Common use of Quality Incentive Program Clause in Contracts

Quality Incentive Program. 12.5.1 The Contractor shall establish and implement a Quality Incentive Program as a mechanism to improve the quality of services provided to Enrollees. The Quality Incentive Program shall be based on a work plan to be submitted to ASES by the Contractor as part of its QAPI program, pursuant to Attachment 12 of this Contract. The Contractor shall implement the Quality Incentive Program within thirty (30) Calendar Days of its approval by ASES. 12.5.2 The Quality Incentive Program shall consist of three (3) categories of performance indicators: performance measures, preventive clinical program measures and ER Utilization measures. ASES will Withhold a total of five percent (5%) of the amount budgeted within the Contractor’s Administrative Fee for the administration of the Quality Incentive Program (hereinafter the “Retention Fund”), which budgeted amount is specified in Attachment 11 of this Contract, and will reimburse the Contractor according to compliance with each of the categories of performance indicators in this Section 12.5. 12.5.3 The Contractor shall, within thirty (30) Calendar Days after the end of each calendar quarter, submit a quarterly report for each of the performance indicators to be evaluated by ASES. For each measure, ASES shall, within thirty (30) Calendar Days after receipt of the Contractor’s quarterly report, make a determination whether the Contractor has met the applicable performance objectives for the quarter. In addition, the Contractor shall submit an annual report within thirty (30) Calendar Days after the end of the year for which the performance is measured. If the Contractor is then in compliance with the applicable performance targets or portions thereof for said period, ASES shall then release to the Contractor, no later than thirty (30) Calendar Days after ASES determines compliance with the performance objectives, the portion of the Retention Fund associated with each measure for such period, or the portion corresponding to the percentage of compliance with each such indicator, as the case may be. 12.5.4 The following is a description of each of the three categories of performance indicators and the associated reimbursement level for each.

Quality Incentive Program. 12.5.1 The Contractor shall establish and implement a Quality Incentive Program as a mechanism to improve the quality of services provided to Enrollees. The Quality Incentive Program shall be based on a work plan to be submitted to ASES by the Contractor as part of its QAPI program, pursuant to Attachment 12 of this Contract. The Contractor shall implement the Quality Incentive Program within thirty (30) Calendar Days of its approval by ASES. 12.5.2 The Quality Incentive Program shall consist of three (3) categories of performance indicators: performance measures, preventive clinical program measures and ER Utilization measures. ASES will Withhold a total of five percent (5%) of the amount budgeted within the Contractor’s Administrative Fee for the administration of the Quality Incentive Program (hereinafter the “Retention Fund”), which budgeted amount is specified in Attachment 11 of this Contract, and will reimburse the Contractor according to compliance with each of the categories of performance indicators in this Section 12.5. 12.5.3 The Contractor shall, within thirty (30) Calendar Days after the end of each calendar quarter, submit a quarterly report for each of the performance indicators to be evaluated by ASES. For each measure, ASES shall, within thirty (30) Calendar Days after receipt of the Contractor’s quarterly report, make a determination whether the Contractor has met the applicable performance objectives for the quarter. In addition, the Contractor shall submit an annual report within thirty (30) Calendar Days after the end of the year for which the performance is measured. If the Contractor is then in compliance with the applicable performance targets or portions thereof for said period, ASES shall then release to the Contractor, no later than thirty (30) Calendar Days after ASES determines compliance with the performance objectives, the portion of the Retention Fund associated with each measure for such period, or the portion corresponding to the percentage of compliance with each such indicator, as the case may be. 12.5.4 The following is a description of each of the three categories of performance indicators and the associated reimbursement level for each.

Quality Incentive Program. 12.5.1 The Contractor shall establish and implement a Quality Incentive Program as a mechanism to improve the quality of services provided to Enrollees. The Quality Incentive Program shall be based on a work plan to be submitted to ASES by the Contractor as part of its QAPI program, pursuant to Attachment 12 of this Contract. The Contractor shall implement the Quality Incentive Program within thirty (30) Calendar Days of its approval by ASES. 12.5.2 The Quality Incentive Program shall consist of three (3) categories of performance indicators: performance measures, preventive clinical program measures and ER Utilization measures. ASES will Withhold a total of five one and a half percent (5%1½%) of the amount budgeted within the Contractor’s Administrative Fee for the administration of the Quality Incentive Program (hereinafter the “Retention Fund”), which budgeted amount is specified in Attachment 11 of this Contract, and will reimburse the Contractor according to compliance with each of the categories of performance indicators in this Section 12.5. Before any withholding may take place, the parties shall have agreed on a Quality Improvement Program Procedure Manual to be effective within thirty (30) calendar days of the Effective Date of the Contract. Such Manual will contain the mutual agreements of the parties on reasonable and achievable performance indicators for each category to be measured under the program. Once the Manual is approved by both parties the performance indicators therein stated will be effective during the Term of the Contract, unless that amendments might be required by law or regulation, or reached by mutual agreement during such Term. 12.5.3 The Contractor shall, within thirty (30) Calendar Days after the end of each calendar quarter, submit a quarterly report for each of the performance indicators to be evaluated by ASES. For each measure, ASES shall, within thirty (30) Calendar Days after receipt of the Contractor’s quarterly report, make a determination whether the Contractor has met the applicable performance objectives for the quarter. In addition, the Contractor shall submit an annual report within thirty (30) Calendar Days after the end of the year for which the performance is measured. If the Contractor is then in compliance with the applicable performance targets or portions thereof for said period, ASES shall then release to the Contractor, no later than thirty (30) Calendar Days after ASES determines compliance with the performance objectives, the portion of the Retention Fund associated with each measure for such period, or the portion corresponding to the percentage of compliance with each such indicator, as the case may be. 12.5.4 The following is a description of each of the three categories of performance indicators and the associated reimbursement level for each.