Common use of Clinical Performance Measures Clause in Contracts

Clinical Performance Measures. MCP performance will be assessed based on the analysis of submitted encounter data for each year. For certain measures, standards are established; the identification of these standards is not intended to limit the assessment of other indicators for performance improvement activities. Performance on multiple measures will be assessed and reported to the MCPs and others, including Medicaid consumers. The clinical performance measures described below closely follow the National Committee for Quality Assurance's Health Plan Employer Data and Information Set(HEDIS). Minor adjustments to HEDIS measures were required to account for the differences between the commercial population and the Medicaid population such as shorter and interrupted enrollment periods. NCQA may annually change its method for calculating a measure. These changes can make it difficult to evaluate whether improvement occurred from a prior year. For this reason, ODJFS will use the same methods to calculate the baseline results and the results for the period in which the MCP is being held accountable. For example, the same methods were being used to calculate calendar year 2003 results (the baseline period) and calendar year 2004 results. The methods will be updated and a new baseline will be created during 2005 for calendar year 2004 results. These results will then serve as the baseline to evaluate whether improvement occurred from calendar year 2004 to calendar year 2005. Clinical performance measure results will be calculated after a sufficient amount of time has passed after the end of the report period in order to allow for claims runout. For a comprehensive description of the clinical performance measures below, see ODJFS Methods for Clinical Performance Measures. Performance standards are subject to change based on the revision or update of NCQA methods or other national standards, methods or benchmarks. For an MCP which had membership as of January 1, 2006: Prior to the transition to the regional-based approach. MCP performance will be evaluated using an MCP's statewide result for the counties in which the MCP had membership as of January 1.2006. For reporting periods CY 0000 Xxxxxxxx M and CY 2008, targets and performance standards for Clinical Performance Measures in this Appendix (l.c.i - l.c.vii) will be applicable to all counties in which MCPs had membership as of January 1, 2006. The final reporting year for the counties in which an MCP had membership as of January 1, 2006, will be CY 2008. ^ For any MCP which did not have membership as of January 3. 2006: Performance will be evaluated using a regional-based approach for any active region in which the MCP had membership. Regional-Based Approach: MCPs will be evaluated by region, using results for all counties included in the region. CY 2008 will be the first reporting year that MCPs will be held accountable to the performance standards for an active region, and penalties will be applied for noncompliance. CY 2007 will be the first baseline reporting year for an active region. ODJFS will use a sufficient amount of data needed per performance measure from all MCPs serving an active region to determine performance standards and targets for that region. For example, should a measure call for one calendar year of baseline data. the first full calendaryearofdata will be used. CY 2008 will be the first reporting year for measures that call for one year of baseline data. Should a measure call for two calendar years of baseline data, the first two full calendar years of data will be used. CY 2009 will be the first reporting year for measures that call for two years of baseline data. Report Period: For the SPY 2006 contract period, performance will be evaluated using the January -December 2005 report period. For the SFY 2007 contract period, performance will be evaluated using the January - December 2006 report period. For the SFY 2008 contract period, performance will be evaluated using the January - December 2007 report period.

Clinical Performance Measures. MCP performance will be assessed based on the analysis of submitted encounter data for each year. For certain measures, standards are established; the identification of these standards is not intended to limit the assessment of other indicators for performance improvement activities. Performance on multiple measures will be assessed and reported to the MCPs and others, including Medicaid consumers. The clinical performance measures described below closely follow the National Committee for Quality Assurance's Health Plan Employer Data and Information Set(HEDISSet (HEDIS). Minor adjustments to HEDIS measures were required to account for the differences between the commercial population and the Medicaid population such as shorter and interrupted enrollment periods. NCQA may Appendix M Covered Families and Children (CFC) population Page 5 annually change its method for calculating a measure. These changes can make it difficult to evaluate whether improvement occurred from a prior year. For this reason, ODJFS will use the same methods to calculate the baseline results and the results for the period in which the MCP is being held accountable. For example, the same methods were being used to calculate calendar year 2003 2005 results (the baseline period) and calendar year 2004 2006 results. The methods will be updated and a new baseline will be created during 2005 2007 for calendar year 2004 2006 results. These results will then serve as the baseline to evaluate whether improvement occurred from calendar year 2004 2006 to calendar year 20052007. Clinical performance measure results will be calculated after a sufficient amount of time has passed after the end of the report period in order to allow for claims runout. For a comprehensive description of the clinical performance measures below, see ODJFS Methods for Clinical Performance MeasuresMeasures for the Medicaid CFC Managed Care Program. Performance standards are subject to change based on the revision or update of NCQA methods or other national standards, methods or benchmarks. For an MCP which had membership as of January 1, 2006: Prior to the transition to the regional-based approach. MCP performance will be evaluated using an MCP's statewide result for the counties in which the MCP had membership as of January 1.2006. For reporting periods CY 0000 Xxxxxxxx M and CY 2008, targets and performance standards for Clinical Performance Measures in this Appendix (l.c.i - l.c.vii) will be applicable to all counties in which MCPs had membership as of January 1, 2006. The final reporting year for the counties in which an MCP had membership as of January 1, 2006, will be CY 2008. ^ For any MCP which did not have membership as of January 3. 2006: Performance will be evaluated using a regional-based approach for any active region in which the MCP had membership. Regional-Based Approach: MCPs will be evaluated by region, using results for all counties included in the region. CY 2008 will be the first reporting year that MCPs will be held accountable to the performance standards for an active region, and penalties will be applied for noncompliance. CY 2007 will be the first baseline reporting year for an active region. ODJFS will use a sufficient amount of data needed per performance measure from all MCPs serving an active region to determine performance standards and targets for that region. For example, should a measure call for one calendar year of baseline data. the first full calendaryearofdata will be used. CY 2008 will be the first reporting year for measures that call for one year of baseline data. Should a measure call for two calendar years of baseline data, the first two full calendar years of data will be used. CY 2009 will be the first reporting year for measures that call for two years of baseline data. Report Period: For the SPY 2006 contract period, performance will be evaluated using the January -December 2005 report period. For the SFY 2007 contract period, performance will be evaluated using the January - December 2006 report period. For the SFY 2008 contract period, performance will be evaluated using the January - December 2007 report period.

