Quality Assessment and Performance Improvement Plans. In accordance with Section 2.13.B.5 of the Contract, ACPPs must submit to EOHHS an annual QI workplan that broadly describes ACPP QI initiatives that are conducted as part of the plan’s comprehensive quality assurance and performance improvement (QAPI) program. The QI plan should minimally include the QIPs and performance measures referenced in Appendices B and Q. APPENDIX D PAYMENT EXHIBIT 1 BASE CAPITATION RATES AND ADD-ONS Contract Year 5 Listed below are the Per Member Per Month (PMPM) Base Capitation Rates for Contract Year 5 (January 1, 2022 through December 31, 2022) (also referred to as Rate Year 2022 or RY22), subject to state appropriation and all necessary federal approvals; Base Capitation Rates do not include EOHHS adjustments described in Sections 4.2.C and 4.2.E. of the Contract. In addition to the Base Capitation Rates tables below, additional tables include the add-ons for the Contract Year for CBHI Services as described in Section 4.5.D, for ABA Services as described in Section 4.5.E, and for SUD Risk Sharing Services as described in Section 4.5.I. The add-ons for CBHI Services, ABA Services and SUD Risk Sharing Services are the same for all Regions and will be added to the Risk Adjusted Capitation Rates as defined in Section 4.2.E. ACO Base Capitation Rates / RC I Adult Effective January 1, 2022 – June 30, 2022 REGION NON-HIGH COST DRUG / NON-HCV MEDICAL COMPONENT HCV COMPONENT NON-HCV HIGH COST DRUG COMPONENT ADMINISTRATIVE COMPONENT TOTAL BASE CAPITATION RATE (per member per month) (per member per month) (per member per month) (per member per month) (per member per month) Northern $528.32 $3.26 $2.03 $38.75 $572.36 Greater Boston $540.39 $2.93 $2.06 $35.80 $581.18 Southern $573.38 $4.75 $4.14 $36.79 $619.06 Central $485.92 $3.13 $3.40 $34.31 $526.76 Western $473.31 $2.79 $1.13 $33.77 $511.00 ACO Base Capitation Rates / RC I Child Effective January 1, 2022 – June 30, 2022 REGION NON-HIGH COST DRUG / NON-HCV MEDICAL COMPONENT HCV COMPONENT NON-HCV HIGH COST DRUG COMPONENT ADMINISTRATIVE COMPONENT TOTAL BASE CAPITATION RATE (per member per month) (per member per month) (per member per month) (per member per month) (per member per month) Northern $206.10 $0.02 $4.95 $32.67 $243.74 Greater Boston $204.02 $0.02 $6.66 $30.78 $241.48 Southern $200.78 $0.03 $4.07 $29.60 $234.48 Central $196.28 $0.02 $6.85 $29.04 $232.19 Western $193.80 $0.02 $1.94 $28.92 $224.68 ACO Base Capitation Rates / XX XX Adult Effective January 1, 2022 – June 30, 2022 R...
