Common use of Agent of Record Exception Clause in Contracts

Agent of Record Exception. Reports 5% of total performance penalty for this Group. Pilot Period: January 1, 2017 – March 31, 2017 X Expectation: The Exchange shall receive the required Agent of Record exception reports referenced in Section 2.2.56(f) and (g) within 7 business days of the due date. Performance Level: Incomplete, irregular, late or non-useable data submission: 5% performance penalty. Complete monthly submissions within 7 business days of each monthly reporting cycle for at least 10 out of 12 submissions: no penalty. Group 3: Dental Quality Alliance (DQA) Pediatric Measure Set Measure Description Numerator Denominator QDP Performance Rate Expectation Utilization of Percentage of Unduplicated Unduplicated NUM/DEN 75% Services all enrolled children under age 19 who received at least one dental service within the reporting year. number of children who received at least one dental service. number of all enrolled children under age 19. Oral Percentage of Unduplicated Unduplicated NUM/DEN 75% Evaluation enrolled children under age 19 who received a comprehensive or periodic oral evaluation within the reporting year. number of children who received a comprehensive or periodic oral evaluation as a dental service. number of enrolled children under age 19. Sealants in 6 Percentage of Unduplicated Unduplicated NUM/DEN 75% to 9 years enrolled children in the age category of 6-9 years at “elevated” risk (i.e., “moderate” or “high”) who received a sealant on a permanent first molar tooth within the reporting year. number of all enrolled children age 6-9 years at “elevated” risk (i.e., “moderate” or “high”) who received a sealant on a permanent first molar tooth as a dental service. number of enrolled children age 6 - 9 years at “elevated” risk (i.e., “moderate” or “high”). Group 3: Dental Quality Alliance (DQA) Pediatric Measure Set Measure Description Numerator Denominator QDP Performance Rate Expectation Sealants in 10 to 14 years Percentage of enrolled children in the age category of 10-14 years at “elevated” risk (i.e., “moderate” or “high”) who received a sealant on a permanent second molar tooth within the reporting year. Unduplicated number of enrolled children age 10-14 years at “elevated” risk (i.e., “moderate” or “high”) who received a sealant on a permanent second molar tooth as a dental service. Unduplicated number of enrolled children age 10-14 years at “elevated” risk (i.e., “moderate” or “high”). NUM/DEN 75%

Agent of Record Exception. Reports 5% of total performance penalty for this Group. Pilot Period: January 1, 2017 – March 31, 2017 X Expectation: The Exchange shall receive the required Agent of Record exception reports referenced in Section 2.2.56(f) and (g) within 7 business days of the due date. Performance Level: Incomplete, irregular, late or non-useable data submission: 5% performance penalty. Complete monthly submissions within 7 business days of each monthly reporting cycle for at least 10 out of 12 submissionscycle: no penalty. Group 3: Dental Quality Alliance (DQA) Pediatric Measure Set Measure Description Numerator Denominator QDP Performance Rate Expectation Utilization of Services Percentage of Unduplicated Unduplicated NUM/DEN 75% Services all enrolled children under age 19 who received at least one dental service within the reporting year. Unduplicated number of children who received at least one dental service. Unduplicated number of all enrolled children under age 19age19. Oral Percentage of Unduplicated Unduplicated NUM/DEN 75% Oral Evaluation Percentage of enrolled children under age 19 who received a comprehensive or periodic oral evaluation within the reporting year. Unduplicated number of children who received a comprehensive or periodic oral evaluation as a dental service. Unduplicated number of enrolled children under age 19age19. NUM/DEN 75% Sealants in 6 Percentage of Unduplicated Unduplicated NUM/DEN 75% to 9 years enrolled number of all number of children in the enrolled children enrolled age category of age 6-9 years at children age 6 6-9 years at “elevated” risk - 9 years at “elevated” risk (i.e., “moderate” “elevated” risk (i.e., “moderate” or “high”) who (i.e., or “high”) who received a “moderate” or received a sealant on a “high”). sealant on a permanent first permanent first molar tooth as a molar tooth dental service. within the reporting year. Sealants in Percentage of Unduplicated Unduplicated NUM/DEN 75% 10 to 14 enrolled number of all number of years children in the enrolled