Quality Performance Measures. A. % of learning community meetings/events/activities attended by Street Health Outreach Team
Quality Performance Measures. The Contractor shall comply with all of OHCA’s requirements to improve performance for OHCA- established quality performance measures. Annually, the Contractor shall submit a Quality Performance Measure Report for all quality performance measures established by OHCA pursuant to 42 C.F.R. § 438.330(c)(1)(i) and listed in this Section. Quality performance measures shall: • Be modified annually by OHCA or CMS and published in advance; • Be specific to the SoonerSelect Dental program population; and • Include target performance rates that will increase annually. Required quality performance measures will include measures for both physical health and behavioral health. Annually, the Contractor shall complete the specified measures designated by OHCA as relevant to the Dental Health Plan Enrollees being served in the SoonerSelect Dental program. The Contractor shall contract with an NCQA-certified HEDIS auditor to validate the processes of the Contractor in accordance with NCQA requirements. The Contractor shall submit to OHCA a copy of the signed contract with the NCQA-approved vendor to perform the HEDIS audit. Audited HEDIS results shall be submitted to OHCA, NCQA and OHCA’s SoonerSelect Dental Program EQRO annually as required in Section 1.20: “Reporting” of this Contract. In addition to OHCA-established quality performance measures, the Contractor shall report EPSDT information utilizing Encounter Data submissions in accordance with specifications for the CMS-416 report. This report includes information on EPSDT participation, percentage of children identified for referral, percentage of children receiving follow-up services in a timely manner and other measures. The Contractor shall meet the OHCA-specified performance targets for all quality performance measures. The performance targets for each of the required measures shall be determined by OHCA in collaboration with the Contractor and other SoonerSelect Dental DBMs. Although quality performance targets will be updated annually, OHCA, at its discretion, may change these targets and/or change the timelines associated with meeting the targets. The quality performance targets will be incorporated into the comprehensive Uniform Performance Monitoring Data Set described in Section 1.21.2: “Performance-Based Contracting” of this Contract. OHCA shall post information about quality measures and performance outcomes on OHCA’s website. This information shall be updated at least annually. If OHCA determines that th...