Quality Assessment and Performance Improvement Plans. In accordance with Section 2.13.B.5 of the Contract, MCOs must submit to EOHHS an annual QI workplan that broadly describes MCO QI initiatives that are conducted as part of the plan’s comprehensive quality assurance and performance improvement (QAPI) program. The QI plan should minimally include the QIPs and performance measures referenced in Appendix B. Appendix B Exhibit 1: Performance Measures # Measure Name Measure Description Data Source Measure Xxxxxxx NQF No. Reporting Level* 1 Childhood Immunization Status Percentage of members who received all recommended immunizations by their 2nd birthday Hybrid NCQA 0038 MCO 2 Immunizations for Adolescents Percentage of members 13 years of age who received all recommended vaccines, including the HPV series Hybrid NCQA 1407 MCO 3 Timeliness of Prenatal Care Percentage of deliveries in which the member received a prenatal care visit in the first trimester or within 42 days of enrollment Hybrid NCQA 1517 MCO 4 Oral Health Evaluation Percentage of members under age 21 years who received a comprehensive or periodic oral evaluation during the year Claims ADA DQA 2517 MCO (calculated by EOHHS) 5 Asthma Medication Ratio Percentage of members 5 to 64 years of age who were identified as having persistent asthma and had a ratio of controller medications to total asthma medications of 0.50 or greater Claims NCQA 1800 MCO 6 Controlling High Blood Pressure Percentage of members 18 to 64 years of age with hypertension and whose blood pressure was adequately controlled Hybrid NCQA 0018 MCO 7 Comprehensive Diabetes Care: A1c Poor Control Percentage of members 18 to 64 years of age with diabetes whose most recent HbA1c level demonstrated poor control (> 9.0%) Hybrid NCQA 0059 MCO # Measure Name Measure Description Data Source Measure Xxxxxxx NQF No. Reporting Level* 8 Metabolic Monitoring for Children and Adolescents on Antipsychotics Percentage of members 1 to 17 years of age who had two or more antipsychotic prescriptions and received metabolic testing Claims NCQA 2800 MCO 9 ED Visits for Individuals with Mental Illness, Addiction, or Co- occurring Conditions Risk adjusted ratio (obs/exp) of ED visits for members 18 to 64 years of age identified with a diagnosis of serious mental illness, substance addiction, or co-occurring conditions Claims EOHHS NA MCO (calculated by EOHHS) 10 Follow-Up After Emergency Department Visit for Mental Illness (7 days) Percentage of ED visits for members 6 to 64 years of age with a principal diag...
Quality Assessment and Performance Improvement Plans. In accordance with Section 2.13.B.5 of the Contract, ACPPs must submit to EOHHS an annual QI workplan that broadly describes ACPP QI initiatives that are conducted as part of the plan’s comprehensive quality assurance and performance improvement (QAPI) program. The QI plan should minimally include the QIPs and performance measures referenced in Appendices B and Q. APPENDIX C Exhibit 1: ACO Covered Services ✓ Denotes a covered service The Contractor shall provide to each Enrollee each of the ACO Covered Services listed below in an amount, duration, and scope that is Medically Necessary (as defined in Section 1 of this Contract), provided that the Contractor is not obligated to provide any ACO Covered Service in excess of any service limitation expressly set forth below. Except to the extent that such service limitations are set forth below, the general descriptions below of ACO Covered Services do not limit the Contractor’s obligation to provide all Medically Necessary services. Coverage Types Service MassHealth Standard & CommonHealth Enrollees MassHealth Family Assistance Enrollees CarePlus Acupuncture Treatment - the insertion of metal needles through the skin at certain points on the body, with or without the use of herbs, an electric current, heat to the needles or skin, or both, for pain relief or anesthesia. ✓ ✓ ✓ Acute Inpatient Hospital –all inpatient services such as daily physician intervention, surgery, obstetrics, radiology, laboratory, and other diagnostic and treatment procedures. Coverage of acute inpatient hospital services shall include Administratively Necessary Days. Administratively Necessary Day shall be defined as a day of Acute Inpatient Hospitalization on which an Enrollee’s care needs can be provided in a setting other than an Acute Inpatient Hospital and on which an Enrollee is clinically ready for discharge. ✓ ✓ ✓ Ambulatory Surgery/Outpatient Hospital Care - outpatient surgical, related diagnostic, medical and dental services. ✓ ✓ ✓ Audiologist – audiologist exams and evaluations. See related hearing aid services. ✓ ✓ ✓ Behavioral Health Services – see Appendix C, Exhibit 3. ✓ ✓ ✓ Breast Pumps – to expectant and new mothers as specifically prescribed by their attending physician, consistent with the provisions of the Affordable Care Act of 2010 and Section 274 of Chapter 165 of the Acts of 2014, including but not limited to double electric breast pumps one per birth or as medically necessary. ✓ ✓ ✓ Certain COVID-19 Specimen Co...
Quality Assessment and Performance Improvement Plans. In accordance with section 2.13.B.5 of the Contract, SCOs shall submit to EOHHS a comprehensive quality assurance and performance improvement (QAPI) program plan. The QI plan shall minimally include the PIPs and performance measures referenced in this Appendix. Exhibit 1: Quality Performance Measures Measure Name NQF # Xxxxxxx Domain
