Common use of Access Monitoring Clause in Contracts

Access Monitoring. ‌ a) Covered California, in alignment with other California public purchasers and State Regulators, shall implement an access-monitoring strategy for all QHP issuers. The strategy shall analyze data available from CMS QRS program, provider directory, and the HEI, and may include additional monitoring tools, such as secret shopper surveys, deployed by Covered California to assess Covered California Enrollee experience. b) Contractor will be assessed across the following domains: Covered California Enrollee experience and outcomes, provider availability and accessibility, and service utilization and quality. Benchmarks will be established after two years of data collection and performance will be reported publicly. Underperforming QHP issuers will be required to submit and adhere to an improvement plan. c) Contractor’s data submission obligation for this Section can be met through regular data submissions detailed in Article 4, Section 4.4.4 (Covered California Provider Directory), Article 5, Section 5.5 (Quality Rating System) and Attachment 1, Article 5, Section 5.02.1 Data Submission (Healthcare Evidence Initiative).