible for managing the process that enables business owners to develop, review, revise, or retire policies and procedures in response to standards, regulations and contractual obligations related to CalOptima's programs.
D. A department within the Department of Health & Human Services that is responsible for enforcing the rules and regulations under the Medicare and Medicaid laws, including what should be included in an effective Compliance program.
B. The fundamental requirements for having an effective Compliance program. The elements are reviewed in the 2016-2017 Compliance Handbook on the InfoNet.
H. Department within CalOptima that is comprised of two teams. The Medi-Cal team is responsible for the management of the Medi-Cal contract, and the Medicare team is responsible for the OneCare, PACE, and OneCare Connect contracts.
F. Form used to report issues of noncompliance as they relate to a violation in policy, regulation, or contractual requirements. The form can be found on the InfoNet or CalOptima website.
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