Termination for Uncured Breach. Either Party may terminate this Agreement upon the other Party’s material breach of its obligations hereunder, which breach is uncured for a period of thirty (30) calendar days after the non-breaching Party has given the breaching Party notice of that breach and requested that the breaching Party cure that breach; provided that no opportunity to cure shall be provided and termination shall be immediate in the event of (a) a breach that cannot reasonably be cured within thirty (30calendar days, (b) repeated breaches of the same obligation or (c) a breach that would expose the non-breaching Party to civil or criminal liability or would otherwise cause a violation of applicable laws, rules, regulations or accreditation standards applicable to a non-breaching Party. Termination of this Participation Agreement by either Party shall automatically terminate Participant’s participation in any Project under this agreement. 50% of 2021 payments will be based on the following scale criteria as self-reported by change plan type. Due to COVID-19 response, partners may choose between previously submitted 2019 or new 2020 scale criteria: • Primary Care = 2019 or 2020 Medicaid lives (partner choice) • Behavioral Health = 2019 or 2020 Medicaid encounters (partner choice) • CBOSS = Number of OCH core metrics impacted (based on 2020 change plan) • Hospital = Scale calculation does not apply to payment calculation, although data are collected Scope element (absolute %) Description Frequency and payment Partners with more than 1 change plan (report and earn separate payments for scope for each applicable change plan type) Partner reporting 10% Complete all reporting elements that apply to change plan type (change status, narrative questions, Health Care Authority P4R metrics, simplified quantitative data) Report twice, payment twice per year (5% each) Complete required reporting for all change plans (earn full 10% per change plan). Enhanced transformation activities • Submit project plan in Spring 2021 that details work addressing determinants of health. • Subsequent reporting on progress towards outlined project plan. Work may consist of continued previous change plan activities or new work that advances the determinants of health. Submit 1 project plan, payment once (2.5%) Report once, payment 1 project per change plan, or 1 robust project that spans multiple change plan service lines (earn full 10% per change plan). 10% once (7.5%) Required change plan outcomes status Self-reported status on selected outcomes. NOTE: At least half of all required change plan outcomes status’ must be “fully implemented”, or “scaling and sustaining” to receive credit. Evaluated once (second qualitative reporting of the year), payment once per Earn full 7.5% for each full change plan. Earn 2.25% for each partial change plan.
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Termination for Uncured Breach. Either Party may terminate this Agreement upon the other Party’s material breach of its obligations hereunder, which breach is uncured for a period of thirty (30) calendar days after the non-breaching Party has given the breaching Party notice of that breach and requested that the breaching Party cure that breach; provided that no opportunity to cure shall be provided and termination shall be immediate in the event of (a) a breach that cannot reasonably be cured within thirty (30calendar days, (b) repeated breaches of the same obligation or (c) a breach that would expose the non-breaching Party to civil or criminal liability or would otherwise cause a violation of applicable laws, rules, regulations or accreditation standards applicable to a non-breaching Party. Termination of this Participation Agreement by either Party shall automatically terminate Participant’s participation in any Project under this agreement. 50% of 2021 payments will be based on the following scale criteria as self-reported by change plan type. Due to COVID-19 response, partners may choose between previously submitted 2019 or new 2020 scale criteria: • Primary Care = 2019 or 2020 Medicaid lives (partner choice) • Behavioral Health = 2019 or 2020 Medicaid encounters (partner choice) • CBOSS = Number of OCH core metrics impacted (based on 2020 change plan) • Hospital = Scale calculation does not apply to payment calculation, although data are collected Scope element (absolute %) Description Frequency and payment Partners with more than 1 change plan (report and earn separate payments for scope for each applicable change plan type) Partner reporting 10% Complete all reporting elements that apply to change plan type (change status, narrative questions, Health Care Authority P4R metrics, simplified quantitative data) Report twice, payment twice per year (5% each) Complete required reporting for all change plans (earn full 10% per change plan). Enhanced transformation activities 10% • Submit project plan in Spring 2021 that details work addressing determinants of health. • Subsequent reporting on progress towards outlined project plan. Work may consist of continued previous change plan activities or new work that advances the determinants of health. Submit 1 project plan, payment once (2.5%) Report once, payment once (7.5%) 1 project per change plan, or 1 robust project that spans multiple change plan service lines (earn full 10% per change plan). 10% once (7.5%) Required change plan outcomes status 7.5% Self-reported status on selected outcomes. NOTE: At least half of all required change plan outcomes status’ must be “fully implemented”, or “scaling and sustaining” to receive credit. Evaluated once (second qualitative reporting of the year), payment once per year (7.5%) Earn full 7.5% for each full change plan. Earn 2.25% for each partial change plan. Implementation of enhanced community- clinical linkage work 7.5% Progress towards self-identified milestones as outlined in enhanced community clinical linkage work project proposal. If milestones are not progressing as predicted, partners must provide detailed mitigation strategies. Report once, payment once per year (7.5%) Project proposals are 1 per full change plan or 1 comprehensive across full change plans – report based on submission (earn full 7.5%). Does not apply to partial change plans (earn 0%). Addressing behavioral health needs 5% Implement and report on (1) activity to respond to increased behavioral health needs. Activities may include and are not limited to: expand available behavioral health services (in-person or telehealth), participate in statewide advocacy, partner with agency new to OCH network, etc. Complete 1 activity and report, payment once per year (5%) Complete 1 activity per change plan or 1 comprehensive activity across change plans (earn full 5% per change plan).
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Sources: Interlocal Agreement