Clinical Performance Measures. MCP performance will be assessed based on the analysis of submitted encounter data for each year. For certain measures, standards are established; the identification of these standards is not intended to limit the assessment of other indicators for performance improvement activities. Performance on multiple measures will be assessed and reported to the MCPs and others, including Medicaid consumers. The clinical performance measures described below closely follow the National Committee for Quality Assurance's Health Plan Employer ’s Healthcare Effectiveness Data and Information Set(HEDISSet (HEDIS). Minor adjustments to HEDIS measures were are required to account for the differences between the commercial population and the Medicaid population population, such as shorter and interrupted enrollment periods. NCQA may annually change its method for calculating a measure. These changes can make it difficult to evaluate whether improvement occurred from a prior year. For this reason, ODJFS will use the same methods to calculate the baseline results and the results for the period in which the MCP is being held accountable. For example, the same methods were being used to calculate calendar year 2003 2005 results (the baseline period) and calendar year 2004 2006 results. The methods will be updated and a new baseline will be created during 2005 2007 for calendar year 2004 2006 results. These results will then serve as the baseline to evaluate whether improvement occurred from calendar year 2004 2006 to calendar year 20052007. Clinical performance measure results will be calculated after a sufficient amount of time has passed after the end of the report period in order to allow for claims runout. For a comprehensive description of the clinical performance measures below, see ODJFS Methods for Clinical Performance MeasuresMeasures for the CFC Managed Care Program. Performance standards are subject to change based on the revision or update of NCQA methods or other national standards, methods or benchmarks. For an MCP which had membership as of January 1, 2006: Prior to the transition to the regional-based approach. MCP performance will be evaluated using an MCP's statewide result for the counties in which the MCP had membership as of January 1.2006. For reporting periods CY 0000 Xxxxxxxx Appendix M Covered Families and CY 2008, targets and performance standards for Clinical Performance Measures in this Appendix Children (l.c.i - l.c.viiCFC) will be applicable to all counties in which MCPs had membership as of January 1, 2006. The final reporting year for the counties in which an MCP had membership as of January 1, 2006, will be CY 2008. ^ For any MCP which did not have membership as of January 3. 2006: Performance will be evaluated using a regional-based approach for any active region in which the MCP had membership. Regional-Based Approach: MCPs will be evaluated by region, using results for all counties included in the region. CY 2008 will be the first reporting year that MCPs will be held accountable to the performance standards for an active region, and penalties will be applied for noncompliance. CY 2007 will be the first baseline reporting year for an active region. ODJFS will use a sufficient amount of data needed per performance measure from all MCPs serving an active region to determine performance standards and targets for that region. For example, should a measure call for one calendar year of baseline data. the first full calendaryearofdata will be used. CY 2008 will be the first reporting year for measures that call for one year of baseline data. Should a measure call for two calendar years of baseline data, the first two full calendar years of data will be used. CY 2009 will be the first reporting year for measures that call for two years of baseline data. Report Period: For the SPY 2006 contract period, performance will be evaluated using the January -December 2005 report period. For the SFY 2007 contract period, performance will be evaluated using the January - December 2006 report period. For the SFY 2008 contract period, performance will be evaluated using the January - December 2007 report period.population

Clinical Performance Measures. MCP performance will be assessed based on the analysis of submitted encounter data for each year. For certain measures, standards are established; : the identification of these standards is not intended to limit the assessment of other indicators for performance improvement activities. Performance on multiple measures will be assessed and reported to the MCPs and others, including Medicaid consumers. The clinical performance measures described below closely follow the National Committee for Quality Assurance's Health Plan Employer Data and Information Set(HEDIS). Minor adjustments to HEDIS measures were required to account for the forthe differences between the commercial population and the Medicaid population such as shorter and interrupted enrollment periods. NCQA may annually change its method for calculating a measure. These changes can make it difficult to evaluate whether improvement occurred from a prior year. For this reason, ODJFS OD.IFS will use the same methods to calculate the baseline results and the results for the period in which the MCP is being held accountable. For example, the same methods were being used to calculate calendar year 2003 results (the baseline period) and calendar year 2004 results. The methods will be updated and a new baseline will be created during 2005 for calendar year 2004 results. These results will then serve as the baseline to evaluate whether improvement occurred from calendar year 2004 to calendar year 2005. Clinical performance measure results will be calculated after a sufficient amount of time has passed after the end of the report period in order to allow for claims runout. For a comprehensive description of the clinical performance measures below, see ODJFS Methods for Appendix M Clinical Performance Measures/or (he Medicaid CFC Managed Care Program. Performance standards are subject to change based on the revision or update of NCQA ofNCQA methods or other national standards, methods or benchmarks. For an MCP which had membership as of January 1February51, 2006: Prior to the transition to the regional-based approach. MCP performance will be evaluated using an MCP's statewide result for the counties in which the MCP had membership as of January 1.2006February 1,2006. For reporting periods CY 0000 Xxxxxxxx M 2007 and CY 2008, targets and performance standards for Clinical Performance Measures in this Appendix (l.c.i - l.c.vii) will be applicable to all counties in which MCPs had membership as of January February 1, 2006. The final reporting year for the counties in which an MCP had membership as of January February 1, 2006, will be CY 2008. ^ For any MCP which did not have membership as of January 3. February 7, 2006: Performance will be evaluated using a regional-based approach for any active region in which the MCP had membership. Regional-Based ApproachBasedApproach: MCPs will be evaluated by region, using results for all counties included in the region. CY 2008 will be the first reporting year that MCPs will be held accountable to the performance standards for an active region, and penalties will be applied for noncompliance. CY 2007 will be the first baseline reporting year for an active region. ODJFS will use a sufficient amount of data needed per performance measure from all MCPs serving an active region to determine performance standards and targets for that region. For example, should a measure call for one calendar year of baseline data. the first full calendaryearofdata calendar year data will be used. CY 2008 will be the first reporting year for measures that call for one year of baseline data. Should a measure call for two calendar years of baseline data, the first two full calendar years of data will be used. CY 2009 will be the first reporting year for measures that call for two tw''o years of baseline data. Report Period: In order to adhere to the statewide expansion timeline. reporting periods may be adjusted based on the number of months of managed care membership. For the SPY 2006 contract period, performance will be evaluated using the January -December - December 2005 report period. For the SFY 2007 contract period, performance will be evaluated using the January - December 2006 report period. For the SFY 2008 contract period, performance will be evaluated using the January - December -December 2007 report period.

