Quality Metrics and Reporting for Determining the Retrospective Performance Payment Clause Samples

Quality Metrics and Reporting for Determining the Retrospective Performance Payment i. CMS will review and update the Demonstration core measures and measure specifications annually to ensure compliance with current science and measure development. ii. The State will review and, with CMS approval, update State-specific measures and measure specifications annually to ensure compliance with current science and measure development. Where applicable, CMS will adhere to nationally-endorsed specifications for relevant measures. iii. CMS will establish benchmarks for each measure based on an analysis of the State’s quality performance, as further detailed in Section IV.J.3.b.v.1 below. iv. The Demonstration Measurement Set (including core measures revised from the MOU, State-specific process measures, and State-specific Demonstration measures) is as follows: All Cause Hospital Readmission (Plan All Cause Readmission #1768) Reporting Benchmark Benchmark Ambulatory Care-Sensitive Condition Hospital Admission (PQI Composite #90) Reporting Benchmark Benchmark ED Visits for Ambulatory Care-Sensitive Conditions (▇▇▇▇▇▇▇▇▇) Reporting Benchmark Benchmark Follow-Up after Hospitalization for Mental Illness (NQF #0576) Reporting Benchmark Benchmark Depression screening and follow-up care (#0418) Reporting Benchmark Care transition record transmitted to health care professional (NQF #648) Reporting Reporting Screening for fall risk (#0101) Reporting Initiation and engagement of alcohol and other drug dependent treatment: (a) initiation, (b) engagement (NQF #0004) Reporting Health Action Plans: Percentage of beneficiaries with Health Action Plans within 90 days of enrollment Reporting Benchmark Benchmark Training: Delivery of standardized state training for Health Home Care Coordinators on the Health Action Plan Reporting Benchmark Benchmark Discharge Follow-up: Percentage of beneficiaries with 30 days between hospital discharge to first follow-up visit Reporting Reporting Benchmark State-Specific Demonstration Measures Year 1 Year 2 Year 3 Average change in Patient Activation Measure (▇▇▇) score for participating Medicare- Medicaid Enrollees who initially were least activated Reporting Benchmark Benchmark Percent of high-risk Medicare-Medicaid Enrollees receiving community-based LTCSS Reporting Benchmark Benchmark Percent of high-risk Medicare-Medicaid Enrollees receiving institutional long term care services Reporting Benchmark Benchmark v. Benchmarking and Scoring State Performance: Benchmarks for individual measures will be determined through an analysis...