HEDIS and CAHPS Reporting. Contractor shall submit to the Exchange HEDIS and CAHPS scores to include the measure numerator, denominator and rate for the required measures set that is reported to NCQA Quality Compass and/or DHCS, per each Product Type for which it collects data in California. These measures may change as some may be added or removed by NCQA. The Exchange reserves the right to use the Contractor-reported measures scores to construct Contractor summary quality ratings that the Exchange may use for such purposes as supporting consumer choice and the Exchange’s plan oversight management. (a) Contractor shall report scores for Measurement Year (“MY”) 2011, MY2012, MY2013 and MY2014 based on data reported to NCQA Quality Compass and/or DHCS County- level Product reporting for those periods. Contractor is not required to report DHCS County-level reporting HEDIS or CAHPS information if not already doing so for Medi-Cal if it is not already doing so for Medi-Cal. (b) Contractor shall collect its HEDIS and CAHPS data consistent with the standard measures set that is reported to NCQA Quality Compass and any applicable DHCS County-level reporting for those periods. Contractor shall report scores separately for each Quality Compass Product Type and/or DHCS County-level product type (e.g.: commercial HMO/POS, commercial PPO, Medicaid HMO), for California. Beginning in MY2014, Contractor shall include Exchange Enrollees as part of its commercial population for the respective product types. (c) For the purposes of determining Performance Measurement Standards (see Attachment 14), the Exchange shall use the most appropriate Product Type based on the plan design and network operated for the Exchange. (d) Contractor may be required to conduct QHP product type CAHPS measurement and reporting effective MY 2014 and annually thereafter. (e) Subject to changes in federal requirements, Contractor shall not be required to collect and report QHP-specific HEDIS measures. (f) The timeline for Contractor’s HEDIS and CAHPS quality data submission shall be consistent with the timeline for submitting data to the NCQA Quality Compass and/or DHCS. (g) The Exchange reserves the right, as measures are added or removed from the national standard measures, to add or rename measures to the standard HEDIS measures and will provide Contractor sufficient prior notice of intent to add or rename measures to the existing measure set. (h) Contractors electing to pursue URAC plan accreditation instead of NCQA accreditation per Article 2, are not exempt from these requirements.
Appears in 1 contract
Samples: Qualified Health Plan Contract
HEDIS and CAHPS Reporting. Contractor shall submit to the Exchange HEDIS and CAHPS scores to include the measure numerator, denominator and rate for the required measures set that is reported to NCQA Quality Compass and/or DHCS, per each Product Type for which it collects data in California. These measures may change as some may be added or removed by NCQA. The Exchange reserves the right to use the Contractor-reported measures scores to construct Contractor summary quality ratings that the Exchange may use for such purposes as supporting consumer choice and the Exchange’s plan oversight management.
(a) Contractor shall report scores for Measurement Year (“MY”) 2011, MY2012, MY2013 and MY2014 based on data reported to NCQA Quality Compass and/or DHCS County- County-level Product reporting for those periods. Contractor is not required to report DHCS County-level reporting HEDIS or CAHPS information if not already doing so for Medi-Cal if it is not already doing so for Medi-Cal.
(b) Contractor shall collect its HEDIS and CAHPS data consistent with the standard measures set that is reported to NCQA Quality Compass and any applicable DHCS County-level reporting for those periods. Contractor shall report scores separately for each Quality Compass Product Type and/or DHCS County-level product type (e.g.: commercial HMO/POS, commercial PPO, Medicaid HMO), for California. Beginning in MY2014, Contractor shall include Exchange Enrollees as part of its commercial population for the respective product types.
(c) For the purposes of determining Performance Measurement Standards (see Attachment 14), the Exchange shall use the most appropriate Product Type based on the plan design and network operated for the Exchange. If appropriate, the Exchange may blend Product Type scores (e.g., combining Commercial and Medi-Cal scores).
(d) Contractor may be required to conduct QHP product type CAHPS measurement and reporting effective MY 2014 and annually thereafter.
(e) Subject to changes in federal requirements, Contractor shall not be required to collect and report QHP-specific HEDIS measures.
