Common use of Quality Reports Clause in Contracts

Quality Reports. ACO Contract Exhibit Number Name of Report Deliverable Frequency Target System QR-01 QR-01 QM/QI Program Description/Workplan Report needs to be submitted as per Appendix B, Quality Improvement Goals. Annually OnBase QR-02 QR-02 CAHPS Reports (Submission of full CAHPS Report) CAHPS Reports (Submission of full CAHPS Report as well Member-level and aggregate data made available via NCQA submission process) Annually OnBase QR-03 QR-03 External Research Project Notification External Research Project Notification Ad-Hoc OnBase QR-04 QR-04 External Audit/Accreditation External Accreditation (Submission of NCQA accreditation report and associated results) Ad-Hoc OnBase QR-05 QR-05 HEDIS IDSS Report HEDIS IDSS Report (Submission in Excel and CSV formats). Annually OnBase QR-06 QR-06 HEDIS Member Level Data Annually Email QR-07 QR-07 Clinical Quality Measures Annually Quality Vendor QR-08 QR-08 Supplemental Data for Clinical Quality and Health Equity Measures Supplemental data files (Format for submission determined and communicated by MassHealth’s Comprehensive Quality Measure Vendor (CQMV). Annually Inter- change QR-09 QR-09 Validation of Performance Measures Performance Measure Data (Format for submission determined and communicated by External Quality Review Organization). Annually EQRO QR-10 QR-10 Performance Improvement Projects Performance Improvement Project Reports (Format for submission determined by and communicated by External Quality Review Organization). Bi-Annually EQRO ACO Contract Exhibit Number Name of Report Deliverable Frequency Target System QR-11 QR-11 Serious Reportable Events (SREs) and Provider Preventable Conditions (PPCs) Serious Reportable Events (SREs) and Provider Preventable Conditions (PPCs) (including Health care Acquired Conditions (HCACs) and Other Provider Preventable Conditions (OPPCs) Submission using EOHHS developed template). Notification: Within 30 calendar days of occurrence OnBase QR-12 QR-12 Summary of Serious Reportable Events (SREs) and Provider Preventable Conditions (PPCs) Summary of Serious Reportable Events (SREs) and Provider Preventable Conditions (PPCs) (Submission using EOHHS- developed template). Annually OnBase APPENDIX C‌‌ Exhibit 1: ACO Covered Services ✓ Denotes a covered service The Contractor shall provide to each Enrollee each of the ACO Covered Services listed below in an amount, duration, and scope that is Medically Necessary (as defined in Section 1 of this Contract), provided that the Contractor is not obligated to provide any ACO Covered Service in excess of any service limitation expressly set forth below. Except to the extent that such service limitations are set forth below, the general descriptions below of ACO Covered Services do not limit the Contractor’s obligation to provide all Medically Necessary services. Coverage Types Service MassHealth Standard & CommonHealth Enrollees MassHealth Family Assistance Enrollees CarePlus Acupuncture Treatment - the insertion of metal needles through the skin at certain points on the body, with or without the use of herbs, an electric current, heat to the needles or skin, or both, for pain relief or anesthesia. ✓ ✓ ✓ Acute Inpatient Hospital –all inpatient services such as daily physician intervention, surgery, obstetrics, radiology, laboratory, and other diagnostic and treatment procedures. Coverage of acute inpatient hospital services shall include Administratively Necessary Days. Administratively Necessary Day shall be defined as a day of Acute Inpatient Hospitalization on which an Enrollee’s care needs can be provided in a setting other than an Acute Inpatient Hospital and on which an Enrollee is clinically ready for discharge. ✓ ✓ ✓ Ambulatory Surgery/Outpatient Hospital Care - outpatient surgical, related diagnostic, medical and dental services. ✓ ✓ ✓ Audiologist – audiologist exams and evaluations. See related hearing aid services. ✓ ✓ ✓ Behavioral Health Services – see Appendix C, Exhibit 3. ✓ ✓ ✓ Breast Pumps – to expectant and new birthing parents as specifically prescribed by