Clinical Performance Measures. MCP performance will be assessed based on the analysis of submitted encounter data for each year. For certain measures, standards are established; the identification of these standards is not intended to limit the assessment of other indicators for performance improvement activities. Performance on multiple measures will be assessed and reported to the MCPs and others, including Medicaid consumers. The clinical performance measures described below closely follow the National Committee for Quality Assurance's ’s Health Plan Employer Data and Information Set(HEDISSet (HEDIS). Minor adjustments to HEDIS measures were required to account for the differences between the commercial population and the Medicaid population such as shorter and interrupted enrollment periods. NCQA may annually change its method for calculating a measure. These changes can make it difficult to evaluate whether improvement occurred from a prior year. For this reason, ODJFS will use the same methods to calculate the baseline results and the results for the period in which the MCP is being held accountable. For example, the same methods were being used to calculate calendar year 2003 2005 results (the baseline period) and calendar year 2004 2006 results. The methods will be updated and a new baseline will be created during 2005 2007 for calendar year 2004 2006 results. These results will then serve as the baseline to evaluate whether improvement occurred from calendar year 2004 2006 to calendar year 20052007. Clinical performance measure results will be calculated after a sufficient amount of time has passed after the end of the report period in order to allow for claims runout. For a comprehensive description of the clinical performance measures below, see ODJFS Methods for Clinical Performance MeasuresMeasures for the Medicaid CFC Managed Care Program. Performance standards are subject to change based on the revision or update of NCQA methods or other national standards, methods or benchmarks. For an MCP which had membership as of January February 1, 2006: Prior to the transition to the regional-based approach. , MCP performance will be evaluated using an MCP's ’s statewide result for the counties in which the MCP had membership as of January 1.2006February 1, 2006. For reporting periods CY 0000 Xxxxxxxx M 2007 and CY 2008, targets and performance standards for Clinical Performance Measures in this Appendix (l.c.i - l.c.vii1.c.i – 1.c.vii) will be applicable to all counties in which MCPs had membership as of January February 1, 2006. The final reporting year for the counties in which an MCP had membership as of January February 1, 2006, will be CY 2008. ^ For any MCP which did not have membership as of January 3. February 1, 2006: Performance will be evaluated using a regional-based approach for any active region in which the MCP had membership. Regional-Based Approach: MCPs will be evaluated by region, using results for all counties included in the region. CY 2008 will be the first reporting year that MCPs will be held accountable to the performance standards for an active region, and penalties will be applied for noncompliance. CY 2007 will be the first baseline reporting year for an active region. ODJFS will use a sufficient amount of data needed per performance measure from all MCPs serving an active region to determine performance standards and targets for that region. For example, should a measure call for one calendar year of baseline data. the , first full calendaryearofdata calendar year data will be used. CY 2008 will be the first reporting year for measures that call for one year of baseline data. Should a measure call for two calendar years of baseline data, the first two full calendar years of data will be used. CY 2009 will be the first reporting year for measures that call for two years of baseline data. Report Period: For In order to adhere to the SPY 2006 contract periodstatewide expansion timeline, performance will reporting periods may be evaluated using adjusted based on the January -December 2005 report periodnumber of months of managed care membership. For the SFY 2007 contract period, performance will be evaluated using the January - December 2006 report period. For the SFY 2008 contract period, performance will be evaluated using the January - December 2007 report period. For the SFY 2009 contract period, performance will be evaluated using the January – December 2008 report period.

Clinical Performance Measures. Appendix M Aged, Blind or Disabled (ABD) population Page 5 MCP performance will be assessed based on the analysis of submitted encounter data for each year. For certain measures, standards are established; the identification of these standards is not intended to limit the assessment of other indicators for performance improvement activities. Performance on multiple measures will be assessed and reported to the MCPs and others, including Medicaid consumers. The clinical performance measures described below closely follow the National Committee for Quality Assurance's ’s (NCQA) Health Plan Employer Data and Information Set(HEDISSet (HEDIS). Minor adjustments to HEDIS measures were required to account for the differences between the commercial population and the Medicaid population such as shorter and interrupted enrollment periods. NCQA may annually change its method for calculating a measure. These changes can make it difficult to evaluate whether improvement occurred from a prior year. For this reason, ODJFS will use the same methods to calculate the baseline results and the results for the period in which the MCP is being held accountable. For example, the same methods were being are used to calculate calendar year 2003 2008 results (the baseline period) and calendar year 2004 2009 results. The methods will be updated and a new baseline will be created during 2005 2009 for calendar year 2004 2010 results. These results will then serve as the baseline to evaluate whether improvement occurred from calendar year 2004 2009 to calendar year 20052010. Clinical performance measure results will be calculated after a sufficient amount of time has passed after the end of the report period in order to allow for claims runout. For a comprehensive description of the clinical performance measures below, see ODJFS Methods for Clinical Performance Measures, ABD Medicaid Managed Care Program. Performance standards are subject to change change, based on the revision or update of NCQA methods or other national standards, methods or benchmarks. For an MCP which had membership as of January 1, 2006: Prior to the transition to the regional-based approach. MCP performance will be evaluated using an MCP's statewide result for the counties in which the MCP had membership as of January 1.2006. For reporting periods CY 0000 Xxxxxxxx M and CY 2008, targets and performance standards for Clinical Performance Measures in this Appendix (l.c.i - l.c.vii) will be applicable to all counties in which MCPs had membership as of January 1, 2006. The final reporting year for the counties in which an MCP had membership as of January 1, 2006, will be CY 2008. ^ For any MCP which did not have membership as of January 3. 2006: Performance will be evaluated using a regional-based approach for any active region statewide result, including all regions in which the an MCP had has membership. Regional-Based Approach: MCPs will be evaluated by region, using results for all counties included in the region. CY 2008 will be the first reporting year that MCPs will be held accountable to the performance standards for an active region, and penalties will be applied for noncompliance. CY 2007 will be the first baseline reporting year for an active region. ODJFS will use a sufficient amount the first calendar year of data needed per performance measure from all MCPs serving an active region MCP’s ABD managed care program membership as the baseline year (i.e., CY2007). The baseline year will be used to determine performance standards and targets for that regiontargets; baseline data will come from a combination of FFS claims data and MCP encounter data. For example, should a measure call for one calendar year of baseline data. the first full calendaryearofdata will be used. CY 2008 will be the first reporting year for those performance measures that call for one year of baseline data. Should a measure call for require two calendar years of baseline data, the additional calendar year (i.e., the calendar year prior to the first calendar year of ABD managed care program membership, i.e., CY2006) data will come from FFS claims data. An MCP’s second calendar year of ABD managed care program membership (i.e., CY2008) will be the initial report period of evaluation for performance measures that require one calendar year of baseline data (i.e., CY2007), and for performance measures that require two full calendar years of baseline data will be used. CY 2009 will be the first reporting year for measures that call for two years of baseline data. Report Period: For the SPY 2006 contract period(i.e., performance will be evaluated using the January -December 2005 report period. For the SFY 2007 contract period, performance will be evaluated using the January - December 2006 report period. For the SFY 2008 contract period, performance will be evaluated using the January - December 2007 report periodCY2006 and CY2007).