(f) The timeline for Contractor’s HEDIS and CAHPS quality data submission shall be consistent with the timeline for submitting data to the NCQA Quality Compass and/or DHCS.
(g) The Exchange reserves the right, as measures are added or removed from to the national standard measures, to add or rename measures to the standard HEDIS measures and will provide Contractor sufficient prior notice of intent to add or rename measures to the existing measure set.
. Xxxxxx will provide language to change this (h) Contractors electing to pursue URAC plan accreditation instead of NCQA accreditation per Article 2, are not exempt from these requirements.
Appears in 1 contract
Samples: Qualified Health Plan Contract
HEDIS and CAHPS Reporting. Contractor shall submit to the Exchange HEDIS and CAHPS scores to include the measure numerator, denominator and rate for the required measures set that is reported to NCQA Quality Compass and/or DHCS, per each Product Type for which it collects data in California. These measures may change as some may be added or removed by NCQA. The Exchange reserves the right to use the Contractor-reported measures scores to construct Contractor summary quality ratings that the Exchange may use for such purposes as supporting consumer choice and the Exchange’s plan oversight management.
(a) Contractor shall report scores for Measurement Year (“MY”) 2011, MY2012, MY2013 and MY2014 based on data reported to NCQA Quality Compass and/or DHCS County- County-level Product reporting for those periods. Contractor is not required to report DHCS County-level reporting HEDIS or CAHPS information if not already doing so for Medi-Cal if it is not already doing so for Medi-Cal.
(b) Contractor shall collect its HEDIS and CAHPS data consistent with the standard measures set that is reported to NCQA Quality Compass and any applicable DHCS County-level reporting for those periods. Contractor shall report scores separately for each Quality Compass Product Type and/or DHCS County-level product type (e.g.: commercial HMO/POS, commercial PPO, Medicaid HMO), for California. Beginning in MY2014, Contractor shall include Exchange Enrollees as part of its commercial population for the respective product types.
(c) For the purposes of determining Performance Measurement Standards (see Attachment 14), the Exchange shall use the most appropriate Product Type based on the plan design and network operated for the Exchange. If appropriate, the Exchange may blend Product Type scores (e.g., combining Commercial and Medi-Cal scores).
(d) Contractor may be required to conduct QHP product type CAHPS measurement and reporting effective MY 2014 and annually thereafter.
(e) Subject to changes in federal requirements, Contractor shall not be required to collect and report QHP-specific HEDIS measures.
(f) The timeline for Contractor’s HEDIS and CAHPS quality data submission shall be consistent with the timeline for submitting data to the NCQA Quality Compass and/or DHCS.
(g) The Exchange reserves the right, as measures are added or removed from the national standard measures, to add or rename measures to the standard HEDIS measures and will provide Contractor sufficient prior notice of intent to add or rename measures to the existing measure set.
(h) Contractors electing to pursue URAC plan accreditation instead of NCQA accreditation per Article 2, are not exempt from these requirements.
Appears in 1 contract
Samples: Qualified Health Plan Contract
HEDIS and CAHPS Reporting. (a) Contractor shall submit measure its HEDIS and CAHPS scores to include the measure numerator, denominator and rate for the standard measures set that is reported to NCQA Quality Compass and/or DHCS County-level reporting.
(i) Contractor shall report scores for MY2011, MY2012, and MY2013 based on data reported to both the Exchange and NCQA Quality Compass and/or DHCS County-level Product reporting for those periods.
(ii) Contractor shall report scores separately for each Quality Compass Product Line/Reporting Product and/or DHCS County-level product combination (e.g. Contractor commercial HMO/POS, Contractor commercial PPO, Medicaid HMO), for California, that corresponds to the Contractor’s Exchange products. The Exchange LOB is not required.
(b) Effective MY2014, and on an annual basis, Contractor shall report HEDIS and CAHPS scores to include the measure numerator, denominator and rate for the required measures set that is reported to NCQA Quality Compass and/or DHCSCompass, per each the NCQA Exchange Product Type for which it collects data in California. These measures may change as some may be added or removed by NCQALine reporting specifications (expected late 2014). The Exchange reserves the right to use the Contractor-Contractor reported measures scores to construct Contractor summary quality ratings that the Exchange may use for such purposes as supporting consumer choice and the Exchange’s plan oversight management.
