Common use of Program Establishment and Eligibility Clause in Contracts

Program Establishment and Eligibility. FSSA has established a pay for outcomes program under which Contractor may receive additional compensation if certain conditions are met. The state encourages plans to share earned incentive payments with members and providers. The compensation under the pay for outcomes program is subject to Contractor’s complete and timely satisfaction of its obligations under the Contract. This includes but is not limited to timely submission of the Contractor’s HEDIS Report for the measurement year and the Certified HEDIS Compliance Auditor’s attestation, as well as timely submission of the Priority Reports listed in Section A.5 of this Exhibit. In furtherance of the foregoing and not by limitation, the Contractor may, in FSSA’s discretion, lose eligibility for its compensation under the pay for outcomes program if:

Program Establishment and Eligibility. FSSA has established a pay for outcomes program under which Contractor may receive additional compensation if certain conditions are met. The state encourages plans to share earned incentive payments with members and providers. The compensation under the pay for outcomes program is subject to Contractor’s complete and timely satisfaction of its obligations under the Contract. This includes but is not limited to timely submission of the Contractor’s CAHPS and HEDIS Report Reports for the measurement year and the Certified HEDIS Compliance Auditor’s attestation, as well as timely submission of the Priority Reports listed in Section A.5 of this Exhibit. In furtherance of the foregoing and not by limitation, the Contractor may, in FSSA’s discretion, lose eligibility for its compensation under the pay for outcomes program if: