Often the reviewer is under a deadline. When a new contract is being processed the plan wants the material approved so that it can be utilized immediately when the contract is approved. It is significant to note that the above effort is with respect to each plan individually. The challenge is how to permit plans their individuality and accommodate standardization and consistency across the board. You would also be interested to know that the review process is inconsistent among the regions.
Some regions are more strict than others.
Some of this is dictated by the nature of the plans in the region. Some plans in the Atlanta region were so abusive we had to be more strict. Some is due to regional leadership attitudes or just different levels of expertise in personnel. Some is due to the particular central office personnel relating to their assigned region. I will generalize that implementation of national guidelines could be standardized and made more consistent.