(a) Contractor shall report scores for Measurement Year (“MY”) 2011, MY2012, MY2013 and MY2014 based on data reported to NCQA Quality Compass and/or DHCS County- level Product reporting for those periods. Contractor is not required to report DHCS County-level reporting HEDIS or CAHPS information if not already doing so for Medi-Cal if it is not already doing so for Medi-Cal.
(b) Contractor shall collect its HEDIS and CAHPS data consistent with the standard measures set that is reported to NCQA Quality Compass and any applicable DHCS County-level reporting for those periods. Contractor shall report scores separately for each Quality Compass Product Type and/or DHCS County-level product type (e.g.: commercial HMO/POS, commercial PPO, Medicaid HMO), for California. Beginning in MY2014, Contractor shall include Exchange Enrollees as part of its commercial population for the respective product types.
(c) For the purposes of determining Performance Measurement Standards (see Attachment 14), the Exchange shall use the most appropriate Product Type based on the plan design and network operated for the Exchange.
(d) Contractor may be required to conduct QHP product type CAHPS measurement and reporting effective MY 2014 and annually thereafter.
(e) Subject to changes in federal requirements, Contractor shall not be required to collect and report QHP-specific HEDIS measures.
(f) The timeline for Contractor’s HEDIS and CAHPS quality data submission shall be consistent with the timeline for submitting data to the NCQA Quality Compass and/or DHCS.
(g) The Exchange reserves the right, as measures are added or removed from the national standard measures, right to add or rename new measures to the standard HEDIS measures and will provide Contractor sufficient sixty (60) days prior notice of intent to add or rename new measures to the existing measure set.
(hd) Contractors electing to pursue URAC plan accreditation accreditation, instead of NCQA accreditation per Article 2, are not exempt from these requirements.
(e) The timeline for Contractor’s HEDIS and CAHPS quality reporting shall be as set forth below, as such timelines may be modified from time to time by the Exchange and included in updates to the Administrative Manual: Commercial HEDIS Historical (MY2011) Historical (MY2012) Historical (MY2013) QHP Specific (MY2014) Commercial CAHPS Historical (MY2011) Historical (MY2012) QHP Specific (MY2014) QHP Specific (MY2015) MMC HEDIS (EAS)* Historical (MY2011) Historical (MY2012) Historical (MY2013) QHP Specific (MY2014) MMC CAHPS Historical (MY2010) Historical (MY2012) QHP Specific (MY2014) QHP Specific (MY2015) MMC Bridge Plan HEDIS (EAS)** NA April 2014 Historical (MY2012) Historical (MY2013) QHP Specific (MY2014) MMC Bridge Plan CAHPS** NA April 2014 Historical (MY2012) QHP Specific (MY2014) QHP Specific (MY2015) *External Accountability Set (DHCS subset of HEDIS measures) **Clarify if MMC Bridge Plan QRS reporting requirements
Appears in 1 contract
Samples: Qualified Health Plan Contract
HEDIS and CAHPS Reporting. Contractor shall submit to the Exchange HEDIS and CAHPS scores to include the measure numerator, denominator and rate for the required measures set that is reported to NCQA Quality Compass and/or DHCS, per each Product Type for which it collects data in California. These measures may change as some may be added or removed by NCQA. The Exchange reserves the right to use the Contractor-reported measures scores to construct Contractor summary quality ratings that the Exchange may use for such purposes as supporting consumer choice and the Exchange’s plan oversight management.
(a) Contractor shall report scores for Measurement Year (“MY”) 2011, MY2012, MY2013 and MY2014 based on data reported to NCQA Quality Compass and/or DHCS County- level Product reporting for those periods. Contractor is not required to report DHCS County-level reporting HEDIS or CAHPS information if not already doing so for Medi-Cal if it is not already doing so for Medi-Cal.
(b) Contractor shall collect its HEDIS and CAHPS data consistent with the standard measures set that is reported to NCQA Quality Compass and any applicable DHCS County-level reporting for those periods. Contractor is not required to collect DHCS County-level reporting HEDIS or CAHPS information if not already doing so for existing Line of Business.
