Provider Satisfaction Survey. The CONTRACTOR shall conduct at least one (1) annual Provider Satisfaction Survey that covers Contract Providers and follows NCQA guidelines to the extent applicable. The CONTRACTOR shall provide results to HCA as directed by the HCA CONTRACTOR shall also make a summary of the results available to interested parties. The CONTRACTOR shall have mechanisms in place to incorporate results in the CONTRACTOR’s QM/QI plan and Population Health Management plan for program and systems improvements. The CONTRACTOR shall: Adopt practice guidelines that meet the following requirements: Are based on valid and reliable clinical evidence or a consensus of health care professionals in the particular field; Consider the needs of the Members; Are adopted in consultation with Contract Providers; and Are reviewed and updated every two (2) years. Disseminate the guidelines to all affected Contract Providers and, upon request, to Members; and Ensure that decisions for Utilization Management, Member education, coverage of services, and other applicable areas are consistent with the guidelines. All PMs and targets shall be based on HEDIS technical specifications for the current reporting year. In the event that NCQA alters the measure or technical specifications for the PMs listed, the CONTRACTOR will follow relevant and current NCQA standards. PMs and targets shall be reasonable and based on industry standards that are applicable to substantially similar populations. The CONTRACTOR shall meet performance targets specified by HCA. The PMs will be revised to meet HCA designated targets for Calendar Year (CY) 2024, 2025, and 2026. The CONTRACTOR will be required to collect, track, trend, and report PMs quarterly as directed by HCA and/or its designee. The CONTRACTOR shall provide quality data and other relevant information as requested to HCA/or its designee. Reporting elements and data are to be provided to HCA in the same format as the template provided by HCA as directed by HCA. The reporting period is based upon one (1) quarter of a Calendar Year (e.g., Q1 Total= January –March) and data is to be reported cumulatively as follows: Quarter 1 (Q1) = January – March, Quarter 2 (Q2) = January – June, Quarter 3 (Q3) = January – September, and Quarter 4 (Q4) = January – December. For the measurement period and reporting elements for each measure, please refer to the relevant technical specifications. The report must be submitted within twenty (20) Calendar Days from the end of each reporting period. If the twentieth Calendar Day is not a Business Day, then the report must be submitted the following Business Day. If HCA requests any revisions to reports previously submitted by the CONTRACTOR, the CONTRACTOR shall make the changes and re-submit the reports according to the time frame set forth by HCA. The naming convention for this report is: MCO.HCAPMQXCYXX.vX. If the proper naming convention is not used, the report will be rejected by HCA. The Turquoise Care PMs identified in Attachment 12: Turquoise Care PMs and TMs shall be evaluated. Target criteria will be established following HCA’s selection of Turquoise Care MCOs. The CONTRACTOR shall report on the Turquoise Care TMs included in Attachment 12: Turquoise Care PMs and TMs as directed by HCA. All TMs shall be based on HCA directed technical specifications for the current reporting year. The CONTRACTOR shall be required to collect, track, trend, and report TMs quarterly as directed by HCA and/or its designee. The CONTRACTOR shall provide quality data and other relevant information as requested to HCA and/or its designee. Reporting elements and data are to be provided to HCA in the same format as the template provided by HCA as directed by HCA. If HCA requests any revisions to reports previously submitted by the CONTRACTOR, the CONTRACTOR shall make the changes and re-submit the reports according to the time frame set forth by HCA. The naming convention for this report is: MCO.HCATMQXCYXX.vX. If the proper naming convention is not used, the report will be rejected by HCA. The TM reports included in this Section 4.12.9 are subject to sanctions in Section 7.3.3 of this Agreement.
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Samples: Medicaid Managed Care Services Agreement, Medicaid Managed Care Services Agreement, Medicaid Managed Care Services Agreement
Provider Satisfaction Survey. The CONTRACTOR shall conduct at least one (1) annual Provider Satisfaction Survey that covers Contract Providers and follows NCQA guidelines to the extent applicable. The CONTRACTOR shall provide results to HCA HSD as directed by the HCA HSD. The CONTRACTOR shall also make a summary of the results available to interested parties. The CONTRACTOR shall have mechanisms in place to incorporate results in the CONTRACTOR’s QM/QI plan and Population Health Management plan for program and systems improvements. The CONTRACTOR shall: Adopt practice guidelines that meet the following requirements: Are based on valid and reliable clinical evidence or a consensus of health care professionals in the particular field; Consider the needs of the Members; Are adopted in consultation with Contract Providers; and Are reviewed and updated every two (2) years. Disseminate the guidelines to all affected Contract Providers and, upon request, to Members; and Ensure that decisions for Utilization Management, Member education, coverage of services, and other applicable areas are consistent with the guidelines. All PMs and targets shall be based on HEDIS technical specifications for the current reporting year. In the event that NCQA alters the measure or technical specifications for the PMs listed, the CONTRACTOR will follow relevant and current NCQA standards. PMs and targets shall be reasonable and based on industry standards that are applicable to substantially similar populations. The CONTRACTOR shall meet performance targets specified by HCAHSD. The PMs will be revised required to meet HCA HSD designated targets for Calendar Year (CY) 2024, 2025, and 2026. The CONTRACTOR will be required to collect, track, trend, and report PMs quarterly as directed by HCA HSD and/or its designee. The CONTRACTOR shall provide quality data and other relevant information as requested to HCA/or HSD and/or its designee. Reporting elements and data are to be provided to HCA HSD in the same format as the template provided by HCA HSD, as directed by HCAHSD. The reporting period is based upon one (1) quarter of a Calendar Year (e.g., Q1 Total= January –March) and data is to be reported cumulatively as follows: Quarter 1 (Q1) = January – March, Quarter 2 (Q2) = January – June, Quarter 3 (Q3) = January – September, and Quarter 4 (Q4) = January – December. For the measurement period and reporting elements for each measure, please refer to the relevant technical specifications. The report must be submitted within twenty (20) Calendar Days from the end of each reporting period. If the twentieth Calendar Day is not a Business Day, then the report must be submitted the following Business Day. If HCA HSD requests any revisions to reports previously submitted by the CONTRACTOR, the CONTRACTOR shall make the changes and re-submit the reports according to the time frame set forth by HCAHSD. The naming convention for this report is: MCO.HCAPMQXCYXX.vX. MCO.HSDPMQXCYXX.vX. If the proper naming convention is not used, the report will be rejected by HCAHSD. The Turquoise Care child and adult PMs identified in Attachment 12: Turquoise Care PMs and TMs shall be evaluated. Target criteria will be established following HCAHSD’s selection of Turquoise Care MCOs. The CONTRACTOR shall report on the Turquoise Care child and adult TMs included in Attachment 12: Turquoise Care PMs and TMs as directed by HCA. All TMs shall be based on HCA directed technical specifications for the current reporting yearHSD. The CONTRACTOR shall be required to collect, track, trend, and report TMs quarterly as directed by HCA and/or its designee. The CONTRACTOR shall provide quality data and other relevant information as requested to HCA and/or its designee. Reporting elements and data are to be provided to HCA in the same format as the template provided by HCA as directed by HCA. If HCA requests any revisions to reports previously submitted by the CONTRACTOR, the CONTRACTOR shall make the changes and re-submit the reports according to the time frame set forth by HCA. The naming convention for this report is: MCO.HCATMQXCYXX.vX. If the proper naming convention is not used, the report will be rejected by HCA. The TM reports included in this Section 4.12.9 4.12.8 are not subject to sanctions in Section 7.3.3 of this Agreement.
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