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

Quality Metrics and Reporting for Determining the Retrospective Performance Payment: General Principles. Under this Demonstration, Colorado will be eligible to receive a retrospective performance payment based on its performance on savings and quality 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: The State will receive the full retrospective performance payment in the first Demonstration year based on complete and accurate reporting of all measures included in that Demonstration year. In subsequent Demonstration years, the State is eligible to receive 60% of the retrospective performance payment by meeting the minimum quality threshold and may receive the remaining 40% of the retrospective performance payment scaled on performance above these thresholds. Measurement Groups: The Demonstration will consider quality for payment purposes in three grouping:  Model Core Measures  State-specific Process Measures  State-specific Demonstration Measures Benchmarking and Scoring State Performance: CMS will establish benchmarks for the Demonstration based on a set of principles. Once benchmark levels are set, CMS will provide the State with no less than 30 days to review the benchmark levels, the methodological considerations, and the data supporting any baseline calculations. All benchmarks will consider the population served under the Demonstration, and for measures in which the baseline is set from pre-Demonstration experience, the extent to which pre-Demonstration experience data are reflective of the Demonstration population. Benchmarks will include minimum achievement levels, improvement relative to those levels, or both (i.e., either/or). For claims-based measures, where it is feasible to assess experience prior to the start of the Demonstration, improvement-focused benchmarking will be based on improvement from the pre-Demonstration baseline. For measures for which the baseline cannot be based on pre-Demonstration experience, improvement- focused benchmarking will be based on improvement from the reporting period baseline. The State may earn credit on measures in two ways: