Quality Reporting System Clause Samples
The Quality Reporting System clause establishes requirements for monitoring and reporting the quality of goods or services provided under an agreement. Typically, it obligates one party to collect, document, and submit data on performance metrics, such as defect rates or service response times, at specified intervals. This clause ensures transparency and accountability by providing a structured method for evaluating whether contractual quality standards are being met, thereby helping to identify and address issues proactively.
Quality Reporting System. (QRS)-) - Plan Service- CAHPS measure set summaryQuality and Network Management – QRS Expectation: Plan Service - CAHPS measure set summary (Product type reporting) - 10% of total performance requirement expected. Claims Processing Composite (CAHPS) Customer Service Composite (CAHPS) Plan Information on Costs Composite(CAHPS) Global Rating of Plan(CAHPS) *certain CAHPS measures may not be available for all Product Types
Quality Reporting System. (QRS) - Access to Care- HEDIS/CAHPS measure set summary
Quality Reporting System. (QRS-Plan Service); related to Attachment 7, Section 3.01. Specific measures noted in Appendix 1 to this Attachment 14. Quality and Network Management – (QRS); related to Attachment 7, Section 3.01 Expectation: Plan Service- CAHPS measure set summary (Product type reporting) 106.255% of total performance requirement expected. Performance Level: <50th PCT:105% penalty;51-75th PCT: no penalty; >75th PCT: 105% performance credit (vs. national HMO benchmark). 3.65 eValue8 – specific to Attachment 7, Section 3.05 Expectation: Total Covered California eValue8 performance, 795.5 points total. 10% of total performance penalty at risk. Performance Level: < 40% of total points: 10% performance penalty. 40-74% of total points-no penalty. 75% or greater of total points: 10% performance credit. Covered California Performance Standards for Contractor Group 3 continued: Covered California Performance Standards Quality, Network Management and Delivery System Standards 0.0% of Performance Penalty or Credit for Measurement Year 2014 50% of Performance Penalty or Credit ThereafterQuality, Network Management and Delivery System Standards 50% of Performance Penalty or Credit 3.75 6 Quality and Network Management- Health Status Assessment; Attachment 7, Section 3.06. Performance expectation to be determined in collaboration with QHPs based on 2014 measurement with Year 1- Track only; Year 2-3 performance measure based on Year 1 determined performance with preliminary target of exceeding QHP 50th percentile to avoid penalty NOTE: for 2014 measurement year/2015 penalty/credit assessment, track and report to QHPs only;5% penalty at risk thereafter (2015 measurement and beyond) 3.86 7 Quality and Network Management- Preventive Health and Wellness; Attachment 7, Section 4.01. Performance expectation to be determined in collaboration with QHPs based on 2014 measurement with preliminary target of exceeding QHP 50th percentile to avoid penalty NOTE: for 2014 measurement year/2015 penalty/credit assessment, track and report to QHPs only;5% penalty at risk thereafter (2015 measurement and beyond) Year 1- Track only; Year 2-3 performance measure based on Year 1 determined performance with preliminary target of exceeding QHP 50th percentile to avoid penalty 3.97 8 Quality and Network Management- New Care Models; Attachment 7, Section 5.02. Performance expectation to be determined in collaboration with QHPs based on 2014 measurement with preliminary target of exceeding QHP 50th percentile t...
Quality Reporting System. (QRS-Plan Service); related to Attachment 7, Section 3.01. Specific measures noted in Appendix 1 to this Attachment 14. Quality and Network Management – (QRS); related to Attachment 7, Section 3.01 Expectation: Plan Service- CAHPS measure set summary (Product type reporting) 106.255% of total performance requirement expected. Performance Level: <50th PCT:105% penalty;51-75th PCT: no penalty; >75th PCT: 105% performance credit (vs. national HMO benchmark). Covered California – Final Health Plan Contract Attachments, May 620117, 2013 Attachment 14-8 3.65 eValue8 – specific to Attachment 7, Section 3.05 Expectation: Total Covered California eValue8 performance, 795.5 points total. 10% of total performance penalty at risk. Performance Level: < 40% of total points: 10% performance penalty. 40-74% of total points-no penalty. 75% or greater of total points: 10% performance credit. Covered California – Final Health Plan Contract Attachments, May 620117, 2013 Attachment 14-9 ATTACHMENTS TO COVERED CALIFORNIA QUALIFIED HEALTH PLAN CONTRACT Covered California Performance Standards for Contractor Group 3 continued: Covered California Performance Standards Quality, Network Management and Delivery System Standards 0.0% of Performance Penalty or Credit for Measurement Year 2014 50% of Performance Penalty or Credit ThereafterQuality, Network Management and Delivery System Standards 50% of Performance Penalty or Credit