(i) Contractor shall report scores for Measurement Year (“MY”) 2011, MY2012, MY2013 and MY2014 based on data reported to NCQA Quality Compass and/or DHCS County-level Product reporting for those periods .Contractor shall repor these scores directly to the Exchange in addition to NCQA and DHCS..
(ii) Contractor shall report scores separately for each Quality Compass Product Type and/or DHCS County-level product type (e.g.: e.g. each of the Contractor’s lines of business (LOB): commercial HMO/POS, commercial PPO, Medicaid HMO), for California, that corresponds to the Contractor’s Exchange products. Beginning in MY2014, Contractor shall include Exchange Enrollees population as part of its commercial population for the respective product typesby LOB.
(ciii) For the purposes of determining Performance Measurement Standards (see Attachment 14), the Exchange shall use the most appropriate Product Type based on the plan design and network operated for the Exchange. If appropriate, the Exchange may blend Product Type scores (e.g., combining Commercial and Medi-Cal scores).
(div) Contractor may be required to conduct QHP product type Product Type CAHPS measurement and reporting effective MY 2014 and annually thereafter.
(ev) Subject to changes in federal requirements, Contractor shall not be required to collect and report QHP-specific HEDIS measures.
(fvi) The timeline for Contractor’s HEDIS and CAHPS quality data submission reporting shall be consistent with the timeline for submitting data reporting to the NCQA Quality Compass and/or DHCS.
(gb) Effective MY2014, and on an annual basis thereafter, Contractor shall submit directly to the Exchange or through an accepted third party (e.g., NCQA or DHCS) HEDIS and CAHPS scores to include the measure numerator, denominator and rate for the required measures set that is reported to NCQA Quality Compass, per each Product Line for which it collects data in California. The Exchange reserves the right to use the Contractor reported measures scores to construct Contractor summary quality ratings that the Exchange may use for such purposes as supporting consumer choice and the Exchange’s plan oversight management.
(c) The Exchange reserves the right, as measures are added or removed from the national standard measures, right to add or rename new measures to the standard HEDIS measures and will provide Contractor sufficient prior notice of intent to add or rename new measures to the existing measure set.
(hd) Contractors electing to pursue URAC plan accreditation accreditation, instead of NCQA accreditation per Article 2, are not exempt from these requirements.
(e) In the event that reporting timelines established by the NCQA Quality Compass conflict with timelines established by the Exchange, the timelines established by the NCQA timelines will take precedence.
Appears in 1 contract
Samples: Qualified Health Plan Contract
HEDIS and CAHPS Reporting. (a) Contractor shall measurecollect its HEDIS and CAHPS scores to includedata consistent with the measure numerator, denominator and rate for the standard measures set that is reported to NCQA Quality Compass and any applicable DHCS County-level reporting for those periods. Contractor is not required to collect DHCS County-level reporting HEDIS or CAHPS information if not already doing so for existing Line of Business.
(i) Contractor shall report scores for Measurement Year (“MY”) MY2011, MY2012, and MY2013 and MY2014 based on data reported both to the Exchange and to NCQA Quality Compass and/or DHCS County-level Product reporting for those periods .Contractor shall repor these scores directly to the Exchange in addition to NCQA and DHCS..
(ii) Contractor shall report scores separately for each Quality Compass Product Line/Reporting Product Type and/or DHCS County-level product combination (e.g. each of the Contractor’s lines of business (LOB): commercial HMO/POS, Contractor commercial PPO, Medicaid HMO), for California, that corresponds to the Contractor’s Exchange products. Contractor shall include Exchange population as part of its commercial population by LOB.
(iii) For the purposes of determining Performance Measurement Standards (see Attachment 14), the Exchange shall use the most appropriate Line of BusinessProduct Type based on the plan design and network operated for the Exchange. If appropriate, the Exchange may blend Product TypeLOB scores (e.g., combining Commercial and Medi-Cal scores).
(iv) Contractor may be required to conduct QHP Product TypeLOB CAHPS measurement and reporting effective MY 2014 and annually thereafter.
