Common use of Points Clause in Contracts

Points. If there is only one (1) additional measure in the Domain and the Contractor earned 9 total points for this measure; the total score for the Contractor would be 20.0 (out of 20) given that domain scores are capped at the maximum number of achievement points (20) in the domain. Once the total number of points has been calculated, EOHHS will divide the resulting sum by the maximum number of achievement points that the Contractor is eligible for in the domain to produce the Contractor’s Domain Score. Domain Scores are a value between zero (0) and one (1) expressed as a percentage (i.e., 0% to 100%). EOHHS will score the Contractor on each P4P Quality Measure unless the Contractor does not meet eligibility requirements for a specific measure (e.g., it does not meet the minimum denominator requirement). In cases like this, the measure is not factored into the denominator. Reporting measures do not factor into the Domain Score. Additionally, improvement points do not count towards the denominator; they are therefore “bonus” points. Domain Scores are each capped at a maximum value of 100%. Example Calculations of Unweighted Domain Score Example 1 Domain only has two Quality Measures (Measure A and Measure B) Therefore, maximum number of achievement points is 2x10 = 20 points Measure A: Achievement points: 1.5 Improvement Points: 0 Measure B: Achievement points: 0 Improvement Points: 5 Total achievement points: 1.5 + 0 = 1.5 points Total improvement points: 0 + 5 = 5 points Sum of achievement and improvement points: 1.5 + 5 = 6.5 points Unweighted domain score = 6.5/20 * 100 = 32.5% Example 2 Domain only has two Quality Measures (Measure A and Measure B) Therefore, maximum number of achievement points is 2x10 = 20 points Measure A: Achievement points: 8 Improvement Points: 5 Measure B: Achievement points: 9.3 Improvement Points: 0 Total achievement points: 8 + 9.3 = 17.3 Total improvement points: 5 points Sum of achievement and improvement points: 17.3 + 5 = 22.3 points However, total number of points cannot exceed maximum number of achievement points (20) Therefore, total domain points = 20 Unweighted domain score = 20/20 * 100 = 100% An assessment of electronic-based quality measure readiness (e.g., Electronic Clinical Quality Measures (eCQM), and Electronic Clinical Data Systems (ECDS)) shall be integrated into the overall ACO Quality Score as a bonus element for PY2024. The assessment shall be scored on an all-or-nothing basis, with possible scores equaling zero or 100%. Any ACO achieving 100% on the bonus will earn a total of 5.0 points added to the sum of the weighted domain score, resulting in an overall quality score. Note: the sum of weighted domains and the 5.0 point bonus may not exceed the overall quality score maximum of 100%. Example Preventative and 45% 75.0 33.75 Pediatric Care Care Coordination / Care for Chronic & Acute Conditions 40% 70.0 28.00 Member Experience 15% 72.0 10.8 Total 100% N/A 72.55 Bonus N/A 5.0 points N/A Total of weighted domains = 72.55 Total bonus: 5.0 points Sum of weighted domains and bonus points: 72.55 + 5.0 = 77.55 points Overall Quality Score = 77.55%

Points. If there is only one (1) additional measure in the Domain and the Contractor earned 9 total points for this measure; the total score for the Contractor would be 20.0 (out of 20) given that domain scores are capped at the maximum number of achievement points (20) in the domain. Once the total number of points has been calculated, EOHHS will divide the resulting sum by the maximum number of achievement points that the Contractor is eligible for in the domain to produce the Contractor’s Domain Score. Domain Scores are a value between zero (0) and one (1) expressed as a percentage (i.e., 0% to 100%). In PY4 and PY5, EOHHS will score the Contractor on each P4P Quality Measure unless the Contractor does not meet eligibility requirements for a specific measure (e.g., it does not meet the minimum denominator requirement). In cases like this, the measure is not factored into the denominator. Reporting measures do not factor into the Domain Score. Additionally, improvement points do not count towards the denominator; they are therefore “bonus” points. Domain Scores are each capped at a maximum value of 100%. Exhibit 5 below shows an example calculation of an unweighted Domain Score for a Quality Domain. EXHIBIT 5 – Example Calculations of Unweighted Domain Score Example Calculations of Unweighted Domain Score Example 1 Domain only has two Quality Measures (Measure A and Measure B) Therefore, maximum number of achievement points is 2x10 = 20 points Measure A: Achievement points: 1.5 Improvement Points: 0 Measure B: Achievement points: 0 Improvement Points: 5 Total achievement points: 1.5 + 0 = 1.5 points Total improvement points: 0 + 5 = 5 points Sum of achievement and improvement points: 1.5 + 5 = 6.5 points Unweighted domain score = 6.5/20 * 100 = 32.5% Example 2 Domain only has two Quality Measures (Measure A and Measure B) Therefore, maximum number of achievement points is 2x10 = 20 points Measure A: Achievement points: 8 Improvement Points: 5 Measure B: Achievement points: 9.3 Improvement Points: 0 Total achievement points: 8 + 9.3 = 17.3 Total improvement points: 5 points Sum of achievement and improvement points: 17.3 + 5 = 22.3 points However, total number of points cannot exceed maximum number of achievement points (20) Therefore, total domain points = 20 Unweighted domain score = 20/20 * 100 = 100% An assessment of electronic-based quality measure readiness Quality Measure Scoring Methodology (e.g., Electronic Clinical Quality Measures (eCQM), and Electronic Clinical Data Systems (ECDS)) shall be integrated into Budget Period 3)‌ In order to address the overall ACO Quality Score as a bonus element for PY2024. The assessment shall be scored on an all-or-nothing basis, with possible scores equaling zero or 100%. Any ACO achieving 100% on the bonus will earn a total of 5.0 points added to the sum impact of the weighted state of emergency declared by the federal or state government on ACO quality performance, domain score, resulting in an overall quality score. Note: scores for Budget Period 3 (BP3) are calculated using the sum of weighted domains and the 5.0 point bonus may not exceed the overall quality score maximum of 100%. Example Preventative and 45% 75.0 33.75 Pediatric Care Care Coordination / Care for Chronic & Acute Conditions 40% 70.0 28.00 Member Experience 15% 72.0 10.8 Total 100% N/A 72.55 Bonus N/A 5.0 points N/A Total of weighted domains = 72.55 Total bonus: 5.0 points Sum of weighted domains and bonus points: 72.55 + 5.0 = 77.55 points Overall Quality Score = 77.55%following methodology.