Network Design Based on Quality. Article 1, Section 1.02 4% of total performance penalty at risk. Expectation: Contractor shall include quality criteria into its Exchange network development, with a phased approach starting in plan year 2017. Contractor will report on progress after 2017 plan year is complete, in 2018, through the Application for Certification for 2019. Performance Levels Contractor is unable to describe valid inclusion of quality criteria into Exchange network development by end of year 2017: 4% penalty Contractor reports strategy for inclusion of quality criteria in all networks offered to Exchange enrollees, and demonstrates implementation of criteria by end of year 2017: No penalty Contractor fulfills the requirement for “no penalty” above, plus submits documentation that contracted hospitals have been notified in 2017 of expectation to meet targets for appropriate use of C- Section and reduction in Hospital Acquired Conditions by 2019: 4% credit
Network Design Based on Quality. Attachment 7, Article 1, Section 1.02 - 4% of total performance penalty for Group 3 Contractor shall include quality criteria into its Covered California network development, with a phased approach starting in plan year 2017 and continuing in plan years 2018, 2019, 2020 and 2021. Performance Requirements Measurement Year 2017 Expectation: Describe valid inclusion of quality criteria into Covered California network development and begin implementation of criteria Performance Levels: Contractor is unable to describe valid inclusion of quality criteria into Covered California network development by end of year 2017: 4% penalty Contractor reports strategy for inclusion of quality criteria in all networks offered to Covered California enrollees, and demonstrates Measurement Year 2018 Expectation: Describe valid inclusion of quality criteria into Covered California network development and begin implementation of criteria Performance Levels: Contractor is unable to describe valid inclusion of quality criteria into Covered California network development by end of year 2018: 4% penalty Contractor submits report showing that quality criteria for all provider types has been applied to at least part of each Covered California network offered to Measurement Year 2019 Expectation: Describe valid inclusion of quality criteria into Covered California network development and begin implementation of criteria Performance Levels: Contractor is unable to describe valid inclusion of quality criteria into Covered California network development by end of year 2019: 4% penalty Contractor submits report showing that quality criteria for all provider types has been applied to at least part of each Covered California network offered to Covered Measurement Year 2020 Expectation: Describe valid inclusion of quality criteria into Covered California network development and begin implementation of criteria Performance Levels: Contractor submits report and is unable to describe valid inclusion of quality criteria into Covered California network development for all provider types by the end of 2020 or has not reviewed any providers against established quality metrics: 4% penalty Measurement Year 2021 Expectation: Describe valid inclusion of quality criteria into Covered California network development and evaluation and make progress on implementation of criteria including the exclusion of outlier poor performing hospitals as defined by Covered California in Attachment 7 Performance Levels: ...
