Common use of Statewide Health Outcomes and Quality of Care Targets Clause in Contracts

Statewide Health Outcomes and Quality of Care Targets. a. Vermont shall achieve the population-level health outcomes targets, healthcare delivery system quality targets, and process milestones (collectively “Statewide Health Outcomes and Quality of Care Targets”) as described in Appendix 1. b. Consequences for not being on track to achieve the population-level health outcomes targets. CMS may determine that the State is not on track to achieve at least four of the six population-level health targets, as described in Appendix 1.a.i through Appendix 1.a.iv, provided that the three chronic condition targets will be considered separately. If CMS makes such determinations, CMS may initiate the following remedies: i. CMS may determine it is a Triggering Event and issue the State a Warning Notice as described in section 21. ii. Any State CAP in response to this Triggering Event, as set forth in section 21, shall include the methodology the State will use to improve its performance against the population-level health outcomes targets for which the State is not on track to achieve. The State’s plan to improve its performance against the population-level health outcomes targets may include, but is not limited to, any or all of the following: increasing the State’s investments into community-based resources, or increasing the Vermont Medicare ACO Initiative Benchmark’s weight given to ACO quality performance. c. Consequences for not being on track to achieve the healthcare delivery system quality targets. CMS may determine that the State is not on track to achieve at least five of the nine healthcare delivery system quality targets, as described in Appendix 1.b.i through Appendix 0.x.xx, provided that Initiation and Engagement of Alcohol and Other Drug Dependence Treatment are considered separately, as are each of the Chronic Condition Targets for diabetes, hypertension, and multiple chronic conditions. If CMS makes such determinations, CMS may initiate the following remedies: i. CMS may determine it is a Triggering Event and issue the State a Warning Notice as described in section 21. ii. Any State CAP in response to this Triggering Event, as set forth in section 21, shall include the methodology the State will use to improve its performance against the healthcare delivery system quality targets for which the State is not on track to achieve. The State’s plan to improve its performance against the population-level health outcomes targets may include, but is not limited to, any or all of the following: increasing the State’s investments into community-based resources, increasing the Vermont ACO’s investments into community-based resources, or increasing the Vermont Medicare ACO Initiative Benchmark’s weight given to ACO quality performance. iii. If after implementation of the CAP for one year from its approval by CMS, CMS determines that the State is still not on track to achieve at least five of the nine healthcare delivery system quality targets, or if CMS rejects the CAP, CMS may take the following actions: 1) Establish or modify the quality measures and targets to which the Vermont Medicare ACO Initiative Benchmark is tied. 2) Directly set the percentage of the Vermont Medicare ACO Initiative Benchmark that is tied to quality for Medicare FFS beneficiaries aligned to the VMA ACO or Modified Next Generation ACO. d. Consequences for not being on track to achieve the process milestones. CMS may determine that the State is not on track to achieve at least five of the seven process milestones, as described in Appendix 1.c.i through Appendix 1.c.

Statewide Health Outcomes and Quality of Care Targets. a. Vermont shall achieve the population-level health outcomes targets, healthcare delivery system quality targets, and process milestones (collectively “Statewide Health Outcomes and Quality of Care Targets”) as described in Appendix 1. b. Consequences for not being on track to achieve the achieving population-level health outcomes targets. If CMS may determine determines that the State is not on track to achieve at least four of the six (note: each of the three chronic conditions targets will be considered separately) of the population-level health targets, as described in Appendix 1.a.i through Appendix 1.a.iv, provided that the three chronic condition targets will be considered separately. If CMS makes such determinations, CMS may initiate the following remedies: i. CMS may determine it is provide a Triggering Event and issue warning notice to the State in accordance with section 21 that the State is not on track to achieve a Warning Notice as described in section 21population-level health outcomes target, indicating the relevant target(s). ii. Any Within ninety days of receipt of the warning notice, Vermont shall submit to CMS, for CMS approval, a written response. CMS will review the State’s response within 90 calendar days and will either accept the response as sufficient or require the State to submit a Corrective Action Plan (CAP). The State’s CAP submission shall be in response to this Triggering Event, as accordance with the requirements set forth in section 21, and shall include the methodology on how the State will use to improve its performance against the population-level health outcomes targets target(s) for which the State is not on track to achieveachieve the target. The State’s plan to improve its performance against the population-level health outcomes targets target(s) may include, but is not limited to, any or all of the following: increasing the StateState and/or Vermont ACO’s investments into community-based resources, or resources and/or increasing the Vermont Medicare ACO Initiative Benchmark’s weight given to ACO quality performance. c. Consequences for not being on track to achieve the achieving healthcare delivery system quality targets. If CMS may determine determines that the State is not on track to achieve at least five four of the nine seven healthcare delivery system quality targets, as described in Appendix 1.b.i through Appendix 0.x.xx, provided that Initiation and Engagement of Alcohol and Other Drug Dependence Treatment are considered separately, as are each of the Chronic Condition Targets for diabetes, hypertension, and multiple chronic conditions. If CMS makes such determinations1.b.vii, CMS may initiate the following remedies: i. CMS may determine it is will provide a Triggering Event and issue warning notice to the State in accordance with section 21 that the State is not on track to achieve a Warning Notice as described in section 21healthcare delivery system quality target, indicating the relevant target(s). ii. Any Within ninety days of receipt of the warning notice, Vermont shall submit to CMS, for CMS approval, a written response. CMS will review the State’s response within 90 calendar days and will either accept the response as sufficient or require the State to submit a Corrective Action Plan (CAP). The State’s CAP submission shall be in response to this Triggering Event, as accordance with the requirements set forth in section 21, and shall include the methodology on how the State will use to improve its performance against the healthcare delivery system quality targets target(s) for which the State is not on track to achieveachieve the target. The State’s plan to improve its performance against the population-level health outcomes targets target(s) may include, but is not limited to, any or all of the following: increasing the State’s investments into community-based resources, increasing the State and/or Vermont ACO’s investments into community-based resources, or resources and/or increasing the Vermont Medicare ACO Initiative Benchmark’s weight given to ACO quality performance. iii. If after implementation of the CAP corrective action plan, per the start date in the corrective action plan, for one year from its approval by CMS, CMS determines that the State is still not on track to achieve at least five two-thirds of the nine healthcare delivery system quality targets, or if CMS the Innovation Center rejects the CAP, CMS may take the following actions: 1) Establish or modify Determine the quality measures and targets to which the Vermont Medicare ACO Initiative Benchmark is tied. 2) Directly set Determine the percentage of the Vermont Medicare ACO Initiative Benchmark that is tied to quality for Medicare FFS beneficiaries aligned to the VMA ACO or Modified Next Generation ACO. d. Consequences for not being on track to achieve the achieving process milestones. If CMS may determine determines that the State is not on track to achieve at least five of the seven process milestones, as described in Appendix 1.c.i through Appendix 1.c1.c.vii, CMS may initiate the following remedies: i. CMS may provide a warning notice to the State in accordance with section 21 that the State is not on track to achieve a process milestone, indicating the relevant process milestone(s). ii. Within ninety days of receipt of the warning notice, Vermont shall submit to CMS, for CMS approval, a written response. CMS will review the State’s response within 90 calendar days and will either accept the response as sufficient or require the State to submit a Corrective Action Plan (CAP). The State’s CAP submission shall be in accordance with the requirements set forth in section 21, and shall include methodology on how the State will improve its performance against the process milestone(s) for which the State is not on track to achieve.