Common use of EXPANSION PHASE PERFORMANCE METRICS Clause in Contracts

EXPANSION PHASE PERFORMANCE METRICS. 7.2.1. Once the Contractor has entered the Expansion Phase, the Department shall begin enrolling additional Members into the Contractor’s plan at the Department’s discretion. The Department may enroll any eligible Client within the Contractor’s Region into the Contractor’s plan, and the Contractor shall accept all new Members enrolled by the Department. 7.2.2. The Department will use three performance targets to measure the Contractor during the first year of the Expansion Phase. The three performance targets will be Emergency Room Visits per 1,000 Full Time Enrollees (FTEs), Hospital Readmissions per 1,000 FTEs, and Outpatient Service Utilization of MRIs and CT Scans per 1,000 FTEs. The Department will use four performance targets to measure the Contractor during the second year of the Expansion Phase. The performance targets will be the three existing targets and Well Child Visits (EPSDT Screens) as defined by CMS 416 standards. After the second year of the Expansion Phase, the Department may adjust performance targets to align with goals of the program. The performance target measures and goals will be the same as those described in Section 11.2, Pay for Performance Program. The baseline for all performance targets listed in the table at Section 11.2.4., Key Performance Indicator Payment Table, shall be calculated based on the most recently available twelve (12) month period by the Department utilizing methodology that is fully disclosed to the Contractor in advance, with opportunity for consideration of comments submitted by the Contractor prior to finalization of the methodology by the Department. 7.2.3. The Department shall not include Members who are eligible for both Medicare and Medicaid in the incentive performance payment calculations, because the Department does not have completed Medicare data to calculate the measures. The incentive payments for Medicare and Medicaid clients not eligible for the Medicare-Medicaid Program (MMP) shall be paid out based on the Contractor’s performance for all other FTEs. MMP clients are not included in the performance calculations or the incentive payment calculations, because the demonstration has its own incentive program as part of the demonstration. 7.2.4. During the second year of the Expansion phase and every subsequent year, the Department shall consult with the Contractor to determine the measurement areas and performance targets for the Contractor based on the Department’s priorities, goals, objectives and initiatives. The Department shall amend this Contract to establish the new measurement areas and performance targets.

EXPANSION PHASE PERFORMANCE METRICS. 7.2.1. Once the Contractor has entered the Expansion Phase, the Department shall begin enrolling additional Members members into the Contractor’s plan at the Department’s discretion. The Department may enroll any eligible Client within the Contractor’s Region into the Contractor’s plan, and the Contractor shall accept all new Members members enrolled by the Department. 7.2.2. The Department will use three performance targets to measure the Contractor during the first year of the Expansion Phase. The three performance targets will be Emergency Room Visits per 1,000 Full Time Enrollees (FTEs), Hospital Readmissions per 1,000 FTEs, and Outpatient Service Utilization of MRIs and CT Scans per 1,000 FTEs. The Department will use four performance targets to measure the Contractor during the second year of the Expansion Phase. The performance targets will be the three existing targets and Well Child Visits (EPSDT Screens) as defined by CMS 416 standards. After the second year of the Expansion Phase, the Department may adjust performance targets to align with goals of the program. The performance target measures and goals will be the same as those described in the Section 11.2, Pay for Performance Program. The baseline for all performance targets listed in the table at Section 11.2.4., Key Performance Indicator Payment Table, shall be calculated based on the most recently available twelve (12) month period by the Department utilizing methodology that is fully disclosed to the Contractor in advance, with opportunity for consideration of comments submitted by the Contractor prior to finalization of the methodology by the Department. 7.2.3. The Department shall not include Members who are eligible for both Medicare and Medicaid in the incentive performance payment calculations, because the Department does not have completed complete Medicare data to calculate the measures. The incentive payments for Medicare and Medicaid clients not eligible for the Medicare-Medicaid Program (MMP) shall be paid out based on the Contractor’s performance for all other FTEs. MMP clients are not included in the performance calculations or the incentive payment calculations, because the demonstration has its own incentive program as part of the demonstration. 7.2.4. During the second year of the Expansion phase and every subsequent year, the Department shall consult with the Contractor to determine the measurement areas and performance targets for the Contractor based on the Department’s priorities, goals, objectives and initiatives. The Department shall amend this Contract to establish the new measurement areas and performance targets.