their attending physician, consistent with the provisions of the Affordable Care Act of 2010 and Section 274 of Chapter 165 of the Acts of 2014, including but not limited to double electric breast pumps one per birth or as medically necessary. ✓ ✓ ✓ Coverage Types Service MassHealth Standard & CommonHealth Enrollees MassHealth Family Assistance Enrollees CarePlus Certain COVID-19 Specimen Collection and Testing – until May 11, 2023, Specimen collection codes G2023 and G2024 billed with modifier CG, used when provider 1) has a qualified ordering clinician present at the specimen collection site available to order medically necessary COVID-19 diagnostic tests; and 2) ensures the test results are provided to the patient (along with any initial follow-up counseling, as appropriate), either directly or through the patient’s ordering clinician. ✓ ✓ ✓ Chiropractic Services – The Contractor is responsible for providing chiropractic manipulative treatment, office visits, and radiology services for all Enrollees. The Contractor may establish a per Enrollee per Contract Year service limit of 20 office visits or chiropractic manipulative treatments, or any combination of office visits and chiropractic manipulative treatments. ✓ ✓ ✓ Chronic, Rehabilitation Hospital or Nursing Facility Services – services, for all levels of care, including for eligible Enrollees under the age of 22 in accordance with applicable state requirements, provided at either a nursing facility, chronic or rehabilitation hospital, or any combination thereof, 100 days per Contract Year per Enrollee The 100-day limitation shall not apply to Enrollees receiving Hospice services and the Contractor may not request disenrollment of Enrollees receiving Hospice services based on the length of time in a nursing facility. The Contractor shall use the following MassHealth admission/coverage criteria for admission into a chronic hospital, rehabilitation hospital and nursing facility, and may not request disenrollment of any Enrollee who meets such coverage criteria until the Enrollee exhausts such 100-day limitation described above. For the applicable criteria, see 130 CMR 456.408, 456.409, 456.410 and 435.408, 435.409 and 435.410 (rehabilitation hospitals). In addition, for Enrollees under the age of 22, the Contractor shall ensure that its contracted nursing facilities comply with the relevant provisions of 105 CMR 150.000, et seq. The Contractor must ensure that its contracted nursing facilities establish and follow a written policy regarding its bed-hold period, consistent with the MassHealth bed-hold policy. For applicable criteria, see 130 CMR 456.425. For clarification purposes, an Enrollee’s stay while recovering from COVID-19 in a nursing facility or chronic or rehabilitation hospital, or any combination thereof, shall count towards the 100-day per Contract Year per Enrollee coverage ✓ ✓ ✓ Coverage Types Service MassHealth Standard & CommonHealth Enrollees MassHealth Family Assistance Enrollees CarePlus described in this section; provided, however for an Enrollee’s stays in a Commonwealth- designated COVID-19 nursing facility, see non-ACO Covered Services in Exhibit 2 below. Dental - Emergency related dental services as described under Emergency Services in Appendix C, Exhibit 1 and oral surgery which is Medically Necessary to treat a medical condition performed in any place of service, including but not limited to an outpatient setting, as described in Ambulatory Surgery/Outpatient Hospital Care in Appendix C, Exhibit 1 as well as a clinic or office settings. ✓ ✓ ✓ Diabetes Self-Management Training – diabetes self-management training and education services furnished to an individual with pre-diabetes or diabetes by a physician or certain accredited mid-level providers (e.g., registered nurses, physician assistants, nurse practitioners, and licensed dieticians). ✓ ✓ ✓ Dialysis – laboratory; prescribed drugs; tubing change; adapter change; and training related to hemodialysis; intermittent peritoneal dialysis; continuous cycling peritoneal dialysis; continuous ambulatory peritoneal dialysis. ✓ ✓ ✓