The EQRO will develop the scoring criteria that will be used to determine each score on the scale for each standard and substandard to be scored. This must specify the level of performance that would result in a particular numeric score. The scoring criteria must be approved by HSD. Detailed Procedures and Forms to be Used for Measurement and Scoring The EQR will develop the detailed procedures, forms, and guidelines for the evaluator that will be used to perform the evaluations of MCO performance against the quality standards. These documents must be approved by HSD. Conduct and Report In response to a Letter of Direction, the EQRO will measure and score the performance of each managed care contractor against all applicable managed care standards. This will be done by applying the Measurement and Scoring Methodology that was developed in accordance with Section V above. Normally the compliance performance of more than one MCO for the same population will be evaluated to allow comparison of performance among MCOs. When this is done, the EQRO will ensure that the compliance performance measured is for the same time period for all MCOs. A complete review of a single MCO against all or specified applicable standards and the written report of that review constitutes a single unit of work for reimbursement purposes. The content and format of the report will be proposed by the EQRO and approved by HSD before performance measurements begin. (D) Follow-Up Review and Performance Measurement Activity From time to time, HSD may direct the EQRO to perform an ad hoc review or performance measurement activity. This may be in many different forms. Among these are the following: Follow-up Reviews Related to the Activity Described in Section V; Focused Measurement of Performance Applied to any Combination of the Following, including but not limited to: (a) Specific standard or set of standards; (b) Special defined population of members; (c) Specific age or other demographic group; (d) Specific geographic area;
The EQRO will develop the scoring criteria that will be used to determine each score on the scale for each standard and substandard to be scored. This must specify the level of performance that would result in a particular numeric score. The scoring criteria must be approved by HSD. Detailed Procedures and Forms to be Used for Measurement and Scoring The EQR will develop the detailed procedures, forms, and guidelines for the evaluator that will be used to perform the evaluations of MCO performance against the quality standards. These documents must be approved by HSD. Conduct and Report In response to a Letter of Direction, the EQRO will measure and score the performance of each managed care contractor against all applicable managed care standards. This will be done by applying the Measurement and Scoring Methodology that was developed in accordance with Section V above. Normally the compliance performance of more than one MCO for the same population will be evaluated to allow comparison of performance among MCOs. When this is done, the EQRO will ensure that the compliance performance measured is for the same time period for all MCOs. A complete review of a single MCO against all or specified applicable standards and the written report of that review constitutes a single unit of work for reimbursement purposes. The content and format of the report will be proposed by the EQRO and approved by HSD before performance measurements begin. (D) Follow-Up Review and Performance Measurement Activity From time to time, HSD may direct the EQRO to perform an ad hoc review or performance measurement activity. This may be in many different forms. Among these are the following: Follow-up Reviews Related to the Activity Described in Section V; Focused Measurement of Performance Applied to any Combination of the Following, including but not limited to: (a) Specific standard or set of standards; (b) Special defined population of members; (c) Specific age or other demographic group; (d) Specific geographic area;
1463080000004%20EQRO%20RFP.docx