children enrolled age 6category of age 10-9 14 years children age 10-14 years at at “elevated” risk 10-14 years at “elevated” risk (i.e., “moderate” “elevated” risk (i.e., “moderate” or “high”) who received a sealant on a permanent first molar tooth as a dental service. number of enrolled children age 6 - 9 years at “elevated” risk (i.e., “moderate” or “high”). Group 3: Dental Quality Alliance (DQA) Pediatric Measure Set Measure Description Numerator Denominator QDP Performance Rate Expectation Sealants in 10 to 14 years Percentage of enrolled children in the age category of 10-14 years at “elevated” risk (i.e., “moderate” or “high”) who received a “moderate” or received a sealant on a “high”). sealant on a permanent permanent second molar second molar tooth as a dental tooth within the service. reporting year. Topical Percentage of Unduplicated Unduplicated NUM/DEN 75% Fluoride for enrolled number of number of Children at children aged 1- children at enrolled Elevated 18 years who “elevated” risk children age 10aged Caries Risk are at (i.e. “moderate” 1-14 18 years at “elevated” risk (i.e., “moderate” or “high”) who received a sealant on a permanent second molar tooth as a dental service. Unduplicated number of enrolled children age 10-14 years at “elevated” risk (i.e., i.e. “moderate” received at least (i.e. or “high”) who 2 topical fluoride “moderate” or received at applications as a “high”). least 2 topical dental service. fluoride applications within the reporting year. Ambulatory Number of Number of ED All member (NUM/DEN) x < 15% Care emergency visits with caries- months for 100,000 Sensitive department related diagnosis enrollees 0 Emergency (ED) visits for code among all through 18 Department caries-related enrolled children. years during Visits for reasons per the reporting Dental 100,000 year. Caries in member Children months for all enrolled children. Follow-Up The percentage Number of Number of NUM/DEN 75%% After ED of caries-related caries-related ED caries-related Visit by emergency visits in the ED visits in the Children for department reporting year for reporting year. Dental visits among which the Caries children 0 member visited a through 18 dentist within 7 years in the days (NUM) of reporting year the ED visit. for which the member visited a dentist within 7 days of the ED visit. Follow-Up The percentage Number of Number of NUM/DEN 90% After ED of caries-related caries-related ED caries-related Visit by emergency visits in the ED visits in the Children for department reporting year for reporting year. Dental visits among which the Caries children 0 member visited a through 18 dentist within 30 years in the days (NUM) of reporting year the ED visit. for which the member visited a dentist within 30 days of the ED visit. Group 34: Covered California Performance Measurement Standards and Reporting Requirements Utilization Measures for Adult Dental Utilization Measures Performance Measurement Standards Covered California will work with contractors as appropriate to adjust measure sets where a contractor does not have all of the specific Utilization measures. Annual Dental Visit (ADV) Measure includes all members ages 19 years and older as of December 31, 2016 (denominator) who had at least one dental visit in 2016 (numerator). Measure include members enrolled for at least 11 of the 12 months in 2016. Age Expectation Group 19+ 75% Preventive Dental Services (PDS). Measure includes members enrolled for at least 11 of the 12 months in 2016 (denominator) who received any preventive dental service (D1000- D1999) in 2016 (numerator). Age Expectation Group 19+ 75% Use of Dental Treatment Services (UDTS). Measure includes members enrolled for at least 11 of the 12 months of 2016 (denominator) who received any dental treatment other than diagnostic or preventive services (D2000-D9999) in 2016 (numerator). Age Group Expectation 19+ 75% Group 45: Covered California Performance Standards for Contractor: Quality and Delivery System Reform The following questions support the narrative reporting requirement for Performance Measurement Standards. In performing its services under this agreement, Contractor shall use commercially reasonable efforts to meet or exceed the Performance Measurement Standards. Group 45 expectations apply equally to individual and small group lines of business and should be reported separately. The completed questions are to be submitted to Covered California by February 28, 20178 in electronic format to be determined by Covered California. 45.1 Attachment 7, 1.03(b)