EXPANSION PHASE PERFORMANCE METRICS. 7.2.1. Once the Contractor has entered the Expansion Phase, the Department shall begin enrolling additional Members members into the Contractor’s plan at the Department’s discretion. The Department may enroll any eligible Client within the Contractor’s Region into the Contractor’s plan, and the Contractor shall accept all new Members members enrolled by the Department. 7.2.2. The Department will use three performance targets to measure the Contractor during the first year of the Expansion Phase. The three performance targets will be Emergency Room Visits per 1,000 Full Time Enrollees (FTEs), Hospital Readmissions per 1,000 FTEs, and Outpatient Service Utilization of MRIs and CT Scans per 1,000 FTEs. The Department will use four performance targets to measure the Contractor during the second year of the Expansion Phase. The performance targets will be the three existing targets and Well Child Visits (EPSDT Screens) as defined by CMS 416 standards. After the second year of the Expansion Phase, the Department may adjust performance targets to align with goals of the program. The performance target measures and goals will be the same as those described in the Section 11.29.2, Pay for Performance ProgramProgram for Members. The baseline for all performance targets listed in the table at Section 11.2.49.2.4., Key Performance Indicator Payment Table, Table shall be calculated based on the most recently available twelve (12) month period by the Department utilizing methodology that is fully disclosed to the Contractor in advance, with opportunity for consideration of comments submitted by the Contractor prior to finalization of the methodology by the Department. 7.2.3. The Department shall not include Members who are eligible for both Medicare and Medicaid in the incentive performance payment calculations, because the Department does not have completed Medicare calculations until sufficient data to calculate the measuresand analytic capabilities are available. The incentive payments for Medicare and Medicaid clients not eligible for the Medicare-Medicaid Program (MMP) this population shall be paid out based on the Contractor’s performance for all other FTEs. MMP clients are not included in the performance calculations or the incentive payment calculations, because the demonstration has its own incentive program as part of the demonstration. 7.2.4. During the second year of the Expansion phase and every subsequent year, the Department shall consult with the Contractor to determine the measurement areas and performance targets for the Contractor based on the Department’s priorities, goals, objectives and initiatives. The Department shall amend this Contract to establish the new measurement areas and performance targetstargets no later than March 1st. 7.2.5. The Department may initiate a shared savings program, subject to CMS approval of the shared savings methodology. Upon approval by CMS, the Department shall work with the Contractor to amend this Contract as necessary.

EXPANSION PHASE PERFORMANCE METRICS. 7.2.1. Once the Contractor has entered the Expansion Phase, the Department shall begin enrolling additional Members members into the Contractor’s plan at the Department’s discretion. The Department may enroll any eligible Client within the Contractor’s Region into the Contractor’s plan, and the Contractor shall accept all new Members members enrolled by the Department. 7.2.2. The Department will use three performance targets to measure the Contractor during the first year of the Expansion Phase. The three performance targets will be Emergency Room Visits per 1,000 Full Time Enrollees (FTEs), Hospital Readmissions per 1,000 FTEs, and Outpatient Service Utilization of MRIs and CT Scans per 1,000 FTEs. The Department will use four performance targets to measure the Contractor during the second year of the Expansion Phase. The performance targets will be the three existing targets and Well Child Visits (EPSDT Screens) as defined by CMS 416 standards. After the second year of the Expansion Phase, the Department may adjust performance targets to align with goals of the program. The performance target measures and goals will be the same as those described in the Section 11.29.2, Pay for Performance ProgramProgram for Members. The baseline for all performance targets listed in the table at Section 11.2.49.2.4., Key Performance Indicator Payment Table, shall be calculated based on the most recently available twelve (12) month period by the Department utilizing methodology that is fully disclosed to the Contractor in advance, with opportunity for consideration of comments submitted by the Contractor prior to finalization of the methodology by the Department. 7.2.3. The Department shall not include Members who are eligible for both Medicare and Medicaid in the incentive performance payment calculations, because the Department does not have completed Medicare calculations until sufficient data to calculate the measuresand analytic capabilities are available. The incentive payments for Medicare and Medicaid clients not eligible for the Medicare-Medicaid Program (MMP) this population shall be paid out based on the Contractor’s performance for all other FTEs. MMP clients are not included in the performance calculations or the incentive payment calculations, because the demonstration has its own incentive program as part of the demonstration. 7.2.4. During the second year of the Expansion phase and every subsequent year, the Department shall consult with the Contractor to determine the measurement areas and performance targets for the Contractor based on the Department’s priorities, goals, objectives and initiatives. The Department shall amend this Contract to establish the new measurement areas and performance targetstargets no later than March 1st. 7.2.5. The Department may initiate a shared savings program, subject to CMS approval of the shared savings methodology. Upon approval by CMS, the Department shall work with the Contractor to amend this Contract as necessary.