Quality Metrics and Reporting for Determining the Retrospective Performance Payment Sample Clauses

Quality Metrics and Reporting for Determining the Retrospective Performance Payment i. CMS will review and update the Demonstration core measures and measure specifications annually to ensure compliance with current science and measure development.
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Quality Metrics and Reporting for Determining the Retrospective Performance Payment. General Principles: Under this Demonstration, Washington will be eligible to receive a retrospective performance payment based on its performance on quality and savings criteria, as outlined in Appendix 6 and in this section. The quality metrics and requirements outlined in this Section are for purposes of determining the State’s retrospective performance payment. A separate evaluation conducted as part of the Demonstration will complement this analysis and more extensively examine beneficiary experiences, outcomes, and service utilization patterns. Additional discussion of the evaluation is provided in Appendix 7, Section 4. Approach: If the State meets the minimum quality threshold, it will receive 60% of the retrospective performance payment calculated in Appendix 6. Once the minimum quality threshold is met, the State may qualify to receive the remaining 40% of the retrospective performance payment, or some portion thereof, dependent upon State performance on the individual quality measures outlined in this Section. Measurement Groups: The Demonstration will consider quality for payment purposes in three grouping:  Model Core Measures  State-specific Process Measures  State-specific Demonstration Measures Quality Threshold: State performance on individual measures will be scored using a 100 point system with the highest score for an individual measure being 100 points, 0 the lowest. For purposes of determining whether the State meets the minimum quality threshold, measures will be grouped as outlined above, and a weighted average of those measure groupings will be used to calculate the State’s quality score. The State’s quality score will then be measured against the minimum quality threshold. If the State’s quality score meets or exceeds the minimum quality threshold, it will receive 60% of the retrospective performance payment calculated in Appendix 6. Once the minimum quality threshold is met, the State may receive up to 40% of the retrospective performance payment dependent upon State performance on the individual quality measures outlined in this Section. The portion of the 40% that the State receives will be based on the points earned for each individual measure. If the State does not meet the minimum quality threshold in a particular Demonstration year, no performance payment will be made for that Demonstration year and the State may be required to undergo a corrective action plan or to terminate the Demonstration.
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Related to Quality Metrics and Reporting for Determining the Retrospective Performance Payment

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