(v) Subject to changes in federal requirements, Contractor shall not be required to collect and report QHP-specific HEDIS measures.
(vi) The timeline for Contractor’s HEDIS and CAHPS quality reporting shall be consistent with reporting to the NCQA Quality Compass and/or DHCS.detailed in the Administrative Manual. The Exchange Line of Business (“LOB”) reporting is not required.
(b) Effective MY2014, and on an annual basis thereafter, Contractor shall submit directly to the Exchange report or through an accepted third party (e.g., NCQA or DHCS) HEDIS and CAHPS scores to include the measure numerator, denominator and rate for the required measures set that is reported to NCQA Quality Compass and/or DHCSCompass, per each Product Type Line for which it collects data in California. These measures may change as some may be added or removed by NCQACaliforniareporting specifications (expected late 2014). The Exchange reserves the right to use the Contractor-Contractor reported measures scores to construct Contractor summary quality ratings that the Exchange may use for such purposes as supporting consumer choice and the Exchange’s plan oversight management.
(a) Contractor shall report scores for Measurement Year (“MY”) 2011, MY2012, MY2013 and MY2014 based on data reported to NCQA Quality Compass and/or DHCS County- level Product reporting for those periods. Contractor is not required to report DHCS County-level reporting HEDIS or CAHPS information if not already doing so for Medi-Cal if it is not already doing so for Medi-Cal.
(b) Contractor shall collect its HEDIS and CAHPS data consistent with the standard measures set that is reported to NCQA Quality Compass and any applicable DHCS County-level reporting for those periods. Contractor shall report scores separately for each Quality Compass Product Type and/or DHCS County-level product type (e.g.: commercial HMO/POS, commercial PPO, Medicaid HMO), for California. Beginning in MY2014, Contractor shall include Exchange Enrollees as part of its commercial population for the respective product types.
(c) For the purposes of determining Performance Measurement Standards (see Attachment 14), the Exchange shall use the most appropriate Product Type based on the plan design and network operated for the Exchange.
(d) Contractor may be required to conduct QHP product type CAHPS measurement and reporting effective MY 2014 and annually thereafter.
(e) Subject to changes in federal requirements, Contractor shall not be required to collect and report QHP-specific HEDIS measures.
(f) The timeline for Contractor’s HEDIS and CAHPS quality data submission shall be consistent with the timeline for submitting data to the NCQA Quality Compass and/or DHCS.
(g) The Exchange reserves the right, as measures are added or removed from the national standard measures, right to add or rename new measures to the standard HEDIS measures and will provide Contractor sufficient sufficientsixty (60) days prior notice of intent to add or rename new measures to the existing measure set.
(hd) Contractors electing to pursue URAC plan accreditation accreditation, instead of NCQA accreditation per Article 2, are not exempt from these requirements.
(e) In the event that reporting timelines established by the NCQA Quality Compass conflict with timelines established by the Exchange, the timelines established by the NCQA timelines will take precedence. The timeline for Contractor’s HEDIS and CAHPS quality reporting shall be as set forth below, as such timelines may be modified from time to time by the Exchange and included in updates to the Administrative Manual. Commercial HEDIS Historical (MY2011) Historical (MY2012) Historical (MY2013) QHP Specific (MY2014) Commercial CAHPS Historical (MY2011) Historical (MY2012) QHP Specific (MY2014) QHP Specific (MY2015) MMC HEDIS (EAS)* Historical (MY2011) Historical (MY2012) Historical (MY2013) QHP Specific (MY2014) MMC CAHPS Historical (MY2010) Historical (MY2012) QHP Specific (MY2014) QHP Specific (MY2015) MMC Bridge Plan HEDIS (EAS)** NA April 2014 Historical (MY2012) Historical (MY2013) QHP Specific (MY2014) MMC Bridge Plan CAHPS** NA April 2014 Historical (MY2012) QHP Specific (MY2014) QHP Specific (MY2015) *External Accountability Set (DHCS subset of HEDIS measures) **Clarify if MMC Bridge Plan QRS reporting requirements
Appears in 1 contract
Samples: Qualified Health Plan Contract
