Common use of Quality Challenge Award Clause in Contracts

Quality Challenge Award. Data collection for the Quality Challenge Award will begin on September 1, 2006; however, the Quality Challenge Award will not be implemented until State Fiscal Year 2008. Should one or more HMOs be unable to earn the full amount of the performance-based at-risk portion of the Capitation Rate, HHSC will reallocate the funds through the HMO Program’s Quality Challenge Award. HHSC will use these funds to reward HMOs that demonstrate superior clinical quality, service delivery, access to care, and/or Member satisfaction. HHSC will determine the number of HMOs that will receive Quality Challenge Award funds annually based on the amount of the funds to be reallocated. Separate Quality Challenge Award payments will be made for each of the HMO Programs. As with the performance-based Capitation Rate, each HMO will be evaluated separately for each HMO Program. HHSC intends to evaluate HMO performance annually on some combination of performance indicators in order to determine which HMOs demonstrate superior performance. In no event will a distribution from the Quality Challenge Award, plus any other incentive payments made in accordance with the HMO Contract, when combined with the Capitation Rate payments, exceed 105% of the Capitation Rate payments to an HMO. Information about the data collection period to be used and each indicator that will be considered for any specific time period can be found in the HHSC Uniform Managed Care Manual. HHSC will calculate the HMOs’ degree of compliance with the Quality Challenge Award indicators based on Encounter Data and other information supplied by the HMOs. Failure to provide timely and accurate information will result in HHSC’s assignment of a zero percent performance rate for each applicable Quality Challenge Award indicator. HHSC will evaluate the Quality Challenge Award methodology annually in consultation with HMOs. HHSC will make methodology modifications annually as it deems necessary and appropriate to motivate, recognize, and reward HMOs for superior performance based on available Quality Challenge Award funds and/or other performance incentives applicable to the award. HHSC will include the Quality Challenge Award methodology and any modifications in the HHSC Uniform Managed Care Manual.

Quality Challenge Award. Data collection for the Quality Challenge Award will begin on September 1, 2006; however, the Quality Challenge Award will not be implemented until State Fiscal Year 2008. Should one or more HMOs MCOs be unable to earn the full amount of the performance-based at-risk portion of the Capitation Rate, HHSC will reallocate the funds through the HMO MCO Program’s Quality Challenge Award. HHSC will use these funds to reward HMOs MCOs that demonstrate superior clinical quality, service delivery, access to care, and/or Member satisfaction. HHSC will determine the number of HMOs MCOs that will receive Quality Challenge Award funds annually based on the amount of the funds to be reallocated. Separate Quality Challenge Award payments will be made for each of the HMO MCO Programs. As with the performance-based Capitation Rate, each HMO MCO will be evaluated separately for each HMO MCO Program. HHSC intends to evaluate HMO MCO performance annually on some combination of performance indicators in order to determine which HMOs MCOs demonstrate superior performance. In no event will a distribution from the Quality Challenge Award, plus any other incentive payments made in accordance with the HMO MCO Contract, when combined with the Capitation Rate payments, exceed 105% of the Capitation Rate payments to an HMOMCO. Information about the data collection period to be used and each indicator that will be considered for any specific time period can be found in the HHSC Uniform Managed Care Manual. Manual Chapter 6.2.6, “Quality Challenge Award Performance Indicators.” HHSC will calculate the HMOsMCOs’ degree of compliance with the Quality Challenge Award indicators based on Encounter Data and other information supplied by the HMOsMCOs. Failure to provide timely and accurate information will result in HHSC’s assignment of a zero percent (0%) performance rate for each applicable Quality Challenge Award indicator. HHSC will evaluate the Quality Challenge Award methodology annually in consultation with HMOsMCOs. HHSC will make methodology modifications annually as it deems necessary and appropriate to motivate, recognize, and reward HMOs MCOs for superior performance based on available Quality Challenge Award funds and/or other performance incentives applicable to the award. HHSC will include the Quality Challenge Award methodology and any modifications in the HHSC Uniform Managed Care ManualManual Chapter 6.2.6, “Quality Challenge Award Performance Indicators.”

Quality Challenge Award. Data collection for the Quality Challenge Award will begin on September 1, 2006; however, the Quality Challenge Award will not be implemented until State Fiscal Year 2008. Should one or more HMOs be unable to earn the full amount of the performance-based at-risk portion of the Capitation Rate, HHSC will reallocate the funds through the HMO Program’s Quality Challenge Award. HHSC will use these funds to reward HMOs that demonstrate superior clinical quality, service delivery, access to care, and/or Member satisfaction. HHSC will determine the number of HMOs that will receive Quality Challenge Award funds annually based on the amount of the funds to be reallocated. Separate Quality Challenge Award payments will be made for each of the HMO Programs. The Expansion Counties are not included in the calculations for the Quality Challenge Award for Calendar Year 2011 for the STAR and STAR+PLUS Programs. As with the performance-based Capitation Rate, each HMO will be evaluated separately for each HMO Program. HHSC intends to evaluate HMO performance annually on some combination of performance indicators in order to determine which HMOs demonstrate superior performance. In no event will a distribution from the Quality Challenge Award, plus any other incentive payments made in accordance with the HMO Contract, when combined with the Capitation Rate payments, exceed 105% of the Capitation Rate payments to an HMO. Information about the data collection period to be used and each indicator that will be considered for any specific time period can be found in the HHSC Uniform Managed Care Manual. HHSC will calculate the HMOs’ degree of compliance with the Quality Challenge Award indicators based on Encounter Data and other information supplied by the HMOs. Failure to provide timely and accurate information will result in HHSC’s assignment of a zero percent performance rate for each applicable Quality Challenge Award indicator. HHSC will evaluate the Quality Challenge Award methodology annually in consultation with HMOs. HHSC will make methodology modifications annually as it deems necessary and appropriate to motivate, recognize, and reward HMOs for superior performance based on available Quality Challenge Award funds and/or other performance incentives applicable to the award. HHSC will include the Quality Challenge Award methodology and any modifications in the HHSC Uniform Managed Care Manual.