Common use of Network Design Based on Quality Clause in Contracts

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. Article 1, Section 1.02 4% of total performance penalty at riskriskfor this Group. 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. 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. Article 1, Section 1.02 4% of total performance penalty at riskfor this Group. 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