Clinical Performance Measures. MCP performance will be assessed based on the analysis of submitted encounter data for each year. For certain measures, standards are established; the identification of these standards is not intended to limit the assessment of other indicators for performance improvement activities. Performance on multiple measures will be assessed and reported to the MCPs and others, including Medicaid consumers. The clinical performance measures described below closely follow the National Committee for Quality Assurance's (NCQA) Health Plan Employer Data and Information Set(HEDISSet (HEDIS). Minor adjustments to HEDIS measures were required to account for the differences between the commercial population and the Medicaid population such as shorter and interrupted enrollment periods. NCQA may annually change its method for calculating a measure. These changes can make it difficult to evaluate whether improvement occurred from a prior year. For this reason, ODJFS will use the same methods to calculate the baseline results and the results for the period in which the MCP is being held accountable. For example, the same methods were being are used to calculate calendar year 2003 2008 results (the baseline period) and calendar year 2004 2009 results. The methods will be updated and a new baseline will be created during 2005 2009 for calendar year 2004 2010 results. These results will then serve as the baseline to evaluate whether improvement occurred from calendar year 2004 2009 to calendar year 20052010. Clinical performance measure results will be calculated after a sufficient amount of time has passed after the end of the report period in order to allow for claims runout. For a Appendix M comprehensive description of the clinical performance measures below, see ODJFS Methods for Clinical Performance Measures, ABD Medicaid Managed Care Program. Performance standards are subject to change change, based on the revision or update of NCQA ofNCQA methods or other national standards, methods or benchmarks. For an MCP which had membership as of January 1, 2006: Prior to the transition to the regional-based approach. MCP performance will be evaluated using an MCP's statewide result for the counties in which the MCP had membership as of January 1.2006. For reporting periods CY 0000 Xxxxxxxx M and CY 2008, targets and performance standards for Clinical Performance Measures in this Appendix (l.c.i - l.c.vii) will be applicable to all counties in which MCPs had membership as of January 1, 2006. The final reporting year for the counties in which an MCP had membership as of January 1, 2006, will be CY 2008. ^ For any MCP which did not have membership as of January 3. 2006: Performance will be evaluated using a regional-based approach for any active region statewide result, including all regions in which the an MCP had has membership. Regional-Based Approach: MCPs will be evaluated by region, using results for all counties included in the region. CY 2008 will be the first reporting year that MCPs will be held accountable to the performance standards for an active region, and penalties will be applied for noncompliance. CY 2007 will be the first baseline reporting year for an active region. ODJFS will use a sufficient amount the first calendar year of data needed per performance measure from all MCPs serving an active region MCP's ABD managed care program membership as the baseline year (i.e., CY2007). The baseline year will be used to determine performance standards and targets for that regiontargets; baseline data will come from a combination ofFFS claims data and MCP encounter data. For example, should a measure call for one calendar year of baseline data. the first full calendaryearofdata will be used. CY 2008 will be the first reporting year for those performance measures that call for one year of baseline data. Should a measure call for require two calendar years of baseline data, the additional calendar year (i.e., the calendar year prior to the first calendar year of ABD managed care program membership, i.e., CY2006) data will come from FFS claims data. An MCP's second calendar year of ABD managed care program membership (i.e., CY2008) will be the initial report period of evaluation for performance measures that require one calendar year of baseline data (i.e., CY2007), and for performance measures that require two full calendar years of baseline data will be used. CY 2009 will be the first reporting year for measures that call for two years of baseline data. Report Period: For the SPY 2006 contract period(i.e., performance will be evaluated using the January -December 2005 report period. For the SFY 2007 contract period, performance will be evaluated using the January - December 2006 report period. For the SFY 2008 contract period, performance will be evaluated using the January - December 2007 report periodCY2006 and CY2007).

