Performance Monitoring and Incentives Sample Clauses

Performance Monitoring and Incentives. MDCH will be implementing a performance incentive structure for the Medicaid PIHPs. During each contract year, MDCH will withhold a portion of the approved capitation payment from each PIHP (range to be determined, but likely to be between .02 and .015). These funds will be used for the PIHP performance incentive awards. These awards will be made to PIHPs according to criteria pre-established by MDCH. The criteria will include assessment of performance from areas such as: access, health and welfare, and compliance with the Balanced Budget Act (BBA) per External Quality Review, including performance measure data validation. In 2014, the two areas of focus will be PIHP proper and complete reporting of monetary amounts and billing/rendering provider; and completeness of Quality Improvement health conditions and developmental disabilities characteristics data.

Performance Monitoring and Incentives. The primary source of data the State uses in its monitoring efforts is data submitted by the MCO, which comes to the State in various formats and at different times. The data may be transmitted as an aggregate report, specific data elements, or via shadow claims. OMPP and its monitoring contractor will review the MCO’s data and compare the results to established performance targets, i.e., Hoosier Healthwise standards, national benchmarks or industry standards. The MCO Reporting Manual provides information on performance reporting and targets. OMPP may award non-financial incentives, as described in Section 7.8.2, to the MCO whose performance is consistently above the targets for the majority of the measures listed below. OMPP also reserves the right to assess liquidated damages or apply other remedies in Section 8.0 for failure to meet the minimum requirements listed below. 7.8.1 Performance Targets, Standards, and Benchmarks Listed below are the performance indicators and the performance target for each measure. OMPP reserves the right to identify additional performance indicators and targets. • The MCO must maintain its average monthly telephone service for member services helpline efficiency at 95 percent of calls received being answered by a live voice within 30 seconds and service rates (i.e., opposite of abandonment rate) not less than 95 percent. • On a quarterly basis, the ratio of MCO members to PMPs is no greater than an average of 250 members to one PMP across all mandatory RBMC counties. • Ninety-eight percent of the MCO’s members must have pharmacy access within 30 miles or 30 minutes of the member’s residence. • For mandatory RBMC counties, at least two specialty providers of each specialty type (per requirements in Section 4.2.3 of this Attachment) will be accessible to 90 percent of all the MCO’s members within 60 miles or 60 minutes of the member’s residence zip code. • All clean claims submitted electronically must be adjudicated within 21 calendar days of receipt. • All clean claims submitted on paper must be adjudicated within 30 calendar days of receipt. • All MCO adjudicated claims must be submitted as shadow claims within 30 days of adjudication. • All member grievances will be resolved within 20 calendar days of receipt. • All children must receive a blood lead screening/testing in accordance with EPSDT and CDC guidelines. • All children must receive EPSDT screening visits in accordance with EPSDT guidelines. • On a quarterly basis,...