Common use of Goal Statement Clause in Contracts

Goal Statement. The Contractor shall continue the model of care integration and Member Engagement (as described in Section 6) to improve the rate at which Covered Individuals who had been hospitalized for a mental illness receive timely and adequate mental health services aftercare using Behavioral Health Covered Services and reduction in the rate of re-hospitalization. The technical specifications for measures one and two (M1 and M2), including the denominator and numerator definitions, shall conform to the HEDIS FUH specifications published by NCQA, and shall be applied to the measurement period corresponding to the current Contract Year. The contractor shall report performance as per the 2018 HEDIS measure specification. Within M3(A), the definition of Readmission shall mean the number of episode discharges from a mental health 24-hour Level of Care and the number of discharges that were followed by a subsequent admission to the same or equivalent 24-hour Level of Care within 0-90 days of the discharge date of the episode. Using the count of discharges and the count of readmissions, the rate of readmission is calculated. Within M4, the definition of “arranged prior to discharge” shall mean as evidenced within either the MHS/Connect (the Contractor’s clinical documentation application) or the Provider’s medical record, documentation of: Member and/or family involvement and agreement, the name of the Behavioral Health Covered Service, name of the Provider, and the date and time of the first appointment M1. the rate for 7-day follow-up per HEDIS 2018 specifications greater than or equal to the HEDIS 2017 50th percentile $50,000 greater than or equal to the HEDIS 2017 75th percentile $75,000 M2. the rate for 30-day follow-up per HEDIS 2018 specifications greater than or equal to the HEDIS 2017 50th percentile $50,000 greater than or equal to the HEDIS 2017 75th percentile $75,000 M3(A). A decrease of up to 1.25 percent in the rate of mental health readmission within 90 days ≥ 0.75% decrease from the 2017 rate $200,000 ≥ 1.25% decrease from the 2017 rate $250,000 M4. The rate for aftercare appointments being arranged prior to discharge as documented in Contractor’s system 50%-79% rate $75,000 ≥80% rate $150,000 The maximum incentive payment for this P4P is $550,000.