Clinical Performance Measures. MCP performance will be assessed based on the analysis of submitted encounter data for each year. For certain measures, standards are established; the identification of these standards is not intended to limit the assessment of other indicators for performance improvement activities. Performance on multiple measures will be assessed and reported to the MCPs and others, including Medicaid consumers. The clinical performance measures described below closely follow the National Committee for Quality Assurance's ’s Health Plan Employer Data and Information Set(HEDISSet (HEDIS). Minor adjustments to HEDIS measures were are required to account for the differences between the commercial population and the Medicaid population population, such as shorter and interrupted enrollment periods. NCQA may annually change its method for calculating a measure. These changes can make it difficult to evaluate whether improvement occurred from a prior year. For this reason, ODJFS will use the same methods to calculate the baseline results and the results for the period in which the MCP is being held accountable. For example, the same methods were being used to calculate calendar year 2003 2005 results (the baseline period) and calendar year 2004 2006 results. The methods will be updated and a new baseline will be created during 2005 2007 for calendar year 2004 2006 results. These results will then serve as the baseline to evaluate whether improvement occurred from calendar year 2004 2006 to calendar year 20052007. Clinical performance measure results will be calculated after a sufficient amount of time has passed after the end of the report period in order to allow for claims runout. For a comprehensive description of the clinical performance measures below, see ODJFS Methods for Clinical Performance MeasuresMeasures for the CFC Managed Care Program. Performance standards are subject to change based on the revision or update of NCQA methods or other national standards, methods or benchmarks. For an MCP which had membership as of January February 1, 2006: Prior to the transition to the regional-based approach. MCP performance will be evaluated using an MCP's ’s county-based statewide result for the counties in which the MCP had membership Appendix M Covered Families and Children (CFC) population Page 7 as of January 1.2006February 1, 2006. For reporting periods CY 0000 Xxxxxxxx M 2007 and CY 2008, targets and performance standards for Clinical Performance Measures in this Appendix (l.c.i - l.c.vii1.c.i — 1.c.vii) will be applicable to all counties in which MCPs had membership as of January February 1, 2006. The final reporting year for the counties in which an MCP had membership as of January February 1, 2006, will be CY 2008. ^ For any MCP which did not have membership as of January 3. February 1, 2006: Performance will be evaluated using a regional-based statewide approach for any all active region regions and counties (Trumbull and Mahoning) in which the MCP had has membership. Regional-Based Statewide Approach: MCPs will be evaluated by regionstatewide, using results for all active regions and counties included (Mahoning and Trumbull) in which the regionMCP has membership. For measures requiring one year of baseline data, ODJFS will use the first full calendar year of data (CY 2007 — which may be adjusted based on the number of months of managed care membership) from all MCPs serving CFC membership to determine statewide minimum performance standards. CY 2008 will be the first reporting year that MCPs will be held accountable to the statewide performance standards for an active regionone year measures, and penalties will be applied for noncompliance. CY 2007 will be the first baseline reporting year for an active region. ODJFS will use a sufficient amount of data needed per performance measure from all MCPs serving an active region to determine performance standards and targets for that region. For example, should a measure call for one calendar year of baseline data. the first full calendaryearofdata will be used. CY 2008 will be the first reporting year for measures that call for one year of baseline data. Should a measure call for requiring two calendar years of baseline data, ODJFS will use the first two full calendar years of data will (CY 2007 and CY 2008 — which may be usedadjusted based on the number of months of managed care membership) from all MCPs serving CFC membership to determine statewide minimum performance standards. CY 2009 will be the first reporting year for measures that call MCPs will be held accountable to the statewide performance standards for two years of baseline data. Report Period: For the SPY 2006 contract periodyear measures, performance and penalties will be evaluated using the January -December 2005 report periodapplied for noncompliance. For the SFY 2007 contract period, Statewide performance measure results will be evaluated using calculated after a sufficient amount of time has passed after the January - December 2006 end of the report period. For the SFY 2008 contract period, performance will be evaluated using the January - December 2007 report periodperiod in order to allow for claims runout.

Clinical Performance Measures. MCP performance will be assessed based on the analysis of submitted encounter data for each year. For certain measures, standards are established; the identification of these standards is not intended to limit the assessment of other indicators for performance improvement activities. Performance on multiple measures will be assessed and reported to the MCPs and others, including Medicaid consumers. The clinical performance measures described below closely follow the National Committee for Quality Assurance's ’s Health Plan Employer Data and Information Set(HEDISSet (HEDIS). Minor adjustments to HEDIS measures were required to account for the differences between the commercial population and the Medicaid population such as shorter and interrupted enrollment periods. NCQA may annually change its method for calculating a measure. These changes can make it difficult to evaluate whether improvement occurred from a prior year. For this reason, ODJFS will use the same methods to calculate the baseline results and the results for the period in which the MCP is being held accountable. For example, the same methods were being used to calculate calendar year 2003 results (the baseline period) and calendar year 2004 results. The methods will be updated and a new baseline will be created during 2005 for calendar year 2004 results. These results will then serve as the baseline to evaluate whether improvement occurred from calendar year 2004 to calendar year 2005. Clinical performance measure results will be calculated after a sufficient amount of time has passed after the end of the report period in order to allow for claims runout. For a comprehensive description of the clinical performance measures below, see ODJFS Methods for Appendix M Clinical Performance MeasuresMeasures for the Medicaid CFC Managed Care Program. Performance standards are subject to change based on the revision or update of NCQA methods or other national standards, methods or benchmarks. For an MCP which had membership as of January 1, 2006: Prior to the transition to the regional-based approach. MCP performance will be evaluated using an MCP's statewide result for the counties in which the MCP had membership as of January 1.2006. For reporting periods CY 0000 Xxxxxxxx M and CY 2008, targets and performance standards for Clinical Performance Measures in this Appendix (l.c.i - l.c.vii) will be applicable to all counties in which MCPs had membership as of January 1, 2006. The final reporting year for the counties in which an MCP had membership as of January 1, 2006, will be CY 2008. ^ For any MCP which did not have membership as of January 3. 2006: Performance will be evaluated using a regional-based approach for any active region in which the MCP had membership. Regional-Based Approach: MCPs will be evaluated by region, using results for all counties included in the region. CY 2008 will be the first reporting year that MCPs will be held accountable to the performance standards for an active region, and penalties will be applied for noncompliance. CY 2007 will be the first baseline reporting year for an active region. ODJFS will use a sufficient amount of data needed per performance measure from all MCPs serving an active region to determine performance standards and targets for that region. For example, should a measure call for one calendar year of baseline data. the first full calendaryearofdata will be used. CY 2008 will be the first reporting year for measures that call for one year of baseline data. Should a measure call for two calendar years of baseline data, the first two full calendar years of data will be used. CY 2009 will be the first reporting year for measures that call for two years of baseline data. Report Period: For the SPY 2006 contract period, performance will be evaluated using the January -December 2005 report period. For the SFY 2007 contract period, performance will be evaluated using the January - December 2006 report period. For the SFY 2008 contract period, performance will be evaluated using the January - December 2007 report period.

