Common use of Quality Assessment and Performance Improvement Plans Clause in Contracts

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. 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 Collection and Testing – Specimen collection codes G2023 and G2024 billed with modifier CG, used when provider 1) has a qualified ordering clinician ✓ ✓ ✓ Coverage Types Service MassHealth Standard & CommonHealth Enrollees MassHealth Family Assistance Enrollees CarePlus present at the specimen collection site available to order medically necessary COVID-19 diagnostic tests; and 2) ensures the test results are provided to the patient (along with any initial follow-up counseling, as appropriate), either directly or through the patient’s ordering clinician.