Network Design Based on Quality. Article 1, Section 1.02 4% of total performance penalty at risk. Expectation: Contractor shall include quality criteria into its Exchange network development, with a phased approach starting in plan year 2017. Contractor will report on progress after 2017 plan year is complete, in 2018, through the Application for Certification for 2019. Performance Levels Contractor is unable to describe valid inclusion of quality criteria into Exchange network development by end of year 2017: 4% penalty Contractor reports strategy for inclusion of quality criteria in all networks offered to Exchange enrollees, and demonstrates implementation of criteria by end of year 2017: No penalty Contractor fulfills the requirement for “no penalty” above, plus submits documentation that contracted hospitals have been notified in 2017 of expectation to meet targets for appropriate use of C- Section and reduction in Hospital Acquired Conditions by 2019: 4% credit
Network Design Based on Quality. Attachment 7, Article 1, Section 1.02 - 4% of total performance penalty for Group 3 Contractor shall include quality criteria into its Exchange network development, with a phased approach starting in plan year 2017 and continuing in plan years 2018 and 2019. Measurement Year 2017 Expectation: Describe valid inclusion of quality criteria into Exchange network development and begin implementation of criteria Performance Levels: Contractor is unable to describe valid inclusion of quality criteria into Exchange network development by end of year 2017: 4% penalty Contractor reports strategy for inclusion of quality criteria in all networks offered to Exchange enrollees, and demonstrates implementation of criteria by end of year 2017: No penalty Contractor reports strategy for inclusion of quality criteria in all networks offered to Exchange enrollees, demonstrates Measurement Year 2018 Expectation: Describe valid inclusion of quality criteria into Exchange network development and begin implementation of criteria Performance Levels: Contractor is unable to describe valid inclusion of quality criteria into Exchange network development by end of year 2018: 4% penalty Contractor submits report showing that quality criteria for all provider types has been applied to at least part of each Exchange network offered to Exchange enrollees by end of 2018; report shows that providers have been reviewed against established quality metrics and providers not meeting metrics either have a corrective action Measurement Year 2019 Expectation: Describe valid inclusion of quality criteria into Exchange network development and begin implementation of criteria Performance Levels: Contractor is unable to describe valid inclusion of quality criteria into Exchange network development by end of year 2019: 4% penalty Contractor submits report showing that quality criteria for all provider types has been applied to at least part of each Exchange network offered to Exchange enrollees by end of 2019; report shows that those providers that have been reviewed against established quality metrics and providers not meeting metrics either have a corrective action plan to improve or have been removed from networks: No penalty Contractor submits a report showing that quality criteria for all provider types has been applied to 100% of each Exchange network offered to Exchange enrollees by the end of 2019; report shows that provider have been reviewed against established quality metrics and those not...