Clinical Performance Measures. MCP performance will be assessed based on the analysis of submitted encounter data for each year. For certain measures, standards are established; the identification of these standards is not intended to limit the assessment of other indicators for performance improvement activities. Performance on multiple measures will be assessed and reported to the MCPs and others, including Medicaid consumers. The clinical performance measures described below closely follow the National Committee for Quality Assurance's ’s (NCQA) Health Plan Employer Data and Information Set(HEDISSet (HEDIS). Minor adjustments to HEDIS measures were required to account for the differences between the commercial population and the Medicaid population such as shorter and interrupted enrollment periods. NCQA may annually change its method for calculating a measure. These changes can make it difficult to evaluate whether improvement occurred from a prior year. For this reason, ODJFS will use the same methods to calculate the baseline results and the results for the period in which the MCP is being held accountable. For example, the same methods were being are used to calculate calendar year 2003 2008 results (the baseline period) and calendar year 2004 2009 results. The methods will be updated and a new baseline will be created during 2005 2009 for calendar year 2004 2010 results. These results will then serve as the baseline to evaluate whether improvement occurred from calendar year 2004 2009 to calendar year 20052010. Clinical performance measure results will be calculated after a sufficient amount of time has passed after the end of the report period in order to allow for claims runout. For a comprehensive description of the clinical performance measures below, see ODJFS Methods for Clinical Performance Measures, ABD Medicaid Managed Care Program. Performance standards are subject to change change, based on the revision or update of NCQA methods or other national standards, methods or benchmarks. For an MCP which had membership as of January 1, 2006: Prior to the transition to the regional-based approach. MCP performance will be evaluated using an MCP's statewide result for the counties in which the MCP had membership as of January 1.2006. For reporting periods CY 0000 Xxxxxxxx M and CY 2008, targets and performance standards for Clinical Performance Measures in this Appendix (l.c.i - l.c.vii) will be applicable to all counties in which MCPs had membership as of January 1, 2006. The final reporting year for the counties in which an MCP had membership as of January 1, 2006, will be CY 2008. ^ For any MCP which did not have membership as of January 3. 2006: Performance will be evaluated using a regional-based approach for any active region statewide result, including all regions in which the an MCP had has membership. Regional-Based Approach: MCPs will be evaluated by region, using results for all counties included in the region. CY 2008 will be the first reporting year that MCPs will be held accountable to the performance standards for an active region, and penalties will be applied for noncompliance. CY 2007 will be the first baseline reporting year for an active region. ODJFS will use a sufficient amount the first calendar year of data needed per performance measure from all MCPs serving an active region MCP’s ABD managed care program membership as the baseline year (i.e., CY2007). The baseline year will be used to determine performance standards and targets for that regiontargets; baseline data will come from a combination of FFS claims data and MCP encounter data. For example, should a measure call for one calendar year of baseline data. the first full calendaryearofdata will be used. CY 2008 will be the first reporting year for those performance measures that call for one year of baseline data. Should a measure call for require two calendar years of baseline data, the additional calendar year (i.e., the calendar year prior to the first calendar year of ABD managed care program membership, i.e., CY2006) data will come from FFS claims data. An MCP’s second calendar year of ABD managed care program membership (i.e., CY2008) will be the initial report period of evaluation for performance measures that require one calendar year of baseline data(i.e., CY2007), and for performance measures that require two full calendar years of baseline data will be used. CY 2009 will be the first reporting year for measures that call for two years of baseline data. Report Period: For the SPY 2006 contract period(i.e., performance will be evaluated using the January -December 2005 report period. For the SFY 2007 contract period, performance will be evaluated using the January - December 2006 report period. For the SFY 2008 contract period, performance will be evaluated using the January - December 2007 report periodCY2006and CY2007).

Clinical Performance Measures. MCP performance will be assessed based on the analysis of submitted encounter data for each year. For certain measures, standards are established; the identification of these standards is not intended to limit the assessment of other indicators for performance improvement activities. Performance on multiple measures will be assessed and reported to the MCPs and others, including Medicaid consumers. The clinical performance measures described below closely follow the National Committee for Quality Assurance's Health Plan Employer ’s Healthcare Effectiveness Data and Information Set(HEDISSet (HEDIS). Minor adjustments to HEDIS measures were are required to account for the differences between the commercial population and the Medicaid population population, such as shorter and interrupted enrollment periods. NCQA may annually change its method for calculating a measure. These changes can make it difficult to evaluate whether improvement occurred from a prior year. For this reason, ODJFS will use the same methods to calculate the baseline results and the results for the period in which the MCP is being held accountable. For example, the same methods were being used to calculate calendar year 2003 2005 results (the baseline period) and calendar year 2004 2006 results. The methods will be updated and a new baseline will be created during 2005 2007 for calendar year 2004 2006 results. These results will then serve as the baseline to evaluate whether improvement occurred from calendar year 2004 2006 to calendar year 20052007. Clinical performance measure results will be calculated after a sufficient amount of time has passed after the end of the report period in order to allow for claims runout. For a comprehensive description of the clinical performance measures below, see ODJFS Methods for Clinical Performance MeasuresMeasures for the CFC Managed Care Program. Performance measures and standards are subject to change based on the revision or update of NCQA methods or other national measures, standards, methods or benchmarks. For an MCP which had membership as of January 1, 2006: Prior to the transition to the regional-based approach. MCP performance will be evaluated using an MCP's statewide result for the counties in which the MCP had membership as of January 1.2006. For reporting periods CY 0000 Xxxxxxxx Appendix M Covered Families and CY 2008, targets and performance standards for Clinical Performance Measures in this Appendix Children (l.c.i - l.c.viiCFC) will be applicable to all counties in which MCPs had membership as of January 1, 2006. The final reporting year for the counties in which an MCP had membership as of January 1, 2006, will be CY 2008. ^ For any MCP which did not have membership as of January 3. 