Common use of Quality Challenge Award Program Clause in Contracts

Quality Challenge Award Program. Should one or more MCOs be unable to earn the full amount of the performance-based at-risk portion of the Capitation Rate, HHSC may reallocate the funds through the MCO Program's Quality Challenge Award. Under this program, HHSC may use these funds to reward MCOs that demonstrate superior clinical quality, service delivery, access to care, or Member satisfaction. HHSC will determine the number of MCOs that will receive Quality Challenge Award funds annually based on the amount of the funds to be reallocated. Separate Quality Challenge Award payments will be made for each of the MCO Programs. As with the performance-based Capitation Rate, each MCO will be evaluated separately for each MCO Program. HHSC may evaluate MCO performance annually on some combination of performance indicators in order to determine which MCOs demonstrate superior performance. In no event will a distribution from the Quality Challenge Award, plus any other incentive payments made in accordance with the MCO Contract, when combined with the Capitation Rate payments, exceed 105% of the Capitation Rate payments to an MCO. Measures utilized for the Quality Challenge Program may be the same as those used in the Performance-Based Capitation Rate Program, or may be different than those selected for the Performance-Based Capitation Rate Program. Information about the data collection period to be used and each indicator that will be considered for any specific time period can be found in Uniform Managed Care Manual Chapter 6.2.6, "Quality Challenge Award Performance Indicators." Failure to provide timely and accurate information may result in HHSC's assignment of a 0% performance rate for each applicable Quality Challenge Award indicator. HHSC may evaluate the Quality Challenge Award methodology annually in consultation with MCOs. HHSC may make methodology modifications annually as it deems necessary and appropriate to motivate, recognize, and reward MCOs for superior performance based on available Quality Challenge Award funds and/or other performance incentives applicable to the award. HHSC may include the Quality Challenge Award methodology and risk adjustment factors, or any other modifications in Uniform Managed Care Manual Chapter 6.2.6, "Quality Challenge Award Performance Indicators."