Reducing Health Disparities. Article 3, Sections 3.01 and 3.02 5% of total performance penalty at risk. a. Expectation: Plan reports the percent of enrollees across all lines of business excluding Medicare who have self-identified race/ethnicity in the Application for Certification for 2017. This information will be used as baseline to set targets for percent of membership who have self-identified by end of 2017, which will be reported in 2018 through the Application for Certification for 2019, Data will be submitted in a run chart demonstrating improvement in collection of self-reported identity compared to baseline reported. Performance Levels: Contractor achieves no improvement in self-identified race/ethnicity: 2% penalty Contractor shows improvement in reported identity but does not meet target: no penalty Contractor achieves target improvement in self-reported identify: 2% credit b. Expectation: Covered California will have set targets for reduction in disparities for end of year 2019 and for annual intermediate milestones after baseline was reported. (Total of 10 metrics.) Contractor reports required HEDIS/IHA/non-HEDIS metrics across all lines of business excluding Medicare for diabetes, asthma, hypertension and depression by race/ethnicity and overall gender once the scores for 2017 performance become available, in July 2018. The scores will be reported in run charts demonstrating comparison with baseline 2016 performance, which will be reported in July 2017. Performance will be defined by the number of metrics where contractor has shown reduced disparities, and targets will be set once baseline data has been reported. Performance Levels: Contractor does not achieve target, and does not reduce disparities in the agreed upon number of metrics: 3% penalty Contractor achieves target, by reducing disparities in the agreed upon number of metrics: No penalty. Contractor exceeds target, by reducing disparities in more than the agreed upon number of metrics: 3% credit
Reducing Health Disparities. Attachment 7, Article 1, Sections 1.01 and 1.02 – 7.5% of At-Risk Amount Contractor will meet the target of eighty percent (80%) enrollee self-reported race or ethnicity data for Covered California Enrollees by year-end 2022. Contractor must demonstrate compliance by including valid race and ethnicity attributes for at least 80% of Covered California Enrollees in its Healthcare Evidence Initiative (HEI) data submissions. Please note the following specifications: a. See list of acceptable standard values in separate methodology document. b. “Other", "mixed", "multi-racial", etc. values do apply toward meeting the 80% race and ethnicity thresholds. c. “Null”, “blank”, "missing", “unknown”, "not reported", "decline to state", etc. values DO NOT apply toward meeting the 80% race and ethnicity thresholds. Performance Requirements 3.3a) Measurement Year 2017 No Assessment for Measurement Year 2017. Measurement Year 2018 Expectation: Meet 2018 intermediate milestone for self-reported racial or ethnic identify by the end of 2018. Performance Levels: Contractor achieves no improvement in self- reported identity from baseline: 2% penalty Contractor shows improvement in self- reported identity, but Measurement Year 2019 Expectation: Meet target of 80% self- reported racial or ethnic identify by the end of 2019. Performance Levels: Contractor achieves no improvement in self-reported identity from 2018 and does not meet 80% target: 2% penalty Measurement Year 2020 Expectation: Meet or continue to meet target of 80% self-reported racial or ethnic identity for Measurement Year 2020. Performance Levels: Contractor does not meet 80% target for self- reported identity: 2% penalty Contractor achieves 80% target for self- Measurement Year 2021 Expectation: Meet or continue to meet target of 80% self- reported racial or ethnic identity for Measurement Year 2021. Performance Levels: Contractor does not meet 80% target for self-reported Measurement Year 2022 Expectation: Meet the target of 80% self- reported race or ethnic identity for Measurement Year 2022. Performance Levels: Contractor does not meet 80% target for self- reported identity for Covered California Enrollees: 7.5% penalty Contractor meets 80% target for self-reported does not meet incremental target by end of 2018: No penalty Contractor achieves incremental target for self-reported identity by end of 2018: 2% credit Contractor achieves improvement in self- reported identity, but does not meet 80% target: No penalt...
Reducing Health Disparities. Disparities Reduction Intervention – Attachment 1, Article 1.03
Reducing Health Disparities. Article 3, Sections 3.01 and 3.02 5% of total performance penalty for this Group. a. Expectation: Contractor reports the percent of Exchange enrollees who have self-reported racial or ethnic identity in the Application for Certification for 2017. This information will be used as baseline to set incremental targets for percent of membership who have self-identified by end of 2017, which will be reported in 2018 through the Application for Certification for 2019. In 2020, the Contractor will report the percent of membership who have self- identified and will be measured against the 2019 target for 80% self- reported identity, to be reported in the Application for Certification for 2021. Data will be submitted in a run chart demonstrating improvement in the percentage of self-reported identity compared to baseline reported. Performance Levels: Contractor achieves no improvement in self-reported identity: 2% penalty Contractor shows improvement in self-reported identity but does not meet target: no penalty Contractor achieves target improvement in self-reported identity: 2% credit b. Expectation: The Exchange will set targets for reduction in disparities for end of year 2019 and for annual intermediate milestones after baseline was reported. Contractor reports required metrics across all lines of business excluding Medicare for diabetes, asthma, hypertension and depression by race/ethnicity and gender once the scores for 2017 performance become available, in July 2018. The scores will be reported in run charts demonstrating comparison with baseline 2016 performance, which will be reported in July 2017. The Exchange and Contractor will set an intermediate milestone for each measure against which performance in 2017 will assessed. Performance Levels: Contractor achieves intermediate milestones for less than half of all measures: 3% penalty Contractor achieves intermediate milestones for at least half of all measures: No penalty. Contractor achieves intermediate milestones for all measures: 3% credit
Reducing Health Disparities. Article 3, Sections 3.01 and 3.02 5% of total performance penalty at risk. a.
Reducing Health Disparities. Demographic Data Collection – Enrollee Spoken and Written Language – Attachment 1, Article 1.01 Contractor must include valid spoken and written language attributes for Enrollees in its HEI submissions for 2023 and must meet the negotiated annual standard for self-reported spoken and written language in 2024 and 2025. Contractor must demonstrate compliance by including valid spoken and written language attributes for Enrollees in its Healthcare Evidence Initiative (HEI) data submissions. Measurement Year 2023 Contractor does not include valid spoken and written language attributes for Enrollees in its HEI submissions: 10% penalty Contractor includes valid spoken and written language attributes for Enrollees in its HEI submissions: no penalty Measurement Year 2024 Contractor does not meet the negotiated annual standard for self- reported spoken language for Enrollees: 2.5% penalty Contractor does not meet the negotiated annual standard for self- reported written language for Enrollees: 2.5% penalty Contractor meets the negotiated annual standard for self-reported spoken and written language for Enrollees: no penalty Measurement Year 2025 Contractor does not meet the negotiated annual standard for self- reported spoken language for Enrollees: 2.5% penalty Contractor does not meet the negotiated annual standard for self- reported written language for Enrollees: 2.5% penalty Contractor meets the negotiated annual standard for self-reported spoken and written language for Covered California Enrollees: no penalty Performance Standards with Penalties Quality, Equity, And Delivery System Transformation Standards Performance Standard 3
Reducing Health Disparities. Demographic Data Collection – Enrollee Spoken and Written Language – Attachment 1, Article 1.01