2006: Performance will be evaluated using a regional-based approach for any active region in which the MCP had membership. Regional-Based Approach: MCPs will be evaluated by region, using results for all counties included in the region. CY 2008 will be the first reporting year that MCPs will be held accountable to the performance standards for an active region, and penalties will be applied for noncompliance. CY 2007 will be the first baseline reporting year for an active region. ODJFS will use a sufficient amount of data needed per performance measure from all MCPs serving an active region to determine performance standards and targets for that region. For example, should a measure call for one calendar year of baseline data. the first full calendaryearofdata will be used. CY 2008 will be the first reporting year for measures that call for one year of baseline data. Should a measure call for two calendar years of baseline data, the first two full calendar years of data will be used. CY 2009 will be the first reporting year for measures that call for two years of baseline data. Report Period: For the SPY 2006 contract period, performance will be evaluated using the January -December 2005 report period. For the SFY 2007 contract period, performance will be evaluated using the January - December 2006 report period. For the SFY 2008 contract period, performance will be evaluated using the January - December 2007 report period.population

Clinical Performance Measures. MCP performance will be assessed based on the analysis of submitted encounter data for each year. For certain measures, standards are established; the identification of these standards is not intended to limit the assessment of other indicators for performance improvement activities. Performance on multiple measures will be assessed and reported to the MCPs and others, including Medicaid consumers. The clinical performance measures described below closely follow the National Committee for Quality Assurance's ’s (NCQA) Health Plan Employer Data and Information Set(HEDISSet (HEDIS). Minor adjustments to HEDIS measures were required to account for the differences between the commercial population and the Medicaid population such as shorter and interrupted enrollment periods. NCQA may annually change its method for calculating a measure. These changes can make it difficult to evaluate whether improvement occurred from a prior year. For this reason, ODJFS will use the same methods to calculate the baseline results and the results for the period in which the MCP is being held accountable. For example, the same methods were being are used to calculate calendar year 2003 2008 results (the baseline period) and calendar year 2004 2009 results. The methods will be updated and a new baseline will be created during 2005 2009 for calendar year 2004 2010 results. These results will then serve as the baseline to evaluate whether improvement occurred from calendar year 2004 2009 to calendar year 20052010. Clinical performance measure results will be calculated after a sufficient amount of time has passed after the end of the report period in order to allow for claims runout. For a AppendixM comprehensive description of the clinical performance measures below, see ODJFS Methods for Clinical Performance Measures, ABD Medicaid Managed Care Program. Performance standards are subject to change change, based on the revision or update of NCQA methods or other national standards, methods or benchmarks. For an MCP which had membership as of January 1, 2006: Prior to the transition to the regional-based approach. MCP performance will be evaluated using an MCP's statewide result for the counties in which the MCP had membership as of January 1.2006. For reporting periods CY 0000 Xxxxxxxx M and CY 2008, targets and performance standards for Clinical Performance Measures in this Appendix (l.c.i - l.c.vii) will be applicable to all counties in which MCPs had membership as of January 1, 2006. The final reporting year for the counties in which an MCP had membership as of January 1, 2006, will be CY 2008. ^ For any MCP which did not have membership as of January 3. 2006: Performance will be evaluated using a regional-based approach for any active region statewide result, including all regions in which the an MCP had has membership. Regional-Based Approach: MCPs will be evaluated by region, using results for all counties included in the region. CY 2008 will be the first reporting year that MCPs will be held accountable to the performance standards for an active region, and penalties will be applied for noncompliance. CY 2007 will be the first baseline reporting year for an active region. ODJFS will use a sufficient amount the first calendar year of data needed per performance measure from all MCPs serving an active region MCP’s ABD managed care program membership as the baseline year (i.e., CY2007). The baseline year will be used to determine performance standards and targets for that regiontargets; baseline data will come from a combination of FFS claims data and MCP encounter data. For example, should a measure call for one calendar year of baseline data. the first full calendaryearofdata will be used. CY 2008 will be the first reporting year for those performance measures that call for one year of baseline data. Should a measure call for require two calendar years of baseline data, the additional calendar year (i.e., the calendar year prior to the first calendar year of ABD managed care program membership, i.e., CY2006) data will come from FFS claims data. An MCP’s second calendar year of ABD managed care program membership (i.e., CY2008) will be the initial report period of evaluation for performance measures that require one calendar year of baseline data (i.e., CY2007), and for performance measures that require two full calendar years of baseline data will be used. CY 2009 will be the first reporting year for measures that call for two years of baseline data. Report Period: For the SPY 2006 contract period(i.e., performance will be evaluated using the January -December 2005 report period. For the SFY 2007 contract period, performance will be evaluated using the January - December 2006 report period. For the SFY 2008 contract period, performance will be evaluated using the January - December 2007 report periodCY2006 and CY2007).

