Common use of Expectation Clause in Contracts

Expectation. Contractor shall report rates of the five selected Hospital Acquired Conditions (HACs) for each Exchange network 4.5% total performance penalty at risk hospital, as defined in Attachment 7, Article 5, Section 5.02, (based on clinical data), in its annual Application for Certification starting with baseline in Application for 2017. Performance Levels Contractor does not report rates on HACs: 2% penalty Contractor reports rates on specified HACs: No penalty Contractor reports rates on specific HACs, and engages non- reporting hospitals to begin tracking specific HAC rates: 2% credit Expectation: Contractor shall adopt a payment strategy that by 2019 places at least six percent of payment to hospitals for Exchange enrollees at-risk for quality performance. Contractor may structure this strategy according to its own priorities including performance metrics such as HACs, readmissions and satisfaction. Contractor shall report progress on adoption of the payment strategy in Application for Certification for 2019. Performance Levels Contractor reports no hospitals in Exchange network(s) contracted based on new payment strategy: 2.5% penalty Contractor reports fewer than 20% of hospitals in Exchange network(s) contracted under new payment strategy: no penalty Contractor reports 20% or more of hospitals in Exchange network(s) contracted under new payment strategy: 2.5% credit

Expectation. Contractor shall report rates of the five selected Hospital Acquired Conditions (HACs) for each Exchange network hospital, as 4.5% total performance penalty at risk hospital, as defined in Attachment 7, Article 5, Section 5.02, (based on clinical data), in its annual Application for Certification starting with baseline in Application application for 2017. Performance Levels Contractor does not report rates on HACs: 2% penalty Contractor reports rates on specified HACs: No penalty Contractor reports rates on specific HACs, and engages non- reporting hospitals to begin tracking specific HAC rates: 2% credit Expectation: Contractor shall adopt a payment strategy that by 2019 places at least six percent of payment reimbursement to hospitals for Exchange enrollees at-risk for quality performance. Contractor may structure this strategy according to its own priorities including performance metrics such as HACs, readmissions and satisfaction. Contractor shall report progress on adoption of the payment strategy in Application for Certification for 2019. Performance Levels Contractor reports no hospitals in Exchange network(s) contracted based on new payment strategy: 2.5% penalty Contractor reports fewer than 20% of hospitals in Exchange network(s) contracted under new payment strategy: no penalty Contractor reports 20% or more of hospitals in Exchange network(s) contracted under new payment strategy: 2.5% credit