Clinical Performance Measures. MCP performance will be assessed based on the analysis of submitted encounter data for each year. For certain measures, standards are established; the identification of these standards is not intended to limit the assessment of other indicators for performance improvement activities. Performance on multiple measures will be assessed and reported to the MCPs and others, including Medicaid consumers. The clinical performance measures described below closely follow the National Committee for Quality Assurance's ’s (NCQA) Health Plan Employer Data and Information Set(HEDISSet (HEDIS). Minor adjustments to HEDIS measures were required to account for the differences between the commercial population and the Medicaid population such as shorter and interrupted enrollment periods. NCQA may annually change its method for calculating a measure. These changes can make it difficult to evaluate whether improvement occurred from a prior year. For this reason, ODJFS will use the same methods to calculate the baseline results and the results for the period in which the MCP is being held accountable. For example, the same methods were being are used to calculate calendar year 2003 2008 results (the baseline period) and calendar year 2004 2009 results. The methods will be updated and a new baseline will be created during 2005 2009 for calendar year 2004 2010 results. These results will then serve as the baseline to evaluate whether improvement occurred from calendar year 2004 2009 to calendar year 20052010. Clinical performance measure results will be calculated after a sufficient amount of time has passed after the end of the report period in order to allow for claims runout. For a comprehensive description of the clinical performance measures below, see ODJFS Methods for Clinical Performance Measures, ABD Medicaid Managed Care Program. Performance standards are subject to change change, based on the revision or update of NCQA methods or other national standards, methods or benchmarks. For an MCP which had membership as of January 1, 2006: Prior to the transition to the regional-based approach. MCP performance will be evaluated using an MCP's statewide result for the counties in which the MCP had membership as of January 1.2006. For reporting periods CY 0000 Xxxxxxxx M and CY 2008, targets and performance standards for Clinical Performance Measures in this Appendix (l.c.i - l.c.vii) will be applicable to all counties in which MCPs had membership as of January 1, 2006. The final reporting year for the counties in which an MCP had membership as of January 1, 2006, will be CY 2008. ^ For any MCP which did not have membership as of January 3. 2006: Performance will be evaluated using a regional-based approach for any active region statewide result, including all regions in which the an MCP had has membership. Regional-Based Approach: MCPs will be evaluated by region, using results for all counties included in the region. CY 2008 will be the first reporting year that MCPs will be held accountable to the performance standards for an active region, and penalties will be applied for noncompliance. CY 2007 will be the first baseline reporting year for an active region. ODJFS will use a sufficient amount the first calendar year of data needed per performance measure from all MCPs serving an active region MCP’s ABD managed care program membership as the baseline year (i.e., CY2007). The baseline year will be used to determine performance standards and targets for that regiontargets; baseline data will come from a combination of FFS claims data and MCP encounter data. For example, should a measure call for one calendar year of baseline data. the first full calendaryearofdata will be used. CY 2008 will be the first reporting year for those performance measures that call for one year of baseline data. Should a measure call for require two calendar years of baseline data, the additional calendar year (i.e., the calendar year prior to the first calendar year of ABD managed care program membership, i.e., CY2006) data will come from FFS claims data. An MCP’s second calendar year of ABD managed care program membership (i.e., CY2008) will be the initial report period of evaluation for performance measures that require one calendar year of baseline data (i.e., CY2007), and for performance measures that require two full calendar years of baseline data will be used. CY 2009 will be the first reporting year for measures that call for two years of baseline data(i.e., CY2006 and CY2007). Report Period: For the SPY 2006 contract period, performance will be evaluated using the January -December 2005 report period. For the SFY 2007 contract period, performance will be evaluated using the January - December 2006 report period. For the SFY 2008 contract period, performance will be evaluated using the January - December 2007 report period and may be adjusted based on the number of months of ABD managed care membership. For the SFY 2009 contract period, performance will be evaluated using the January - December 2008 report period.

Clinical Performance Measures. MCP performance will be assessed based on the analysis of submitted encounter data for each year. For certain measures, standards are established; the identification of these standards is not intended to limit the assessment of other indicators for performance improvement activities. Performance on multiple measures will be assessed and reported to the MCPs and others, including Medicaid consumers. Appendix M Aged, Blind or Disabled (ABD) population Page 5 The clinical performance measures described below closely follow the National Committee for Quality Assurance's ’s (NCQA) Health Plan Employer Data and Information Set(HEDISSet (HEDIS). Minor adjustments to HEDIS measures were required to account for the differences between the commercial population and the Medicaid population such as shorter and interrupted enrollment periods. NCQA may annually change its method for calculating a measure. These changes can make it difficult to evaluate whether improvement occurred from a prior year. For this reason, ODJFS will use the same methods to calculate the baseline results and the results for the period in which the MCP is being held accountable. For example, the same methods were being are used to calculate calendar year 2003 2008 results (the baseline period) and calendar year 2004 2009 results. The methods will be updated and a new baseline will be created during 2005 2009 for calendar year 2004 2010 results. These results will then serve as the baseline to evaluate whether improvement occurred from calendar year 2004 2009 to calendar year 20052010. Clinical performance measure results will be calculated after a sufficient amount of time has passed after the end of the report period in order to allow for claims runout. For a comprehensive description of the clinical performance measures below, see ODJFS Methods for Clinical Performance Measures. , ABD Medicaid Managed Care Program.Performance standards are subject to change change, based on the revision or update of NCQA methods or other national standards, methods or benchmarks. For an MCP which had membership as of January 1, 2006: Prior to the transition to the regional-based approach. MCP performance will be evaluated using an MCP's statewide result for the counties in which the MCP had membership as of January 1.2006. For reporting periods CY 0000 Xxxxxxxx M and CY 2008, targets and performance standards for Clinical Performance Measures in this Appendix (l.c.i - l.c.vii) will be applicable to all counties in which MCPs had membership as of January 1, 2006. The final reporting year for the counties in which an MCP had membership as of January 1, 2006, will be CY 2008. ^ For any MCP which did not have membership as of January 3. 2006: Performance will be evaluated using a regional-based approach for any active region statewide result, including all regions in which the an MCP had has membership. Regional-Based Approach: MCPs will be evaluated by region, using results for all counties included in the region. CY 2008 will be the first reporting year that MCPs will be held accountable to the performance standards for an active region, and penalties will be applied for noncompliance. CY 2007 will be the first baseline reporting year for an active region. ODJFS will use a sufficient amount the first calendar year of data needed per performance measure from all MCPs serving an active region MCP’s ABD managed care program membership as the baseline year (i.e., CY2007). The baseline year will be used to determine performance standards and targets for that regiontargets; baseline data will come from a combination of FFS claims data and MCP encounter data. For example, should a measure call for one calendar year of baseline data. the first full calendaryearofdata will be used. CY 2008 will be the first reporting year for those performance measures that call for one year of baseline data. Should a measure call for require two calendar years of baseline data, the additional calendar year (i.e., the calendar year prior to the first calendar year of ABD managed care program membership, i.e., CY2006) data will come from FFS claims data. An MCP’s second calendar year of ABD managed care program membership (i.e., CY2008) will be the initial report period of evaluation for performance measures that require one calendar year of baseline data (i.e., CY2007), and for performance measures that require two full calendar years of baseline data will be used. CY 2009 will be the first reporting year for measures that call for two years of baseline data. Report Period: For the SPY 2006 contract period(i.e., performance will be evaluated using the January -December 2005 report period. For the SFY 2007 contract period, performance will be evaluated using the January - December 2006 report period. For the SFY 2008 contract period, performance will be evaluated using the January - December 2007 report periodCY2006 and CY2007).